Reproductive genetic carrier screening for cystic fibrosis, fragile X syndrome, and spinal muscular atrophy in Australia: outcomes of 12,000 tests

TLDR

Genetic counseling support and collaboration among laboratories, genetics services, health professionals, and support organizations are essential for effective carrier screening. The study describes the experience of offering simultaneous carrier screening for cystic fibrosis, fragile X syndrome, and spinal muscular atrophy across primary and specialty care settings before or early in pregnancy. Carrier screening was provided in general practice, obstetrics, fertility, and genetics settings, with counseling and prenatal/preimplantation genetic diagnosis offered to high‑risk individuals. In 12,000 screened individuals, 5.1% were carriers (342 CF, 35 FXS, 241 SMA), 94% of CF/SMA carriers had partners tested.

Abstract

PurposeTo describe our experience of offering simultaneous genetic carrier screening for cystic fibrosis (CF), fragile X syndrome (FXS), and spinal muscular atrophy (SMA).MethodsCarrier screening is offered through general practice, obstetrics, fertility, and genetics settings before or in early pregnancy. Carriers are offered genetic counseling with prenatal/preimplantation genetic diagnosis available to those at increased risk.ResultsScreening of 12,000 individuals revealed 610 carriers (5.08%; 1 in 20): 342 CF, 35 FXS, 241 SMA (8 carriers of 2 conditions), approximately 88% of whom had no family history. At least 94% of CF and SMA carriers' partners were tested. Fifty couples (0.42%; 1 in 240) were at increased risk of having a child with one of the conditions (14 CF, 35 FXS, and 1 SMA) with 32 pregnant at the time of testing. Of these, 26 opted for prenatal diagnosis revealing 7 pregnancies affected (4 CF, 2 FXS, 1 SMA).ConclusionThe combined affected pregnancy rate is comparable to the population risk for Down syndrome, emphasizing the need to routinely offer carrier screening. The availability of appropriate genetic counseling support and a collaborative approach between laboratory teams, genetics services, health professionals offering screening, and support organizations is essential.