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ACOG Releases New Guidelines Recommending That All Pregnant Women Be Offered Screening For Down Syndrome In First Trimester

The American College of Obstetricians and Gynecologists in the January issue of the journal Obstetrics & Gynecology released guidelines recommending screening for Down syndrome to all pregnant women in their first trimester, the Los Angeles Times reports (Maugh, Los Angeles Times, 12/31/06). Down syndrome is the most common major chromosomal abnormality in the U.S., occurring in about 5,000 infants born annually. Physicians often administer a blood test to pregnant women -- especially women who are older or who have a family history of genetic abnormalities -- in the second trimester around 16 weeks' gestation. If the blood test, known as the quadruple screen, is positive, the woman then undergoes an invasive test called amniocentesis to confirm the diagnosis. A new method consists of performing an ultrasound test, called the nuchal translucency test, and a different blood test in the first trimester between 10 and 13 weeks' gestation. The nuchal translucency test measures the translucent space in the tissue in the back of a developing fetus' neck, which typically is larger in fetuses with Down syndrome because of excess fluid accumulation. The measurement then is put into a formula with the pregnant woman's age and the gestational age of the fetus to determine the likelihood that the fetus has Down syndrome (Kaiser Daily Women's Health Policy Report, 11/10/05). Recommendations, Reaction
According to the AP/CBS News, the ACOG recommendations are based on the availability of tests such as nuchal translucency that are less invasive than amniocentesis (Neergaard, AP/CBS News, 12/31/06). The guidelines call for a combination of a blood test and a nuchal translucency test be offered to all pregnant women during the first trimester. Invasive tests for Down syndrome previously have been offered routinely to women ages 35 and older, the Times reports. The risk in older women has been managed so successfully that the largest number of children born with Down syndrome is being born to women younger than age 35, Edward McCabe of the Mattel Children's Hospital at the University of California-Los Angeles said. He added that the ACOG committee that wrote the guidelines found that "counseling has been much more effective in the older group, and now it is important to begin looking at younger women" (Los Angeles Times, 12/31/06). James Goldberg of San Francisco Perinatal Associates, who also is a member of the ACOG committee that developed the guidelines, said, "It's a substantial change in our philosophy of screening," adding, "The important thing for women to know is that they have a choice. Age by itself is a poor screening criteria" (Feder Ostrov, San Jose Mercury News, 12/31/06). According to Gautam Chaudhuri, executive chair of the obstetrics department at UCLA's David Geffen School of Medicine, the guidelines are already followed by most academic centers but not in many private practices (Los Angeles Times, 12/31/06).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.





ACOG versiuni noi orientãri care recomandã ca toate femeile gravide fi oferite de screening pentru sindromul Down în primul trimestru - ACOG Releases New Guidelines Recommending That All Pregnant Women Be Offered Screening For Down Syndrome In First Trimester - articole medicale engleza - startsanatate