Offering Prenatal Testing for Adult-Onset Diseases (Argument AGAINST)

The advent of massively parallel ("next-generation") DNA sequencing has enabled prenatal testing for any and all diseases at reasonable cost, resulting in the widespread adoption of highly expanded carrier screening. While the size and constitution of these gene panels may be critiqued on various grounds, at least all the diseases selected represent potential risks to the newborn or older child if affected. Thus, the rationale behind the effort falls within ACOG's definition of prenatal care as a preventive health service "designed to improve the health and well-being of pregnant and birthing individuals and their infants through evidence-based services." Nowhere does it promise to improve the health of offspring when they reach adulthood. Here, we argue that testing for adult-onset diseases in the prenatal setting (in the absence of a positive family history) is neither justified nor desirable, based on considerations of equity, scope of practice, downstream burden on the health care system, and psychosocial repercussions.