How widely will prenatal diagnosis be accepted in the future?

How widely will prenatal diagnosis be accepted in the future?

This article is about how prenatal diagnosis will be widely accepted in the future. How widely is the public aware of NIPT?
According to the report of the Working Group on NIPT Surveys, etc., the number of facilities mp where the NIPT Consortium is testing is 86 for the six years ending March 2019.

New prenatal diagnosis has been widely performed in both licensed and unlicensed facilities since our country began clinical research efforts in 2013.

Of course, the common view is that the decision to perform NIPT is not made by all pregnant women, but by each pregnant woman.

It is predicted that NIPT will become more affordable in the future, and more older pregnant women will want to consider testing due to the trend toward later marriage and later childbearing. As a result, there is a strong possibility that we will end up in a situation where NIPT-related information and testing will be available to all pregnant women, as is the case in other countries.

Although there has been a tendency to be cautious about NIPT until it is recognized by the public due to ethical issues, we are now at a point where NIPT needs to be widely recognized and accepted.

In this article, we will explain how NIPT will be widely recognized and accepted in the future.

How widespread is prenatal diagnosis?

How well is NIPT recognized by the public?

According to the report of the Working Group on NIPT Surveys, etc., the number of facilities mp where the NIPT Consortium is testing is 86 for the six years ending March 2019.

The number of test results has increased to 72,526 cases, and the number of facilities and the number of cases per year have also been increasing every year since the beginning of NIPT.

Furthermore, NIPT can be performed at non-licensed facilities, with 92 licensed and 55 unlicensed facilities confirmed as of October 2019.

It is expected that more facilities will be able to perform NIPT at a lower cost as well as an increase in the number of facilities.

Whether or not to undergo prenatal diagnosis depends on the individual pregnant woman.

In Japan, even though the number of pregnant women who have undergone NIPT has increased, public awareness of NIPT has not spread widely.

Many people are aware of NIPT but do not know what kind of test it is, what kinds of fetal abnormalities it can detect, and what options exist for subsequent pregnancies and treatment after diagnosis.

In Japan, some people view prenatal diagnosis as a test that may lead to giving up the possibility of continuing a pregnancy, or have a negative impression of NIPT.

The fundamental stance is that each pregnant woman should think and decide whether or not to undergo NIPT; it is up to each pregnant woman to decide whether or not to undergo NIPT.

Prenatal diagnosis will become more and more public in the future.

The concept of prenatal testing and diagnosis held by the Japan Society of Obstetrics and Gynecology views it as a tool to learn the exact disease of the fetus when the fetus is suffering from one of the diseases or when it is considered highly likely that the fetus will show the disease.

Therefore, in these days when many women experience pregnancy and childbirth at an older age, many older pregnant women can be eligible for prenatal diagnosis, whether or not it is performed.

Therefore, NIPT is not a personal matter for the generation that will bear and raise children in the future.

Looking at the history of NIPT, clinical testing began in the U.S. in 2011, and in Japan in 2013.

In 2018, there will be an estimated 10 million NIPTs performed worldwide, and dozens of testing companies are in existence around the world today.

In Japan, NIPT testing is conducted at both licensed and unlicensed facilities, and it is easy to imagine that if the number of facilities increases and the cost of testing becomes more affordable, the number of NIPT tests will further increase, and NIPT will become more widely accepted.

The importance of a support system for those who choose prenatal diagnosis

As NIPT becomes increasingly widespread, the following are important considerations for pregnant women undergoing testing

  • Receive appropriate, scientifically based information about NIPT
  • Know what options are available depending on the results of the test.
  • Availability of support for pregnant women's decision making after testing

What is important is to provide correct information and understanding of the tests and diseases, and a support system to help people make decisions about their thoughts before and after testing, such as genetic counseling.

Recently, it is also noteworthy that information is available from activities such as the "Fetal Hotline" of the NPO "Association for the Future of Parents and Children," which provides support for this thinking and decision-making process.

This group is run on a volunteer basis and is characterized by the neutrality of its involvement with pregnant women who have chosen NIPT or other methods, regardless of whether or not they choose to continue their pregnancies based on the results of the test.

At the "Fetal Hotline," pregnant women whose fetuses are found to have congenital diseases during pregnancy can receive advice from people in various positions about their future lives, including what kind of support they can receive after delivery.

As a result, it allows pregnant women to know how to go about their lives while envisioning their lives after the birth of their child.

In the future, there should be a more widespread support system for pregnant women whose fetus is found to have a disease, regardless of the NIPT test, to self-determine their choice of treatment and what support they will receive after delivery.

The idea of treating the fetus

The aforementioned "Association for the Future of Parents and Children" is in a position to support pregnant women who choose the NIPT test, and the background of this support is the idea of "fetal treatment," which the fetus can receive while it is still in the mother's belly.

Fetal therapy is "a treatment technique that is based on prenatal diagnosis of fetal abnormality and provides treatment to the fetus before birth while ensuring the safety of the mother, and is more effective than postnatal treatment. *1

This is where the fetus is already considered a medical subject, and after prenatal diagnostic testing, if necessary, the fetus is given treatment after sufficient information is provided.

Although fetal treatment is still limited, clinical applications of research are increasing, and therefore, NIPT testing may be used to detect and treat fetal disease early and potentially reduce the severity of expected future disabilities.

Summary: What is Needed for Widespread Acceptance of New Prenatal Diagnosis

There is no doubt that NIPT testing will be widely used in Japan in the future.

There are various opinions in favor of, against, or against the test in terms of ethical aspects, and there is an urgent need to deepen the understanding of this test not only among pregnant women but also in society as a whole.

We are now at the stage of thinking more deeply about what is needed to make NIPT, which has been widely accepted in many countries overseas, widely accepted in Japan.

The top priority is to support the self-determination of the family, including the expectant mother, and to ensure that the optimal environment is created for the unborn child.

From the viewpoint of fetal treatment introduced in this report, there is a continuing need to improve the support system for pregnant women who choose to undergo NIPT, including the possibility of selecting medical treatment for a fetus that needs treatment after undergoing NIPT, and knowing in advance the support after delivery in case the fetus has a congenital disease.

As NIPT continues to spread in Japan, there is an urgent need to provide appropriate knowledge and information on NIPT and to establish a system for appropriate follow-up before and after testing.