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Pregnant woman and doctor in a consultation.

Ethox colleagues Adeline Perrot and Ruth Horn and have published a paper in PLOS One exploring ethical issues raised by the provision of expanded NIPT in routine clinical care in France.

Since 2020, some health professionals in the French public health system offer genome-wide Non-Invasive Prenatal Testing (GW NIPT) to pregnant women with a higher probability of a rare abnormality identified in the fetus (beyond the three common aneuploidies (trisomy 21 (T21), trisomy 13 (T13) and trisomy 18 (T18)). This screening test comes with no additional costs than for the standard NIPT for women and is reimbursed by the public health insurance for the same indications as T21. Despite some potential clinical benefits (screening for an expanded number of chromosomal abnormalities, and the potential to better understand these abnormalities), this screening test also raises a number of ethical issues.

The article analyses the views and arguments of French health professionals (gynaecologists-obstetricians, geneticists, midwives, general practitioner) and scientists (medical biologist, researchers in genetics, obstetrics and gynaecology) around the use of GW-NIPT, based on semi-structured interviews (17) and a comprehensive literature review.

The study, which initially focused on standard NIPT, highlights how the provision of expanded NIPT is the subject of much debate and disagreement within the international scientific and medical community. It highlights the importance of addressing ethical issues related to the differing quality of counselling, the complexity of achieving informed consent, and the avoidance of harm to pregnant women in the feedback of findings beyond T21, T18 and T13.

The authors conclude that if there is an increase in the provision of GW-NIPT within the French public health system, it will be essential to develop counselling methods that address the potential impacts on women’s well-being (stress, anxiety, etc.), respect reproductive choices of women, support their autonomous decision and their understanding of the limitations and uncertainties associated with GW screening.

This study is part of a larger project (link) funded by the Economic and Social Research Council, exploring practical ethical issues 'on the arising from the clinical implementation of genetics and genomics in antenatal care in England, France and Germany. 

Perrot A, Horn R (2022) Health professionals and scientists’ views on genome-wide NIPT in the French public health system: Critical analysis of the ethical issues raised by prenatal genomics. PLOS ONE 17(11): e0277010.