The uptake and outcome of prenatal and pre-implantation genetic diagnosis for Huntington's disease in the Netherlands (1998–2008)

Authors

  • MC van Rij,

    1. Department of Clinical Genetics, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
    2. Department of Neurology
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  • PAM de Koning Gans,

    1. Department of Clinical Genetics, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
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  • MJ van Belzen,

    1. Department of Clinical Genetics, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
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  • RAC Roos,

    1. Department of Neurology
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  • JPM Geraedts,

    1. Department of Clinical Genetics, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
    2. GROW, Research School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
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  • M De Rademaeker,

    1. Centre for Medical Genetics, University Hospital Brussels, Brussels, Belgium
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  • EK Bijlsma,

    1. Department of Clinical Genetics, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
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  • CEM de Die-Smulders

    Corresponding author
    1. Department of Clinical Genetics, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
    2. GROW, Research School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
    • Corresponding author: Prof Dr Christine E.M. de Die-Smulders, Department of Clinical Genetics, Maastricht University Medical Centre (MUMC), 6202 AZ Maastricht, The Netherlands.

      Tel.: +31 (0) 43 387 7855;

      fax: +31 (0) 43 3875800;

      e-mail: c.dedie@mumc.nl [PO BOX 5800]

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  • The authors report no conflict of interest.

Abstract

We aimed to study reproductive behaviour of couples opting for prenatal diagnosis (PND) and pre-implantation genetic diagnosis (PGD) for Huntington's disease (HD). In the Netherlands, exclusion PND is available for persons at 50% risk, whereas exclusion PGD is not allowed. All 162 couples who underwent PND or PGD for HD between 1998 and 2008 and referrals for exclusion PGD to Belgium were included. Couples' reproductive information was collected until December 2010; 132 couples (81.5%) underwent PND in 262 pregnancies, 54 (33.3%) started PGD, and 25 used both. Sixteen percent of PND couples used exclusion PND and 6% used exclusion PGD. The outcomes were 76.5% of PND couples delivered ≥1 unaffected child(ren) after PND, and 44.4% of PGD couples delivered ≥1 PGD child(ren) (mean 2.5 cycles/couple). Couples opting for PGD secondarily (after a previous pregnancy) had more frequently terminated a pregnancy for HD (87.0%) compared with couples secondarily opting for PND (55.2%; p = 0.015). At-risk or HD expansion carrier males were underrepresented in the group of couples primarily opting for PGD (25%) and overrepresented in the secondary PGD group (64%). We conclude that couples reconsider their choices in every subsequent pregnancy based on their previous experience, personal beliefs and the gender of the at-risk partner.

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