 |
Linking Family History in Obstetric and Pediatric Care: Assessing
Risk for Genetic Disease and Birth Defects
A rising challenge in
the use of family histories is the collection, translation, and
transfer of that information among the family’s many health care
providers. This is especially important during the periods before
and between pregnancies—times of potentially unique opportunities
for intervention.
- Because
pediatricians often see women more than their obstetricians do
between pregnancies, pediatricians can play an important role in
identifying family history information that can affect future
pregnancies. They can also make families aware of the need to
discuss that information with the mother’s clinician before
future pregnancies to enhance continuity of care.
- Pediatricians see
children and their families many times during the child’s first
year of life. So, they are more likely to find abnormalities
that become important aspects of the family history for future
pregnancies and for the health of the parents and older
children. Also, the father’s family history is important and can
be collected during a pediatric visit.
- Identifying a
family history of a condition before or between pregnancies
gives the physician a chance to talk with the family about
increased risk and to motivate behavior change and
decision-making that might reduce risk and improve pregnancy and
pediatric outcomes.
- Identifying a
family history of a condition during pregnancy can lead to early
diagnosis. Such information can guide secondary interventions
and decisions about issues such as location and mode of
delivery. It also allows families and their physicians to plan
for medical care during the newborn period and childhood.
- Several tools
commonly used during the prenatal period can be used before or
between pregnancies to screen for increased risk on the basis of
family history:
-
First Page,
from the Foundation for Blood Research, asks about personal
or family history of single-gene or chromosomal conditions,
along with structural defects, exposures to teratogens, and
recurrent miscarriages.
-
The
antepartum record of the American College of Obstetricians
and Gynecologists (ACOG) has a section on genetic screening
and teratology counseling. This tool can screen for
increased risk for many conditions in an infant’s mother,
father, or other relatives.
-
ACOG’s
obstetric medical history form gathers information about
personal health history, exposures affecting health,
gynecological health history, family history (including
ethnicity) and genetic screening, and psychological history.
- Family history is
currently used to identify and assess risk for single-gene
disorders, such as cystic fibrosis, sickle cell disease, and
fragile X syndrome. It can also be relevant to assessing risk
for chromosomal abnormalities, complex conditions like neural
tube defects, and adverse birth outcomes such as placental
abruption or preeclampsia.
- Linking pediatric
information with family medical history during periods before
and between pregnancies allows for the most thorough assessment
of risk and adds valuable information to that which
obstetricians gather routinely during prenatal visits.
- Pediatricians can
aid this linkage by working with families and their
obstetricians, family practitioners, and other health care
providers. Such partnerships will increase knowledge and
communication about risks and guide efforts to minimize risk and
improve pregnancy outcome.
For more
information, please see the following Pediatrics supplement
article:
Linking
Family History in Obstetric and Pediatric Care: Assessing
Risk for Genetic Disease and Birth Defects.
[Return to Top]
Date:
September 06, 2007
Content source: National Center on Birth Defects and Developmental
Disabilities
|
|
|
