SIENA, Italy, DEC. 22, 2004 (Zenit.org).- Far from offering or requesting prenatal diagnosis as a routine examination, people should use it with great care, warns a neonatologist.
Dr. Carlo Bellieni of the Santa Maria alle Scotte Polyclinic explains in this ZENIT interview the risks of using — or abusing — prenatal diagnosis.
Q: What is prenatal diagnosis?
Bellieni: It is the way of knowing the fetus’ health conditions. It can be done in an invasive way — by extracting fetal material: blood, chorionic villi, amniotic fluid — or in a non-invasive way.
In the latter case, it can be done by analyzing the maternal blood or carrying out instrumental examinations such as fetal ultrasounds. Chorionic villous sampling is usually done in the first trimester, while amniocentesis is carried out more frequently in the second trimester.
Q: In whose interest is it done?
Bellieni: Good question. Prenatal diagnosis is very useful to be able to determine a good number of fetal pathologies; many of these can be treated, some directly before birth. But prenatal diagnosis may also be used for selective purposes, recently also in the form of pre-implantation testing.
In this latter case it is carried out in in-vitro fertilization, before introducing the “ideal” embryos in the uterus. There are those who suggest that this testing can be done not only to determine major pathologies, but also secondary features, such as sex.
So a distinction must be made between a prenatal diagnosis done in the interest of all the individuals — embryo-fetus and mother — and one which, instead, considers only the interests of the one already born.
Q: Amniocentesis is an ever more widespread examination, yes?
Bellieni: In the 35 years since Jacobson and Barten referred to the first 56 cases of amniocentesis, the number of amniocenteses has increased progressively. Recently, endeavors are under way to overcome the need for invasive examinations in pregnancies, because of the risk of abortion that they entail.
Q: Is it an omissible risk?
Bellieni: A recent study by Seeds in the American Journal of Obstetrics and Gynecology, of 2004, refers to an abortion rate of 0.6%.
Considering that in 2003 in Italy close to 100,000 amniocenteses were carried out, it turns out, according to this data, that more than 500 normal and wanted pregnancies did not end in birth because of this technique, with the consequent trauma for the woman. It is not an omissible fact, despite surgeons being extremely scrupulous and skillful.
Q: You have spoken on other occasions of the fetus’ right to privacy. To what are you referring?
Bellieni: I understand that the fetus is an individual who has the right of non-interference in his innermost sphere. In 1998 the World Health Organization also recommended that prenatal diagnosis be carried out exclusively in the interest of the fetus, and not to satisfy the parents’ curiosity.
Q: Do ultrasounds hold surprises in store?
Bellieni: We must be clear: Ultrasounds are absolutely safe and not harmful. Moreover, they can contribute useful information in the interest of the mother and the fetus. However, we must not trivialize them, as we must not trivialize anything in medicine.
In 2004 the Food and Drug Administration warned about the excess of videos recorded as “mementos.” Many international studies recommend an ultrasound in the course of a pregnancy. In Italy and France the number is even higher than the three that are usually recommended.
Q: What would you say by way of conclusion?
Bellieni: That prenatal diagnosis is too often carried out in the ambit of already widespread anxiety over pregnancy, which stems for the concept of the “search for the perfect child,” since the idea that the pregnancy might end in a way other than perfection is “simply not granted to women.”
Invasive prenatal diagnosis is an instrument that must be used with care — in the first place, knowing its risks and real indications, and not offering or requiring it as a routine examination; in the second place, knowing lamentably that it cannot give the yearned for certainty of the absence of fetal pathology, the pathologies that a pregnancy might entail being so many and of such a varied nature.
Pregnancy must be released from the grip of anxiety, and prenatal diagnosis must be given back its role as coadjutor of a mental and emotional process, and not as an obligation for social ends.
