Cystic Fibrosis Prenatal Screening in Genetic Counseling Practice: Recommendations of the National Society of Genetic Counselors

Abstract

For over a decade, prenatal screening for cystic fibrosis (CF) has been considered a model for the integration of genetic testing into routine medical practice. Data from pilot studies and public policy discourse have led to recommendations by some professional organizations that CF screening should be offered or made available to pregnant women and their partners, and to couples planning a pregnancy. It is crucial that genetic counselors gain thorough understanding of the complexities of CF and the implications of positive test results, so that they may serve as a reliable, educated referral base and resource for health care providers and their patients. While not all pregnant women will be referred for genetic counseling prior to CF carrier testing, genetic counselors often will be asked to counsel clients after they have a positive test result, or who are found to be at increased risk. Genetic counselors can play an important role in providing accurate and current information as well as support for patients’ informed decisions. These recommendations were created by a multicenter working group of genetic counselors with expertise in CF and are based on personal clinical experience, review of pertinent English language medical articles, and reports of expert committees. The recommendations should not be construed as dictating an exclusive course of management, nor does the use of such recommendations guarantee a particular outcome. These recommendations do not displace a health care provider’s professional judgment based on the clinical circumstances of a particular client.

This is a preview of subscription content, access via your institution.

References

  1. Al-Kouatly, H. B., Chasen, S. T., Streltzoff, J., & Chervenak, F. A. (2001). The clinical significance of fetal echogenic bowel. Am J Obstet Gynecol, 185(5), 1035–1038.

    Google Scholar 

  2. American College of Obstetricians and Gynecologists, American College of Medical Genetics, National Institutes of Health (2001). Preconception and Prenatal Carrier Screening for Cystic Fibrosis: Clinical and Laboratory Guidelines Washington, DC: American College of Obstetricians and Gynecologists.

    Google Scholar 

  3. Asch, D. A., Hershey, J. C., Dekay, M. L., Pauly, M. V., Patoon, J. P., Jedriziewski, M. K., et al. (1998). Carrier screening for cystic fibrosis: Costs and clinical outcomes. Med Decis Making, 18, 202–212.

    Google Scholar 

  4. Bennett, R., Motulsky, A., Bittles. A., Hudgins, L., Uhrich, S., Doyle, D., et al. (2002a). Genetic counseling and screening of consanguineous couples and their offspring: Recommendations of the National Society of Genetic Counselors. J Genet Couns, 11(2), 97–119.

    Google Scholar 

  5. Bennett, R. L., Hart, K. A., O’Rourke, E., Barranger, J. A., Johnson, J., MacDermot, K. D., et al. (2002b). Fabry disease in genetic counseling practice: Recommendations of the National Society of Genetic Counselors. J Genet Couns, 11(2), 121-146.

    Google Scholar 

  6. Bernhardt, B. A., Chase, G. A., Faden, R. R., Geller, G., Hofman, K. J., Tambor, E. S., et al. (1996). Educating patients about cystic fibrosis carrier screening in a primary care setting. Arch Fam Med, 5, 336–340.

    Google Scholar 

  7. Bobadilla, J. L., Macek, M. Jr., Fine, J. P., & Farrell, P. M. (2002). Cystic fibrosis: A worldwide analysis of CFTR mutations–correlation with incidence data and application to screening. Hum Mutat, 19(6), 575–606.

    Google Scholar 

  8. Britto, M., Kotagal, U., Hornung, R., Atherton, H., Tsevat, J., & Wilmott, R. (2002). Impact of recent pulmonary exacerbations on quality of life in patients with cystic fibrosis. CHEST, 121, 64–72

    Google Scholar 

  9. Bromley, B., Doubilet, P., Frigoletto, F. D., Jr., Krauss, C., Estroff, J. A., & Benacerraf, B. R. (1994). Is fetal hyperechoic bowel on second-trimester sonogram an indication for amniocentesis? Obstet Gynecol, 83(5 Pt 1), 647–651.

    Google Scholar 

  10. Buller, A., Olson, S., Redman, J. B., Hantash, F., Chen, R., & Strom, C. M. (2004). Frequency of the cystic fibrosis 3199del6 mutation in individuals heterozygous for I148T. Genet Med, 6(2), 108–109.

    Google Scholar 

  11. Caskey, C. T., Kaback, M. M., & Beaudet, A. L. (1990). The American Society of Human Genetics statement on cystic fibrosis screening. Am J Hum Genet, 46(2), 393.

    Google Scholar 

  12. Chillon, M., Casals, T., Mercier, B., Bassas, L., Lissens, W., Silber, S., et al. (1995). Mutations in the cystic fibrosis gene in patients with congenital absence of the vas deferens. N Engl J Med, 332, 1475–1480.

    Google Scholar 

  13. Chu, C.-S., Trapnell, B. C., Curristin, S., Cutting, G. R., & Crystal, R. G. (1993). Genetic basis of variable exon 9 skipping in cystic fibrosis transmembrane conductance regulator mRNA. Nat Genet, 3, 151–156.

    Google Scholar 

  14. Clayton, E. W., V. L. Hannig, J. P. Pfotenhauer, R. A. Parker, P. W. Campbell 3rd, & J. A. Phillips, 3rd (1996). Lack of interest by nonpregnant couples in population-based cystic fibrosis carrier screening. Am J Hum Gene, 58(3), 617–627.

    Google Scholar 

  15. Cuppens, H., Lin, W., Jaspers, M., Costes, B., Teng, H., Vankeerberghen, A., et al. (1998). Polyvariant mutant cystic fibrosis transmembrane conductance regulator genes. The polymorphic (Tg)m locus explains the partial penetrance of the T5 polymorphism as a disease mutation. J Clin Invest, 101(2), 487–496.

    Google Scholar 

  16. Cystic Fibrosis Foundation (2002). Annual Patient Registry Database.

  17. Cystic Fibrosis Foundation (1997). Clinical Practice Guidelines.

  18. Claustres, M., Guittard, C., Bozon, D., Chevalier, F., Verlingue, C., Ferec, C., et al. (2000). Spectrum of CFTR mutations in cystic fibrosis and in congenital absence of the vas deferens in France. Hum Mutat, 16, 143–156.

    Google Scholar 

  19. Dork, T., Dworniczak, B., Aulehla-Scholz, C., Wieczorek, D., Bohm, I., Mayerova, A., et al. (1997). Distinct spectrum of CFTR gene mutations in congenital absence of the vas deferens. Hum Genet, 100, 365–377.

    Google Scholar 

  20. Doherty, R. A., Palomaki, G. E., Kloza, E. M., Erickson, J. L., & Haddow, J. E. (1996). Couple-based prenatal screening for cystic fibrosis in primary care settings. Prenat Diagn, 16(5), 397–404.

    Google Scholar 

  21. Eng, C. M., Schechter, C., Robinowitz, J., Fulop, G., Burgert, T., Levy, B., et al. (1997). Prenatal genetic carrier testing using triple disease screening. JAMA, 278(15), 1268–1272.

    Google Scholar 

  22. Fanos, J. H., & Johnson, J. P. (1995). Barriers to carrier testing for adult cystic fibrosis sibs: The importance of not knowing. Am J Med Genet, 59(1), 85–91.

    Google Scholar 

  23. Fiel, S. B. (1996). Pulmonary function during pregnancy in cystic fibrosis: Implications for counseling. Curr Opin Pulm Med, 2(6), 462–465.

    Google Scholar 

  24. Garred, P., Pressler, T., Madsen, H. O., Frederikson, B., Svejgaard, A., Hoiby, N., et al. (1999). Association of mannose-binding lectin gene heterogeneity with severity of lung disease and survival in cystic fibrosis. J Clin Invest, 104, 431-437.

    Google Scholar 

  25. Girodon, E., Cazeneuve, C., Lebargy, F., Chinet, T., Costes, B., Ghanem, N., et al. (1997). CFTR Gene Mutations in Adults with Disseminated Bronchiectasis. Eur J Hum Genet, 5, 149–155.

    Google Scholar 

  26. Grody, W. W., Cutting, G. R., Klinger, K. W., Richards, C. S., Watson, M. S., & Desnick, R. J. (2001). Laboratory standards and guidelines for population-based cystic fibrosis carrier screening. Genet Med, 3, 149–154.

    Google Scholar 

  27. Groman, J. D., Meyer, M. E., Wilmott, R. W., Zeitlin, P. L., & Cutting, G. R. (2002). Variant cystic fibrosis phenotypes in the absence of CFTR mutations. N Engl J Med, 347(6), 401-407.

    Google Scholar 

  28. Groman, J. D., Hefferon, T. W., Casals, T., Bassas, L., Estivill, X., Des Georges, M., et al. (2004). Variation in a repeat sequence determines whether a common variant of the cystic fibrosis transmembrane conductance regulator gene is pathogenic or benign. Am J Hum Genet, 74(1), 176–179.

    Google Scholar 

  29. Haddow, J. E. (1997). Editorial: Why the term “carrier screening“ should be abandoned. J Med Screen, 4, 1.

    Google Scholar 

  30. Haddow, J. E., Bradley, L. A., Palomaki, G. E., Doherty, R. A., Bernhardt, B. A., Brock, D. J. H., et al. (1999). Issues in implementing prenatal screening for cystic fibrosis: Results of a working conference. Genet Med, 1, 129–135.

    Google Scholar 

  31. Hartley, N. E., Scotcher, D., Harris, H., Williamson, P., Wallace, A., Crauford, D., et al. (1997). The uptake and acceptability to patients of cystic fibrosis carrier testing offered in pregnancy by the GP. J Med Genet, 34, 459–464.

    Google Scholar 

  32. Hill, L. M., Fries, J., Hecker, J., & Grzybek, P. (1994). Second-trimester echogenic small bowel: an increased risk for adverse perinatal outcome. Prenat Diagn, 14(9), 845–850.

    Google Scholar 

  33. Kere, J., Estivill, X., Chillon, M., Morral, N., Nunes, V., Noriooo, R., et al. (1994). Cystic fibrosis in a low-incidence population: Two major mutations in Finland. Hum Genet, 93(2), 162–166.

    Google Scholar 

  34. Kere, J., Norio, R., Savilahti, E., Estivill, X., & de la Chapelle, A. (1989). Cystic fibrosis in Finland: a molecular and genealogical study. Hum Genet, 83(1), 20–25.

    Google Scholar 

  35. Kere, B.-S., Rommens, J. M., Buchanan, J. A., Markiewicz, D., Cox, T. K., Chakravarti, A., et al. (1989). Identification of the cystic fibrosis gene: Genetic analysis. Science, 245, 1073–1080.

    Google Scholar 

  36. Kere, E., Rave-Harel, N., Augarten, A., Madgar, I., Nissim-Rafina, M., Yahav, Y., et al. (1997). A cystic fibrosis transmembrane conductance regulator splice variant with partial penetrance associated with variable cystic fibrosis presentation. Am J Respir Crit Care Med, 155, 1914–1920.

    Google Scholar 

  37. Kere, E., Reisman, J., Corey, M., Canny, G. J., & Levison, H. (1992). Prediction of mortality in patients with cystic fibrosis. New Engl J Med, 326(8), 1187–1191.

    Google Scholar 

  38. Kessler, D., Moehlenkamp, C., & Kaplan, G. (1996). Determination of cystic fibrosis carrier frequency for Zuni native Americans of New Mexico. Clin Genet, 49(2), 95–97.

    Google Scholar 

  39. Kiesewetter, S., Macek, M., Davis, C., Curristin, S. M., Chu, C. S., Graham, C., et al. (1993). A mutation in CFTR produces different phenotypes depending on chromosomal background. Nat Genet, 5, 274–277.

    CAS  PubMed  Google Scholar 

  40. Kraus, C., Naehrlich, L., Mattes, S., & Reis, A. (2002). Routine analysis of the CFTR IVS(8)T polymorphism discloses two pathogenic mutations. Am J Hum Genet, 71(Suppl), A2215.

    Google Scholar 

  41. Kristidis, P., Bozon, D., Corey, M., Markiewicz, D., Rommens, J., Tsui, L. C., et al. (1992). Genetic determination of exocrine pancreatic function in cystic fibrosis. Am J Hum Genet, 50, 1178–1184.

    Google Scholar 

  42. Levenkron, J. C., Loader, S., & Rowley, P. T. (1997) Carrier screening for cystic fibrosis: Test acceptance and one year follow-up. Am J Med Genet, 73(4), 378–386.

    Google Scholar 

  43. Lissens, W., B. Mercier, H. Tournaye, M. Bonduelle, C. Ferec, S. Seneca, et al. (1996). Cystic fibrosis and infertility caused by congenital absence of the vas deferens and related clinical entities. Hum Reprod, 11, 55–80.

    Google Scholar 

  44. Loader, S., P. Caldwell, A. Kozyra, J. C. Levenkron, C. D. Boehm, H. H. Kazazian Jr., et al. (1996). Cystic fibrosis carrier population screening in the primary care setting. Am J Hum Genet, 59(1), 234–247.

    Google Scholar 

  45. Massie, R. J. H., Poplawski, N., Wilcken, B., Goldblatt, J., Byrnes, C., & Robertson, C. (2001). Intron-8 polythymidine sequence in Australasian individuals with CF mutations R117H and R117C. Eur Respir J, 17, 1195–1200.

    Google Scholar 

  46. McIntosh, N., Gane, L., McConkie-Rosell, A., & Bennett, R. (2000). Genetic counseling for fragile X syndrome: Recommendations of the National Society of Genetic Counselors. J Genet Couns, 9(4), 303–325.

    Google Scholar 

  47. McKone, E. F., Emerson, S. S., Edwards., K. L., & Aitken, M. L. (2003). Effect of genotype on phenotype and mortality in cystic fibrosis: A retrospective cohort study. Lancet, 361, 1671-1676.

    Google Scholar 

  48. Male Infertility Best Practice Policy Committee of the American Urological Association, Inc. and the Practice Committee of the American Society for Reproductive Medicine (2001a). Report on Evaluation of the Azoospermic Male. American Urological Association, Inc., Baltimore, Maryland & American Society for Reproductive Medicine, Birmingham, Alabama.

  49. Male Infertility Best Practice Policy Committee of the American Urological Association, Inc. and the Practice Committee of the American Society for Reproductive Medicine (2001b). Report on Optimal Evaluation of the Infertile Male. American Urological Association, Inc., Baltimore, Maryland & American Society for Reproductive Medicine, Birmingham, Alabama.

  50. Mennie, M. E., Gilfillan, A., Compton, M. E., Liston, W. A., & Brock, D. J. (1993b). Prenatal cystic fibrosis carrier screening: factors in a woman’s decision to decline testing. Prenat Diagn, 13, 807–814.

    Google Scholar 

  51. Mennuti, M. T., Thomson, E., & Press, N. (1999). Screening for cystic fibrosis carrier state. Obstet Gynecol, 93(3), 456–461.

    Google Scholar 

  52. Mickle, J. E., & Cutting, G. R. (1998). Clinical implications of cystic fibrosis transmembrane conductance regulator mutations. Clin Chest Med, 19, 443–458.

    Google Scholar 

  53. National Institutes of Health Consensus Development Conference Statement. Genetic Testing for Cystic Fibrosis April 14–16, 1997.

  54. Noone, P. G., & Knowles, M. R. (2001). ‘CFTR-opathies’: Disease phenotypes associated with cystic fibrosis transmembrane conductance regulator gene mutations. Respir Res, 2, 328-332.

    Google Scholar 

  55. Noone, P. G., C. A. Pue Z. Zhou, K. J. Friedman, E. L. Wakelink, M. Ganeshananthan, et al. (2000). Lung disease associated with the IVS8 5T allele of the CFTR gene. Am J Respir Crit Care Med, 162, 1919–1924.

    Google Scholar 

  56. Noone, P. G., Zhou, Z., Silverman, L. H., Jowell, P. S., Knowles, M. R., & Cohn, J. A. (2001). Cystic fibrosis gene mutations and pancreatitis risk: Relation to epithelial ion transport and trypsin inhibitor gene mutations. Gastroenterology, 121, 1310–1319.

    Google Scholar 

  57. Ogino, S., Wilson, R.B., & Grody, W W. (2004). Generalized Bayesian risk calculations for autosomal recessive disease when only one mutation is detected, incorporating test sensitivity and each parent’s ethnicity information: What if a fetus has echogenic bowel and one CFTR mutation? J. Med Genet, 41, e70.

    Google Scholar 

  58. Ormond, K. E., Mills, P. L., Lester, L. A., & Ross, L. F. (2003). Effect of family history on disclosure patterns of cystic fibrosis carrier status. Am J Med Genet, 15, 119C(1), 70–77.

    Google Scholar 

  59. Palomaki, G. E. (2004). Editorial: Prenatal screening for cystic fibrosis: An early report card. Genet Med, 6(3), 1.

    Google Scholar 

  60. Palomaki, G. E., FitzSimmons, S. C., & Haddow, J. E. (2004). Clinical sensitivity of prenatal screening for cystic fibrosis via CFTR carrier testing in a United States panethnic population. Genet Med, 6(5), 405–414.

    Google Scholar 

  61. Pignatti, P. F., C. Bombieri, M. Benetazzo, A. Casartelli, E. Trabetti, L. S. Gile, et al. (1996). CFTR gene variant IVS8-5T in disseminated bronchiectasis. Am J Hum Genet, 58, 889-892.

    Google Scholar 

  62. Rave-Harel, N., E. Kere, Nissim-Rafina, M., I. Madjar, R. Goshen, A. Augarten, et al. (1997). The molecular basis of partial penetrance of splicing mutations in cystic fibrosis. Am J Hum Genet, 60, 87–94.

    CAS  PubMed  Google Scholar 

  63. Richards, C. S., L. A. Bradley, J. Amos, B. A. Allitto, W. W. Grody, A. Maddlena, et al. (2002). Standards and Guidelines for CFTR Mutation Testing. Genet Med, 4, 379–391.

    Google Scholar 

  64. Roberts, T., Schwarz, M. J., Kerr-Liddell, R., Hinks, J. L., & Super, M. (2003). Cascade carrier-testing in cystic fibrosis. Paediatr Respir Rev, 4(4), 293–298.

    Google Scholar 

  65. Rohlfs, E. M., Hallam, S. E., Booker, J. K., Silverman, L. M., Heim, R. A., & Allitto, B. A. (2003). The CFTR polyT 6T allele is associated with CAVD. Genet Med, 5, A157.

    Google Scholar 

  66. Rohlfs, E. M., Sugarman, E. A., Heim, R. A., & Allitto, B. A. (2001). Frequency of carriers of two cystic fibrosis mutations in an apparently unaffected adult population. Genet Med, 3, 237.

    Google Scholar 

  67. Rohlfs, E. M., Z. Zhou, E. A. Sugarman, R. A. Heim, R. G. Pace, M. R. Knowles, et al. (2002), The I148T CFTR allele occurs on multiple haplotypes: A complex allele is associated with cystic fibrosis. Genet Med, 4, 319–323.

    Google Scholar 

  68. Rosenstein, B. J., & Cutting, G. R. (1998) The diagnosis of cystic fibrosis: A consensus statement. Cystic Fibrosis Foundation Consensus Panel. J Pediatr, 132(4), 589–595.

    Google Scholar 

  69. Schlegel, P. N., J. Cohen, M. Goldstein, M. Alikani, A. Adler, B. R. Gilbert, et al. (1995). Cystic fibrosis gene mutations do not affect sperm function during in vitro fertilization with micromanipulation for men with bilateral congenital absence of vas deferens. Fertil Steril, 64(2), 421–426.

    Google Scholar 

  70. Schwind, E. L., Wolfe, M., Greendale, K., Misra, L. M., Pass, K. A., & Wallerstein, R. (1999). Cystic fibrosis carrier screening practices in an ethnically diverse region: Experience of the Genetic Network of the Empire State, Puerto Rico, and the U.S. Virgin Islands. Genet Test, 3(2), 215–218.

    Google Scholar 

  71. Sorenson, J. R., B. Cheuvront, DeVellis, B., N. Callanan, L. Silverman, G. Koch, et al. (1997). Acceptance of home and clinic-based cystic fibrosis carrier education and testing by first, second, and third degree relatives of cystic fibrosis patients. Am J Med Genet, 70(2), 121–129.

    Google Scholar 

  72. Strom, C. M., D. Huang, A. Buller, J. Redman, B. Crossley, B. Anderson, et al. (2002). Cystic fibrosis screening using the College panel: Platform comparison and lessons learned from the first 20,000 samples. Genet Med, 4, 289-296.

    Google Scholar 

  73. Sugarman, E. A., Rohlfs, E. M., Silverman, L. M., & Allitto, B. A. (2004). CFTR Mutation distribution among U.S. Hispanic & African American individuals: Evaluation in CF patient and carrier screening populations. Genet Med, submitted for publication.

  74. Super, M., Schwarz, M. J., Malone, G., Roberts, T., Haworth, A., & Dermody, G. (1994). Active cascade testing for carriers of cystic fibrosis gene. BMJ, 308(6942), 1462–1467.

    Google Scholar 

  75. Tambor, E. S., Bernhardt, B. A., Chase, G. A., Faden, R. R., Geller, G., Hofman, K. J., et al. (1994). Offering cystic fibrosis carrier screening to an HMO population: Factors associated with utilization. Am J Hum Genet, 55, 626–637.

    Google Scholar 

  76. Taussig, L. M., Lobeck, C. C., Kattwinkel, J., & Di Sant’Agnese, P. A. (1972). Fertility in males with cystic fibrosis. N Engl J Med, 287(12), 586–589.

    Google Scholar 

  77. The Cystic Fibrosis Genotype-Phenotype Consortium (1993). Correlation between genotype and phenotype in patients with cystic fibrosis. N Engl J Med, 329(18), 1308–1313.

    Google Scholar 

  78. Trepanier, A., Ahrens, M., McKinnon, W., Peters, J., Stopfer, J., Grumet, S., et al. (2004). Genetic cancer risk assessment and counseling: Recommendations of the National Society of Genetic Counselors. J Genet Couns, 13(2), 83–114.

    Google Scholar 

  79. U.S. Congressional Office of Technology Assessment (OTA) (1992). “Cystic Fibrosis and DNA Tests: Implications of Carrier Screening.“ Washington: OTA.

  80. U.S. Preventive Services Task Force. Chairman Harold C. Sox, Jr. (1995). Guide to Clinical Preventive Services, 2nd ed. Appendix A. U.S. Government Printing Office. Stock No. 017001005258.

  81. Vintzileos, A. M., Ananth, C. V., Smulian, J. C., Fisher, A. J., Day- Salvatore, D., & Beazoglou, T. (1998). A cost effectiveness analysis of prenatal carrier screening for cystic fibrosis. Obstet Gynecol, 91, 529–534.

    Google Scholar 

  82. Wald, N. J., Morris, J. K., Rodeck, C. H., Haddow, J. E., & Palomaki, G. E. (2003). Cystic fibrosis: Selecting the prenatal screening strategy of choice. Prenat Diagn, 23(6), 474–483.

    Google Scholar 

  83. Watson, M. S., Cutting, G. R., Desnick, R. J., Driscoll, D. A., Klinger, K., Mennuti, M., Palomaki, G. E., Popovich, B. W., Pratt, V. M., Rohlfs, E. M., Strom, C. M., Richards, C. S., Witt, D. R., & Grody, W. W. (2004). Cystic fibrosis population carrier screening: 2004 revision of American College of Medical Genetics mutation panel. Genet Med, 6(5), 387–391.

    Google Scholar 

  84. Watson, M. S., Desnick, R. J., Grody, W. W., Mennuti, M. T., Popovich, B. W., & Richards, C. S. (2002). Cystic fibrosis carrier screening: Issues in implementation. Genet Med, 4, 407–409.

    Google Scholar 

  85. Witt, D. R., C. Schaefer, P. Hallam, S. Wi, B. Bulumberg, A. Fishbach, et al. (1996). Cystic fibrosis heterozygote screening in 5,161 pregnant women. Am J Hum Genet, 58, 823–835.

    Google Scholar 

  86. Yankaskas, J. R., & Aris, R. (2000). Outpatient care of the cystic fibrosis patient after lung transplantation. Curr Opin Pulm Med, 6(6), 551–557.

    Google Scholar 

  87. Yankaskas, J. R., Marshall, B. C., Sufian, B., Simon, R. H., & Rodman, D. (2004) Cystic fibrosis adult care: Consensus conference report. Chest, 125(1, Suppl), 1S–39S.

    Google Scholar 

  88. Zielenski, J. (2000). Genotype and phenotype in cystic fibrosis. Respiration 67(2), 117–133.

    Google Scholar 

  89. Zielenski, J., M. Corey, R. Rozmahel, D. Markiewicz, I. Aznarez, T. Casals, et al. (1999). Detection of a cystic fibrosis modifier locus for meconium ileus on human chromosome 19q13. Nat Genet, 22, 128–129.

    Google Scholar 

  90. Zoler, M. L. (2003). Still below target levels, Cystic Fibrosis Screening Soars OB/GYN NEWS 38 (6).

Download references

Author information

Affiliations

Authors

Consortia

Corresponding author

Correspondence to Elinor Langfelder-Schwind.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Langfelder-Schwind, E., Kloza, E., Sugarman, E. et al. Cystic Fibrosis Prenatal Screening in Genetic Counseling Practice: Recommendations of the National Society of Genetic Counselors. J Genet Counsel 14, 1–15 (2005). https://doi.org/10.1007/s10897-005-1496-5

Download citation

Keywords

  • cystic fibrosis carrier screening
  • genetic testing
  • genetic counseling