Prenatal exome sequencing in anomalous fetuses: New opportunities and challenges

Neeta L. Vora*, Bradford Powell, Alicia Brandt, Natasha Strande, Emily Hardisty, Kelly Gilmore, Ann Katherine M. Foreman, Kirk Wilhelmsen, Chris Bizon, Jason Reilly, Phil Owen, Cynthia M. Powell, Debra Skinner, Christine Marie Rini, Anne D. Lyerly, Kim A. Boggess, Karen Weck, Jonathan S. Berg, James P. Evans

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

76 Scopus citations


PurposeWe investigated the diagnostic and clinical performance of exome sequencing in fetuses with sonographic abnormalities with normal karyotype and microarray and, in some cases, normal gene-specific sequencing.MethodsExome sequencing was performed on DNA from 15 anomalous fetuses and from the peripheral blood of their parents. Parents provided consent to be informed of diagnostic results in the fetus, medically actionable findings in the parents, and their identification as carrier couples for significant autosomal recessive conditions. We assessed the perceptions and understanding of exome sequencing using mixed methods in 15 mother-father dyads.ResultsIn seven (47%) of 15 fetuses, exome sequencing provided a diagnosis or possible diagnosis with identification of variants in the following genes: COL1A1, MUSK, KCTD1, RTTN, TMEM67, PIEZO1 and DYNC2H1. One additional case revealed a de novo nonsense mutation in a novel candidate gene (MAP4K4). The perceived likelihood that exome sequencing would explain the results (5.2 on a 10-point scale) was higher than the approximately 30% diagnostic yield discussed in pretest counseling.ConclusionExome sequencing had diagnostic utility in a highly select population of fetuses where a genetic diagnosis was highly suspected. Challenges related to genetics literacy and variant interpretation must be addressed by highly tailored pre- and posttest genetic counseling.

Original languageEnglish (US)
Pages (from-to)1207-1216
Number of pages10
JournalGenetics in Medicine
Issue number11
StatePublished - Nov 1 2017


  • counselling
  • diagnosis
  • ethics
  • exome
  • prenatal

ASJC Scopus subject areas

  • Genetics(clinical)

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