title: Exome Sequencing in Fetuses with Structural Malformations.
abstract: Prenatal diagnostic testing is a rapidly advancing field. An accurate diagnosis of structural anomalies and additional abnormalities in fetuses with structural anomalies is important to allow "triage" and designation of prognosis. This will allow parents to make an informed decision relating to the pregnancy. This review outlines the current tests used in prenatal diagnosis, focusing particularly on "new technologies" such as exome sequencing. We demonstrate the utility of exome sequencing above that of conventional karyotyping and Chromosomal Microarray (CMA) alone by outlining a recent proof of concept study investigating 30 parent-fetus trios where the fetus is known to have a structural anomaly. This may allow the identification of pathological gene anomalies and consequently improved prognostic profiling, as well as excluding anomalies and distinguishing between de novo and inherited mutations, in order to estimate the recurrence risk in future pregnancies. The potential ethical dilemmas surrounding exome sequencing are also considered, and the future of prenatal genetic diagnosis is discussed.
authors.affiliation: Centre of Women's and Children's Health & School of Clinical and Experimental Medicine, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. fionamackie@doctors.org.uk.|Fetal Medicine Centre, Birmingham Women's Foundation Trust, Edgbaston, Birmingham B15 2TT, UK. fionamackie@doctors.org.uk.
authors.forename: Fiona L
authors.initials: FL
authors.lastname: Mackie
authors.affiliation: Genome Mutation and Genetic Disease Group, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, UK. kc7@sanger.ac.uk.
authors.forename: Keren J
authors.initials: KJ
authors.lastname: Carss
authors.affiliation: Centre of Women's and Children's Health & School of Clinical and Experimental Medicine, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. sarahchillman@hotmail.com.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Hillman
authors.affiliation: Genome Mutation and Genetic Disease Group, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge CB10 1SA, UK. meh@sanger.ac.uk.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Hurles
authors.affiliation: Centre of Women's and Children's Health & School of Clinical and Experimental Medicine, College of Medicine and Dentistry, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. m.d.kilby@bham.ac.uk.|Fetal Medicine Centre, Birmingham Women's Foundation Trust, Edgbaston, Birmingham B15 2TT, UK. m.d.kilby@bham.ac.uk.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Kilby
keywords: exome sequencing; fetus; prenatal; prenatal diagnosis