title: Parental Views on Expanded Newborn Screening Using Whole-Genome Sequencing.
abstract: OBJECTIVE
  The potential application of whole-genome sequencing (WGS) to state-mandated standard newborn screening (NBS) challenges the traditional public health approach to NBS and raises ethical, policy, and clinical practice issues. This article examines the perspectives and values of diverse healthy pregnant women and parents of children diagnosed with a primary immunodeficiency disorder about traditional NBS and expanded NBS with the use of WGS.
  
  
  METHODS
  We conducted 4 focus groups (3 in English and 1 in Spanish) with socioeconomically and ethnically diverse pregnant women (n = 26), and a comparison group with parents of children diagnosed with a primary immunodeficiency disorder (n = 5).
  
  
  RESULTS
  Pediatric policy-relevant themes that emerged from our analysis of the focus group data are presented within 4 categories: (1) perspectives on traditional NBS, (2) informed consent, (3) return of results, and (4) storage and retrieval of results. Analyses indicate that study participants desired greater inclusion in the NBS process. Despite an optimistic orientation to the potential benefits and limited harms likely to result from genomic applications of NBS, parents voiced concerns about privacy and control over test results. Limited trust in the medical system and the state-run NBS program informed these concerns.
  
  
  CONCLUSIONS
  Expanded NBS with WGS for pediatricians may require management of more genetic conditions, including mutations that convey risk to both the child and parents for adult-onset disorders, and an informed-consent process to manage the genomic data and storage of blood spots. Attention to how these technologies are understood in diverse populations is needed for effective implementation.
authors.forename: Galen
authors.initials: G
authors.lastname: Joseph
authors.forename: Flavia
authors.initials: F
authors.lastname: Chen
authors.affiliation: Division of Research, Kaiser Permanente, Oakland, California.
authors.forename: Julie
authors.initials: J
authors.lastname: Harris-Wai
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Puck
authors.forename: Charlotte
authors.initials: C
authors.lastname: Young
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Koenig
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D059472:Exome / Q000235:genetics; D005260:Female; D017144:Focus Groups; D020022:Genetic Predisposition to Disease / Q000523:psychology*; D030661:Genetic Privacy; D005820:Genetic Testing; D015894:Genome, Human / Q000235:genetics; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D007231:Infant, Newborn; D016247:Information Storage and Retrieval; D007258:Informed Consent; D015997:Neonatal Screening; D010290:Parents; D010358:Patient Participation; D010597:Pharmacogenetics; D011247:Pregnancy; D017422:Sequence Analysis, DNA; D035502:Trust; D055815:Young Adult