The Center for Fetal Medicine and Prenatal Genetics includes high-risk obstetricians, geneticists, radiologists, genetic counselors and nurses who provide assessment and counseling services before, during, and after pregnancy. Consultations are available at Brigham and Women’s Hospital and locations throughout the community.
Fertility specialists at the Center for Infertility and Reproductive Surgery at Brigham and Women’s Hospital evaluate embryos prior to in vitro fertilization.
Our genetic counselors help patients:
Before a genetic counseling appointment, patients are encouraged to speak with their family members and their partner’s family members about the following:
If there is a specific genetic condition in the family, it is important to obtain copies of evaluations and genetic testing results.
Our team offers comprehensive diagnostic testing for patients during their pregnancy when an increased risk for a genetic condition is identified, including:
Tests such as maternal serum screening or cell-free DNA may be performed to identify an increased risk for a chromosome condition such as Down syndrome.
Genetic Carrier Testing
Genetic carrier testing can identify whether a couple is at risk for have a children with an inherited genetic condition.
Ultrasound may be performed during pregnancy to identify a birth defect.
In situations like these, our team provides education and support to patients to determine further testing and management options. In some cases, patients may choose to have additional diagnostic testing, such as:
During amniocentesis a small sample of the fluid that is around the baby (amniotic fluid) is removed from the uterus for testing.
Chorionic Villus Sampling
During chorionic villus sampling (CVS) a small piece of the placenta (chorionic villi) is removed from the placenta for testing.
Percutaneous Umbilical Blood Sampling (PUBS)
Percutaneous umbilical blood sampling is performed under ultrasound guidance to remove a sample of fetal blood.
If an amniocentesis, chorionic villus sampling or PUBS is planned:
Typically, diagnostic testing is performed to obtain fetal cells for genetic testing of the chromosomes or DNA. Chromosomes are made up of DNA and groups of DNA in specific patterns are called genes. Diagnostic testing may include:
A picture of the chromosomes that detects whole extra or missing chromosomes or large chromosome variations.
DNA testing of the chromosomes that detects extra or missing chromosomal material in greater detail than a karyotype. Chromosome microarray does not test for single-gene conditions or provide information about how genes work.
Single Gene Conditions
Targeted DNA testing may be performed to look at a specific gene associated with a constellation of birth defects. Decisions about single gene testing are made based on the clinical information and known genetic causes. In some cases, further genetic testing can involve examination of specific panels of genes or the exome.
For families expecting the birth of a child with a birth defect or genetic condition, coordinated care including high risk obstetric care, neonatology and pediatric subspecialty care are arranged.
After a pregnancy loss or delivery of a child with birth defects, families have questions about why such an event happened and the impact for future pregnancies. While there are many causes for birth defects and pregnancy loss, genetic testing may detect a specific genetic cause. Additional genetic testing may be suggested to understand recurrence risks in future pregnancies.
Chromosome testing through chromosome microarray is recommended. Even if this testing is normal, it does not rule out an underlying genetic cause. Innovative genetic testing including single-gene testing, directed gene panels and exome sequencing may provide additional information.
Based on clinical information and genetic testing, our team can review testing options for a future pregnancy. If a known genetic cause is identified, diagnostic testing such as CVS or amniocentesis can be offered in a future pregnancy. There may also be an option for pre-implantation genetic diagnosis (PGD), detailed below. Even if there is no known genetic cause, screening by ultrasound or other imaging, such as an MRI or echocardiogram, may also be beneficial.
Pre-implantation genetic diagnosis (PGD) allows for genetic testing of embryos following in-vitro fertilization. PGD increases the probability that the embryos transferred will be unaffected for the disease tested. PGD is only possible for conditions where there is a known genetic cause. Genetic counselors work in conjunction with the fertility specialists in the BWH Center for Infertility and Reproductive Surgery to coordinate this testing.
Our genetic counselors provide educational programs and support to physicians and their office staff. Advances in the decoding of the human genome often places genetic testing, as well as the interpretation and application of these tests, in the physician’s office. Programs taught by genetic counselors can support implementation of prenatal genetic services to the obstetric community.
To schedule an appointment or to learn more about our services, please contact us at (617) 732-4840.
Brigham and Women’s Hospital
75 Francis Street
Boston, MA 02115
Louise E. Wilkins Haug, MD, PhD
Division of Maternal-Fetal Medicine
Rosemary E. Reiss, MD
Division of Maternal-Fetal Medicine
Kathryn J. Gray, MD, PhD
Division of Maternal-Fetal Medicine
The genetic counselors in the Center for Fetal Medicine and Reproductive Genetics have completed a master’s in genetic counseling and are licensed and board certified (LCGC). The genetic counselors have expertise in reproductive genetics including counseling families prior to and during pregnancies, reviewing genetic testing options surrounding pregnancy, preimplantation genetic testing (PGT) and prenatal diagnosis of birth defects and genetic conditions.
Lori Dobson, MS, LCGC
Genetic Counseling Manager
Lori Dobson, LCGC graduated from California State University Northridge. In addition to clinic, she focuses on services to provide genetic testing and education throughout OB/GYN, including non-invasive prenatal testing, carrier screening and PGT.
Hayley Green, MA, MS, LCGC
Hayley Green, LCGC graduated from Boston University and also has a MA in Medical Humanities, Compassionate Care and Bioethics at Stony Brook University. She enjoys helping individuals and families make decisions about genetic testing and genetic information.
Sam Gbur, MS, LCGC
Sam Gbur, LCGC graduated from Arcadia University. Sam has both laboratory and clinical experience. She is interested in making genetic testing more accessible to patients, including introducing carrier screening to primary care clinics.
Sophie Adams, MSc, MS, LCGC
Sophie Adams, LCGC, graduated from Stanford University and also has a MSc in Physiology, Anatomy, and Genetics from the University of Oxford. She specializes in counseling patients with complex fetal anomalies. She is fluent in Spanish and seeks to improve genetics care for underserved patients.
Michelle Pacione, EdM, MS, LCGC
Michelle Pacione, LCGC graduated from Stanford University and also has a EdM from Boston University. In addition to her clinical work, she combines her love of genetics and teaching through educational outreach and programming.
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