Bio-ethics committee advises limited use of NIP-test in pregnancy

Bio-ethics committee advises limited use of NIP-test in pregnancy
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Belgium’s Advisory Committee on Bio-Ethics (CCBB) has advised gynaecologists and GPs not to use the popular NIP test to determine the presence of a number of conditions in a growing foetus, where the information may serve no purpose.

The NIP test, or non-invasive prenatal test, is a commonly used test for pregnant women, where a simple blood sample is taken, usually to determine the possibility the embryo is at risk of Down’s syndrome.

It takes the place of the far more invasive amniocentesis that preceded it, which involved taping off some amniotic fluid from the uterus, which in some cases was enough to end the pregnancy altogether.

However, the NIP test can also be used to detect a number of other sex chromosome aneuploidies (SCA), which are conditions caused by an abnormal number of the chromosomes X and Y.

Briefly, the X chromosome is provided in two copies by the mother, and the father provides an X and a Y. Usually, a child is born with either XX, as a female, or XY, as a male. In some cases, however, more than two chromosomes can be present, as in Klinefelters Syndrome (XXY) which is characterised principally by infertility. Or Trisomy X, which sometimes leads to learning difficulties.

The NIP test is capable of detecting these and other SCAs, but the Advisory Committee advises against exploring the possibilities too far.

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The test has been reimbursed by medical insurance for only two years in Belgium, and in that time, births of children with Down’s have reduced by one-third, 80% of women make use of the test, and the use of other more invasive tests fell by half, the VRT reported back in February.

Belgium was the first country, and is still one of the few, where the test is fully reimbursed,” said Joris Vermeesch, professor of human genetics at the University of Leuven at the time.

But the CCBB advice addresses itself to other tests that are possible using the NIP model.

Often an extra test has to be done to confirm that it is indeed the condition, which in turn wastes the profit of the NIP test," Professor Pascal Borry of the Centre for Biomedical Ethics and Law of the KULeuven told VRT radio.

Moreover, these are conditions that do not cause equally serious problems for everyone. There are many people who lead normal lives and do not even know that they have that condition.”

In some cases, the NIP test is even being used to determine the sex of the unborn child, which is illegal in some other countries.

But the advice of the COC is mainly concerned with the utility of carrying out the battery of tests now available by the NIP method.

What can you do with the information? How useful is it to know certain information?” Prof. Borry summed it up.

In the Netherlands, the Health Council prescribes that screening must be linked to 'meaningful courses of action,’ while in this case it is not entirely clear what information can do.”

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