Newswise — CHICAGO – In a new study, researchers have demonstrated that there is an insufficient basis for incorporating race in prenatal screening for birth defects. In a second, separate study, researchers have found that HIV-exposed uninfected children are at higher risk for health problems compared to uninfected, unexposed children. Both of these studies will be presented today at ADLM 2024 (formerly the AACC Annual Scientific Meeting & Clinical Lab Expo) and could help to improve medical care for Black pregnant patients and HIV-exposed uninfected children, respectively.
Rethinking the role of race in prenatal AFP screening
As the use of race in a variety of clinical testing algorithms continues to be reevaluated, the medical community has debated incorporating race in tests for alpha-fetoprotein (AFP), which is used to diagnose a class of birth defects known as open neural tube defects (ONTD) during pregnancy. Current testing algorithms for AFP account for race because self-reported Black individuals on average have higher AFP levels than White individuals. However, many question whether the clinical benefit of incorporating race into AFP screening models is great enough to justify doing so.
Dr. William Butler and a team of researchers from the Hospital of the University of Pennsylvania compared the risk classification for ONTD given by two different models, one of which accounted for self-reported maternal race and one that did not. Their study involved 7,702 patients who were pregnant with one child, 2,360 of whom self-identified as Black. The researchers found that self-reported Black race or ethnicity had a small, yet statistically significant association with AFP concentration. However, only 0.2% of patients were classified differently when race was not accounted for. Furthermore, none of these discordantly classified patients had children born with ONTD.
“As race is a social construct that should not be used as a surrogate to explain biological differences, we should require strong evidence that its use confers substantial benefit that cannot be achieved through other approaches if we are to consider incorporating it into clinical practice algorithms,” Dr. Butler said. “The modest improvement in normalizing AFP concentrations is outweighed by the harms of continuing a race-based practice and additional studies are warranted to consider patient factors other than race to improve ONTD risk stratification.”
Health issues in HIV-exposed uninfected children in the Bronx
The global rates of HIV transmission from mother to child have dropped drastically thanks to a treatment regimen known as combination antiretroviral therapy (cART). This has led to an increase in the number of HIV-exposed uninfected children, who currently total 16 million worldwide. Although HIV-free and generally healthy, these children may face heightened risks of adverse health outcomes due to prenatal exposure to cART, including growth restriction, increased susceptibility to infections, and neurobehavioral disorders. Furthermore, infants with growth restriction are at a greater risk of developing chronic diseases such as cardiometabolic and neurological disorders later in life — a risk that is worsened by low socioeconomic status.
Drs. Eros Qama and Kayode Balogun of Montefiore Medical Center and Albert Einstein College of Medicine sought to assess the prevalence of neurodevelopmental disorders and hyperlipidemia in HIV-negative children born to HIV-infected mothers in the Bronx, New York, an area of low socioeconomic status. They compared the medical records of 127 HIV-exposed uninfected children from the Bronx to 157 HIV-unexposed and uninfected children from the Bronx, aged 0-15. HIV-exposed uninfected children were found to have significantly higher rates of attention-deficit/hyperactivity disorder, autism spectrum disorder, unspecified developmental delay, and abnormal cholesterol levels.
“It’s important for the sake of public health to start understanding the health trajectory of these kids, so that we can intervene early, and so that we know what regimen might be best for HIV-positive women when they decide to get pregnant to prevent the sequelae of [antiretroviral] drugs,” Dr. Balogun said.
Session Information
ADLM 2024 registration is free for members of the media. Reporters can register online here: https://xpressreg.net/register/adlm0824/media/landing.asp
Abstract A-321: Rethinking the role of race in prenatal AFP screening for open neural tube defects
Both abstracts will be presented during:
Scientific poster session
Tuesday, July 30
9:30 a.m. – 5 p.m. (presenting authors in attendance from 1:30 – 2:30 p.m.)
The session will take place in the Poster Hall on the Expo show floor of McCormick Place, Chicago.
About ADLM 2024
ADLM 2024 (formerly the AACC Annual Scientific Meeting & Clinical Lab Expo) offers 5 days packed with opportunities to learn about exciting science from July 28-August 1 in Chicago. Plenary sessions will explore the projected consequences of ending abortion protection, new HIV prevention options, lymphoma biomarkers and therapeutic targets, pharmacogenetic testing in precision health, and the need for clinical trials of laboratory tests.
At the ADLM 2024 Clinical Lab Expo, more than 900 exhibitors will fill the show floor of the McCormick Place Convention Center in Chicago, with displays of the latest diagnostic technology, including but not limited to artificial intelligence, point-of-care, and automation.
About the Association for Diagnostics & Laboratory Medicine (ADLM)
Dedicated to achieving better health through laboratory medicine, ADLM (formerly AACC) brings together more than 70,000 clinical laboratory professionals, physicians, research scientists, and business leaders from around the world focused on clinical chemistry, molecular diagnostics, mass spectrometry, translational medicine, lab management, and other areas of progressing laboratory science. Since 1948, ADLM has worked to advance the common interests of the field, providing programs that advance scientific collaboration, knowledge, expertise, and innovation. For more information, visit www.myadlm.org.
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ADLM 2024 (formerly the AACC Annual Scientific Meeting & Clinical Lab Expo)
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