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June 29, 2020

In Fetal Therapy, an Obligation to Temper Excitement With Caution

Author Affiliations
  • 1College of Public Health, University of South Florida, Tampa
  • 2Morsani College of Medicine, Department of Obstetrics and Gynecology, University of South Florida, Tampa
JAMA Pediatr. 2020;174(10):929-930. doi:10.1001/jamapediatrics.2020.1525

Innovations in diagnostic techniques, genomic analysis, stem cell treatments, and gene therapies have the potential to revolutionize our approach to many birth defects and genetic diseases that we are presently able to manage only after birth. In their review of gene and stem cell therapies for fetal care in this issue of JAMA Pediatrics, O’Connell et al1 provide a comprehensive perspective on current practice and the probable future for affected pregnancies. Many of the treatments described are presently at the experimental stage. In the theoretical case study of corrected hemophilia before birth, the authors describe a powerful and exciting example of future therapies that build on our current ability to screen for genetic disorders with cell-free DNA (cfDNA). However, we seek to temper some of this excitement with a review of the uncertainties and current limitations of existing fetal therapies and cfDNA testing, as well as a discussion of additional ethical considerations.

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