Mental Health Aspects of Genetic Screening and Testing in Obstetrics and Gynecology

Genetic testing for women of reproductive age may be for various purposes, including identifying fetal aneuploidy or chromosomal risk, identifying carrier risk of disease, or cancer risk. Offering genetic testing is not without psychosocial risk, leading to anxiety a range of emotional distress. Obstetrician Gynecologists are recommended to have a standard practice for genetic testing so that similar testing strategies are made available to all patients, allowing time for appropriate counseling to patients. Expectations regarding genetic testing, including significance of the test, limitations, and options for diagnostic testing should be discussed with patients before a test is offered. Pre- and post-test counseling should be performed in a clear, objective, and non-directive fashion, allowing time for patients to understand the information and make informed decisions. For patients with a positive screen, empathetic communication reduces stress and anxiety. For patients with a positive fetal anomaly or positive chromosomal abnormality, additional counseling and support regarding diagnosis, prognosis and further evaluation and management should be provided in a clear, objective, and non-directive manner. For patients with hereditary cancer risk additional decision support is recommended for patients navigating medical recommendations and prevention strategies to reduce risk. For pregnant women, an additional factor adding to the psychosocial stress to personal decision-making and counseling is the increasing limited options for termination of a pregnancy for patients with abnormal diagnostic results. Since the Supreme Court decision overturned Roe versus Wade, many states have implemented gestational-age based abortion restrictions. Future studies are warranted to understand the impact of the reversal of Roe v. Wade on the psychosocial stresses of genetic testing.