Genetic Counseling Program

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The Natural History of Pregnancies Diagnosed with Down Syndrome:  Developing Counseling and Pregnancy Management Guidelines  By Courtney Kiss

Capstone Project Committee: Sally Harris, MS, CGC (UNC-CH), Chair; Randi C. Stewart, MS, CGC (UNCG); William Goodnight, MD, MSCR (UNC-CH); Sat Gupta, PhD (UNCG) and Shierina Fareed, Graduate Student, UNCG, Statistical Consultants

The natural history of pregnancies following the fetal diagnosis of Down syndrome remain poorly described, thus counseling and prenatal management of such pregnancies is inconsistent. The specific aim of this study was to describe outcomes in pregnancies diagnosed with Down syndrome and determine what predictors including ultrasound anomalies, markers of aneuploidy or other findings are associated with adverse pregnancy outcomes in an effort to establish guidelines for counseling and management.  Ninety four prenatal cases of Down syndrome were identified through The University of North Carolina Health Care system cytogenetic database between January 1, 2000 to December 31, 2010 and a retrospective records review was performed.  Eighty nine cases remained for inclusion and data was available for 23 cases with continuing pregnancies.  Analysis was performed with Wilcoxon rank sum, Fisher’s exact test and the chisquare test.  A significant association between the presence of a congenital anomaly and the occurrence of an adverse pregnancy complication was found.  There was a significant difference in the median maternal age between the pregnancies with fetal death (defined as a second or third trimester loss) and the pregnancies with no fetal death.  These results suggest that the presence of a congenital anomaly, or maternal age greater than 40 years in a pregnancy diagnosed with Down syndrome, may benefit from additional antenatal monitoring.

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  • "I chose to attend UNCG because of its shared learning environment and the access to some of the leading institutions in the country. "

  • "UNCG is a great fit for me. The program directors have extensive experience in the world of genetic counseling and provide you with opportunities to work with some of the best medical centers in the country. Our location allows us to have expert guest lecturers, many of whom you also get to work alongside or observe in your clinical rotations in your second year. We also have some really wonderful and unique opportunities as a part of this program: we observe in syndrome specific support groups and clinics, tour genetic laboratories, and are matched with a family with a genetic disease to learn what it is like to live with a genetic condition. Finally, our directors are genuinely invested in each of us, and care about our success and getting to know each of us personally."

  • "The director and assistant director do their best to ensure that our program provides a collaborative learning experience.  Both are active members of the Genetic Counseling community and strive to introduce you to all aspects of this field.  We also have renowned clinical sites and the beautiful state of North Carolina at our disposal.”