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Congenital malformations concern 3% of pregnancies; most of them can be seen during pregnancy. For some malformations, an invasive sample (trophoblast biopsy or amniocentesis) is proposed to search a chromosomal abnormality by the technique of DNA chip. However, some strongly suggestive signs of a genetic (and not chromosomal) pathology have a very low diagnostic rate with this technique. In the absence of an etiological diagnosis, the prognosis for the unborn child is very difficult to assess, as we can't know if the fetal malformation is really isolated or associted to other unseen features as part of a syndromic condition.
For some malformations strongly suggestive of a genetic condition, we propose to realize an exome (i.e. all coding parts of the genome) sequencing of the trio (child and the 2 parents) with a delivery time compatible with the emergency situation of a pregnancy (6 weeks maximum). We will apply bioinformatics filters to analyse only genes known to be involved in the malformation present in the unborn child and thus avoid the identification of variants in unrelated genes. These lists of genes have been previously validated by the Rare Disease Health Sectors and the affiliated diagnostic laboratories. The selected malformations are: 1) anomalies of the central nervous system (microcephaly (<- 2DS) with anomalies of gyration, anomalies of the posterior fossa, anomalies of the midline except agenesis of the corpus callosum), 2) ophthalmological anomalies (microphthalmia, hyperplasia vitreous) and 3) renal abnormalities (large hyperechoic kidneys).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| 90 trios (270 subjects: 90 fetus, 90 mothers, 90 fathers) | Other |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| CGH-array and exome sequencing | Genetic | A blood sample will be used for CGH-array and exome sequencing |
|
| Measure | Description | Time Frame |
|---|---|---|
| Diagnostic contribution of the exome sequencing in antenatal period in comparison with the chromosomal analysis (CGH-array) realized in current health care | Comparison of the number of genetic diagnoses made by exome sequencing and by CGH-array. | 13 months |
| Measure | Description | Time Frame |
|---|---|---|
| Effects on pregnancy management and/or postnatal child care due to an etiological diagnosis | Percentage of antenatal and/or postnatal fetus/child care modified by the molecular result | 13 months |
| Feasibility study of carrying out exome sequencing in the antenatal period in terms of time to deliver results |
| Measure | Description | Time Frame |
|---|---|---|
| Difficulties of interpretation of the exome sequencing in antenatal period | Numbers of variants of unknown signification identified by exome sequencing with and without bioinformatic filters (targeted exome) | 13 months |
| Identification of new genes responsible of fetal malformations |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Elise SCHAEFER | Contact | +33 3 88 12 81 20 | elise.schaefer@chru-strasbourg.fr |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| CHu de Besançon | Not yet recruiting | Besançon | 25030 | France |
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Time to results from the inclusion of the trio (in days) specifying the time for each step (reception, sequencing, bioinformatics analysis, interpretation) (in days) |
| 13 months |
If the results of CGH-array and targeted exome sequencing are negative, analysis of the entire exome sequencing to find new genes implicated in fetal development |
| 13 months |
| CHU de Dijon | Not yet recruiting | Dijon | 21079 | France |
|
| Hospices Civils de Lyon | Not yet recruiting | Lyon | France |
|
| Groupe Hospitalier Region Mulhouse Et Sud Alsace | Not yet recruiting | Mulhouse | 68070 | France |
|
| CHU de Nancy | Not yet recruiting | Nancy | 54042 | France |
|
| Hôpital d'Enfants Armand-Trousseau | Not yet recruiting | Paris | 75012 | France |
|
| Hôpital de la Pitié Salpêtrière | Not yet recruiting | Paris | 75013 | France |
|
| Hôpital Necker Enfants Malades | Not yet recruiting | Paris | 75743 | France |
|
| CHU de Reims | Not yet recruiting | Reims | 51092 | France |
|
| CHU de Rennes | Not yet recruiting | Rennes | 35203 | France |
|
| Les Hôpitaux Universitaires de Strasbourg | Recruiting | Strasbourg | 67098 | France |
|
| CHU de Toulouse | Not yet recruiting | Toulouse | 31059 | France |
|
| ID | Term |
|---|---|
| D000013 | Congenital Abnormalities |
| ID | Term |
|---|---|
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
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| ID | Term |
|---|---|
| D000073359 | Exome Sequencing |
| ID | Term |
|---|---|
| D000073336 | Whole Genome Sequencing |
| D017422 | Sequence Analysis, DNA |
| D017421 | Sequence Analysis |
| D005821 | Genetic Techniques |
| D008919 | Investigative Techniques |
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