Attitudes toward maternal serum screening in Chinese women with positive results

Maternal serum screening for fetal Down syndrome has been integrated into routine antenatal care in most clinics in Taiwan. We examined the attitudes toward serum screening and the possible implications in women with positive results. From January to July 1995, 276 women were referred to the Genetic Counseling Clinic, Mackay Memorial Hospital for amniocentesis because of positive screening results, and 214 participated in this study. All women opted for amniocentesis after genetic counseling. Over 40% stated that they made decisions independently after being informed of the serum screening. Need for certainty was the most frequently mentioned reason. Two-thirds believed that serum screening could provide a diagnosis. Almost all women would apply for maternal serum screening for future pregnancies. This study demonstrated that Chinese women need more counseling and autonomy regarding maternal serum screening.     

Maternal gestational stress alters adaptive and social behavior in adolescent rhesus monkey offspring

Data from rodent studies have indicated that stress experienced by pregnant mothers may result in behavioral and biological abnormalities in their offspring. However, few studies have examined the effects of prenatal stress on the offspring beyond the childhood period. In this study, 7 prenatally stressed (PNS) monkeys and 7 monkeys from undisturbed pregnancies were tested under mildly challenging conditions at 4 years of age. Following separation from cagemates and group formation, PNS monkeys showed more locomotion, abnormal and disturbance behavior than controls. Controls showed approximately six times more play than PNS animals. The PNS males showed the most clinging to others and the largest increase in contact with other animals over the period. Group differences were also found when the monkeys were observed as groups or alone in a playroom. Controls showed more explanatory behavior in the playroom, whereas PNS monkeys showed more inactivity. Control animals showed a decrease in distress vocalizations over time in the playroom, whereas PNS animals showed the opposite pattern. Control animals spent more time in proximity to and contact with cagemates than PNS animals. These results indicate that prenatal stress can have effects on adaptive and social behavior that persist into adolescence.     

A support group for couples who have terminated a pregnancy after prenatal diagnosis: Recurrent themes and observations

Genetic Counselors are increasingly becoming involved in organizing and facilitating support groups for couples who have terminated a pregnancy because of an abnormal fetal diagnosis. This paper discusses recurrent themes which have emerged in the FATE (Feelings After the Termination Experience) support group which was founded in New Jersey in 1990. By becoming familiar with the issues we have observed in our support group, genetic counselors should be better able to understand and empathize with their patients who make the decision to terminate a much wanted pregnancy. They may also feel better prepared to become involved in organizing and facilitating such support groups.     

Don't get stuck in the mother: regression in analysis

This paper was part of an afternoon workshop on regression. It re views the author's recollections of her own analysis and clinical work with the purpose of discovering the sources of her own ideas on regression. Two specific forms of regression are then delineated – negative therapeutic reaction as described by Rosenfeld and 'umbilical transference' as a possible future development.     

The relations among cry characteristics, demographic variables, and developmental test scores in infants prenatally exposed to methadone

This study examined the relations among developmental test scores, infants' demographic characteristics, and cry features. Cry features were strongly related to developmental test scores at all ages, suggesting that use of the infants' cry characteristics can help to identify those infants at greatest risk for later developmental problems.     

To Use or Not to Use: The Prenatal Genetic Technology/Worry Conundrum

We conducted an exploratory, qualitative study investigating the factors influencing the use of genetic counseling and prenatal genetic testing for two groups: pregnant women 35 years of age and over (AMA) at the time of delivery and pregnant women with an abnormal maternal serum triple screen (MSAFP3). The convenience sample consisted of 25 semistructured interviews of women/couples and 50 observations of genetic counseling sessions. Worry turned out to be the most important variable influencing decision making about prenatal genetic testing and was greater in the MSAFP3 group than in the AMA group. The women in the AMA group appeared to assign the risk of having a child with Down syndrome to their age category rather than to themselves individually, whereas, the risk perception for women with an abnormal MSAFP3 appeared to have shifted from a general population risk for pregnant women to an individual, personal risk. There was a general lack of understanding and also more misinformation about the MSAFP3 screen compared to amniocentesis. Women in both groups were torn between fear of an invasive test and worry about the health of their fetus for the rest of their pregnancy if they did not undergo amniocentesis.     

Association of prenatal attachment and early childhood emotional,behavioral, and developmental characteristics: A longitudinal study

This study examines the associations between prenatal attachment and child development, socioemotional behavioral problems, and competence at early childhood. It also inquires whether maternal depression and anxiety at the prenatal period and at early childhood are associated with child outcomes. The study consisted of 83 mothers and their children. Data regarding the prenatal attachment, depression, and anxiety were collected during Weeks 28 to 40 of gestation. When the children were 21 to 31 months old, the Brief Infant and Toddler Social Emotional Assessment (BITSEA) and the Ankara Developmental Screening Inventory (ADSI) were applied to children along with Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) administered to mothers. Results showed that prenatal attachment scores significantly correlated with BITSEA-Competency subscale scores and ADSI total scores at early childhood, r(83) = 0.246, P = .025, and r(82) = 0.316, P = .004, respectively. Prenatal attachment levels were found to be the predictors of both behavioral and emotional competence and development at early childhood, b = 0.081, t(83) = 2.273, P = .014, and b = 0.281, t(83) = 3.225, P = .002, respectively. In addition, prenatal attachment was shown to be even a stronger predictor of development than was worsening maternal depression at early childhood, b = −0.319, t(83) = 2.140, P = .035. Our results indicate that fostering prenatal attachment may be beneficial for better infant outcomes at early childhood.     

Genetic counseling for a family with two distinct anomalies: A case report of a neural tube defect and 5p- syndrome in a fetus

A couple presented for genetic counseling because of an elevated maternal serum alpha fetoprotein. Ultrasound examination revealed the presence of a neural tube defect. The couple declined an amniocentesis, but chose serial ultrasound evaluations instead. Ultrasounds eventually identified microcephaly, but the couple continued to decline amniocentesis. After the child's birth, the diagnosis of 5p- syndrome was made. The couple's decision not to have an amniocentesis allowed the family their right to autonomy; however, prenatal chromosome analysis would have provided this couple with a great deal more prognostic information. We discuss the conflict between a counselor's duty to respect a client's freedom vs. duty to care for a client's welfare. We address issues of nondirective counseling and the need for more studies looking at the decision-making process in prenatal diagnosis.     

也论朱子对《周易参同契》的整理

本文系对"朱子删改《参同契》文本说"的回应。该说法认为,朱子以宋代之后才出现的"先天方位"思想作为诠释《参同契》思想的基本方向,为弥合其注释与正文之间的矛盾,朱子有选择地删改了《参同契》的文本。本文对该说的几个主要论据做出回应:针对在朱子之前《参同契》文本不稳定的观点,本文指出,《参同契》文本在唐代已经基本稳定,而唐宋之际阐发《参同契》的文献大量出现,导致了《参同契》与之相混同的现象;针对朱子首次把《参同契》所本无的"先天方位"思想强加到对《参同契》的解释中的说法,本文指出,在朱子之前已有先例以"乾坤坎离"释《参同契》的"牝牡四卦"的说法,而《参同契》本身也是陈抟、邵雍"先天方位"说的思想来源之一;最后,本文还就"朱子删改《参同契》文本说"的具体条目做出了分析,指出其判断多有失误。     

Disability Rights,Prenatal Diagnosis and Eugenics: A Cross-Cultural View

This paper considers the disability rights critique of genetic testing in the context of different communities and the issue of nondirectiveness. Despite the wide usage of genetic diagnosis in Israel, no public debate has emerged there concerning disability rights and prenatal testing. The common attitude that emerged from interviews with Israeli representatives of organizations “of’’ and “for’’ people with genetic diseases and congenital disabilities can be described as a two-fold view of disability: support of genetic testing during pregnancy, and support of the disabled person after birth. This two-fold view is explained as a secular construction situated in legal, economic and cultural contexts. The paper concludes by considering the implications of the “two-fold view’’ of disability for the profession of genetic counseling. It is argued that awareness of the existence of conflicting views among clients—such as the view of the ‘disability critique’ as well as of the “two-fold view of disability’’—should strengthen the significance of nondirectiveness.