a043  0250  31 Jul 80
PM-Prenatal Test,490
Proposed Prenatal Test Scored
By WARREN E. LEARY
AP Science Writer
    WASHINGTON (AP) - The possible widespread use of a simple prenatal
test to detect severe birth defects is being questioned because of
social, economic and medical implications, and its role in abortions.
    Doctors, lawyers and consumer advocates said Wednesday that the test
being considered for routine use could do more harm than good if it
is simply made available without careful planning of long-term
effects. Experts agree the test by itself is not sufficient.
    Dr. Stuart L. Nightingale of the Food and Drug Administration said
his agency will propose regulations this year to permit routine use of
the alpha-fetoprotein (AFP) test, but only when specific conditions
are met.
    The agency considered approving the laboratory test two years ago,
but held off because of questions raised by health care planners and
consumers.
    At the meeting sponsored by the FDA and the National Center for
Health Care Technology, experts said the brain and spinal cord defects
the test detects are incurable and virtually untreatable.
    These so-called neural tube disorders, which afflict about one out
of every 1,000 infants, can lead to early death, physical impairment
and mental retardation.
    The test specifically is used to screen for anencephaly, a fatal
condition in which the brain is absent or underdeveloped, and open
spina difida, in which the spine has failed to close and part of the
cord protrudes.
    After diagnosis, the options given a family essentially are to have
a defective child or an abortion. And those opposed to abortion
question the worth of tests that force people to face this choice.
    Dr. David J.H. Brock of Western General Hospital in Scotland said
the AFP test was pioneered in Britain in the early 1970s and is used
routinely there.
    In the United States, thousands of women are receiving AFP screening
tests in experimental programs but other doctors cannot send blood
samples to regular laboratories for the tests.
    Brock said the test detects the chemical in a blood sample taken
from the mother between her 16th and 20th week of pregnancy. Some AFP
is always produced by a fetus, but increased amounts appear when
neural defects are present.
    But since other conditions also can increase AFP levels, the test
isn't difinitive in itself, he noted. Other tests then are needed to
narrow down the diagnosis.
    These tests include using ultrasonic scans to check the fetus' size
and to look for signs of brain and spinal defects, as well as
amniocentesis to check the fluid inside the womb.
    Experts at the meeting said AFP tests should not become routine in
this country unless doctors and patients understand that they are not
final and that further testing is needed before a diagnosis.
Otherwise, the result could be the abortion of healthy fetuses, they
said.
    There are also ethical questions about offering the test to women
who may not be able to afford or to have access to the confirmation
testing. Also to be considered are those who may not have the money
for the abortion option, they added.
    
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