New study published in the Association for Diagnostics
& Laboratory Medicine's (formerly AACC's) Clinical
Chemistry journal
WASHINGTON, May 23, 2024
/PRNewswire/ -- Breaking research demonstrates that clinical labs
should account for the self-reported race of pregnant individuals
when screening for spina bifida and other open neural tube defects.
This finding, which was presented today in the Association for
Diagnostics & Laboratory Medicine's (formerly AACC's)
Clinical Chemistry journal, could improve prenatal care for
pregnant Black individuals.
View the full study here:
https://academic.oup.com/clinchem/advance-article/doi/10.1093/clinchem/hvae053/7657106
In the wake of the racial reckoning that took place in 2020, the
medical community has embarked on a major push to advance health
equity. A significant component of this has involved reevaluating
the use of race in a wide range of clinical testing algorithms. For
example, research found that race-based calculations for estimated
glomerular filtration rate (eGFR) — a test for kidney function —
were actually leading to delayed diagnosis and poorer outcomes for
Black patients with kidney disease. Clinical labs are therefore now
excluding race from their eGFR calculations.
The medical community has also been questioning the use of race
in the test for alpha-fetoprotein (AFP), which is used to diagnose
open neural tube defects such as spina bifida during pregnancy.
Current testing algorithms for AFP account for race because
self-reported Black individuals on average have higher AFP levels
than White individuals. However, recent studies have recommended
omitting race when screening for these birth defects.
A team of researchers led by Glenn E.
Palomaki, PhD, of Women & Infant's Hospital in
Providence, Rhode Island, set out
to determine the clinical impact of omitting race from AFP testing.
Palomaki's team first separately compared the AFP levels of
pregnant White individuals and those of pregnant Black individuals
against the median AFP level of pregnant individuals. Maternal
weight, which is also higher on average in self-reported Black
individuals, was also considered. They then used the same
statistical analysis but eliminated self-reported race from the
algorithm.
When self-reported race was used, the positivity rate of the
screen was roughly equivalent among Black and White individuals.
However, when self-reported race and maternal weight were not
accounted for in the analysis, 1.49% of those identifying as Black
were positive for open neural tube defects, while only 0.63% of
those identifying as White were positive, a 2.36-fold difference.
This discrepancy does not reflect the real-life disparity in open
neural tube defect prevalence and would create inequitable burdens
for Black individuals, including additional diagnostic testing that
may be costly and invasive, as well as maternal anxiety.
"Accounting for maternal race and weight, as well as other
possible covariates such as smoking status, plays a critical role
in ensuring reliability and equity in various prenatal screening
programs," the study's authors wrote. "Our results, together with
existing professional recommendations and other current
publications, endorse the use of self-reported race in prenatal
serum screening."
About the Association for Diagnostics & Laboratory
Medicine (ADLM)
Dedicated to achieving better health through laboratory
medicine, ADLM (formerly AACC) brings together more than 70,000
clinical laboratory professionals, physicians, research scientists,
and business leaders from around the world focused on clinical
chemistry, molecular diagnostics, mass spectrometry, translational
medicine, lab management, and other areas of progressing laboratory
science. Since 1948, ADLM has worked to advance the common
interests of the field, providing programs that advance scientific
collaboration, knowledge, expertise, and innovation. For more
information, visit www.myadlm.org.
Clinical Chemistry (clinchem.org) is the leading
international journal of laboratory medicine, featuring nearly 400
peer-reviewed studies every year that help patients get accurate
diagnoses and essential care. This vital research is advancing
areas of healthcare ranging from genetic testing and drug
monitoring to pediatrics and appropriate test utilization.
Christine DeLong
ADLM
Associate Director, Communications & PR
(p) 202.835.8722
cdelong@myadlm.org
Molly Polen
ADLM
Senior Director, Communications & PR
(p) 202.420.7612
(c) 703.598.0472
mpolen@myadlm.org
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SOURCE Association for Diagnostics & Laboratory Medicine
(ADLM)