JAMA+ AI Conversations Rethinking Race in Prenatal Screening for Open Neural Tube Defects
Mar 28, 2025
Daniel Herman, MD, PhD, from the University of Pennsylvania, dives into the complexities of prenatal screening for open neural tube defects. He discusses the historical implications of race in these screenings, revealing how racial adjustments can lead to misleading false positives, particularly for Black patients. The conversation highlights a significant shift towards race-agnostic approaches, advocating for more equitable prenatal testing methods. Herman emphasizes the necessity for ongoing research to explore new biomarkers that can improve healthcare outcomes for all.
AI Snips
Chapters
Transcript
Episode notes
AFP Testing Requires Complex Models
- Alpha fetal protein (AFP) concentrations rise rapidly during the second trimester, so screening uses gestational age-specific comparisons.
- This prevents using a single threshold and requires a complex interpretive model for prenatal screening.
Race Adjustment Began Decades Ago
- Race adjustment in AFP screening originated from observed differences in average AFP levels among racial groups in studies from the 1970s and 80s.
- These early findings influenced decades of prenatal screening practices, though the evidence showed variability across studies.
Reconsidering Race in Clinical Models
- Race is a social construct and using it in clinical models requires strong evidence due to its imprecision.
- A contemporary study found race associations disappear after adjusting for other factors, prompting reevaluation in specific populations.