http://www.nytimes.com/2012/06/20/health/paternity-blood-tests-that-work-early-in-a-pregnancy.html?pagewanted=2&src=recg
Before Birth, Dad’s ID
Steve Ruark for The New York Times
Dr. Ravinder Dhallan, founder of Ravgen, which has developed a noninvasive prenatal DNA paternity test.
By ANDREW POLLACK
Published: June 19, 2012 188 Comments
Enlarge This ImageIt is an uncomfortable question that, in today’s world, is often asked by expectant mothers who had more than one male partner at the time they became pregnant. Who is the father?
Steve Ruark for The New York Times
A Ravgen researcher at the company’s labs in Columbia, Md., last month. It charges $950 to $1,650 for its paternity test.
With more than half of births to women under 30 now out of wedlock, it is a question that may arise more often.
Now blood tests are becoming available that can determine paternity as early as the eighth or ninth week ofpregnancy, without an invasive procedure that could cause amiscarriage.
Besides relieving anxiety, the test results might allow women to terminate a pregnancy if the preferred man is not the father — or to continue it if he is.
Men who clearly know they are the father might be more willing to support the woman financially and emotionally during the pregnancy, which some studies suggest might lead to healthier babies.
And if the tests gain legal acceptance, some lawyers say, women and state governments might one day pursue child support payments without having to wait until the birth. Under current law, “until and unless the pregnancy produces a child, any costs associated with it are regarded as the woman’s personal problem,” said Shari Motro, a law professor at the University of Richmond.
The testing itself, however, can be awkward because it requires a blood sample from at least one of the possible fathers.
Courtney Herndon, after breaking up with her boyfriend, had a brief relationship with a man she regarded more as a friend. She found herself pregnant at age 19, without knowing which man was the father.
The friend also wanted to know, so he agreed to the testing. He turned out to be the father, and the two agreed on child support even before the baby was born.
“I got the test done and was able to go on with my life,” said Ms. Herndon, who lives in Fort Polk, La.
Estimates of the extent of paternal uncertainty vary.
Studies have found a discrepancy rate — when the presumed father is not the biological father — of anywhere from 0.8 percent to 30 percent, with the median being 3.7 percent, according to one review of such studies. Another study found that about 9 percent of birth certificates in Florida, even excluding births to teenage mothers, did not list the full names of the father, though it was not clear how much of this was related to uncertainty. Infant mortality was higher in those cases than if the father’s name was on the birth certificate.
It has already been possible to determine paternity during pregnancy using amniocentesis or chorionic villus sampling, the same medical procedures used to test a fetus for Down syndrome. But those procedures are invasive and carry a small risk of inducing a miscarriage, so they are rarely used for paternity testing.
By contrast, the new tests require only blood samples from the pregnant woman and the potential father. And doctors generally do not have to be involved.
That could vastly expand testing, said Sara Katsanis of Duke University’s Institute for Genome Sciences and Policy. She is planning a study with one of the testing companies to see if prenatal paternity testing can reduce a pregnant woman’s stress.
Some noninvasive paternity tests have been offered over the Internet for about a decade, and there have been various complaints about inaccurate or even fraudulent results.
But experts say the technology has advanced to the point that such testing can now be done reliably. A brief paper describing one such test, developed by a company called Ravgen, was published recently in the prestigious New England Journal of Medicine.
“I have no doubt that these tests will work clinically,” said Dr. Mark I. Evans, a professor at the Mount Sinai School of Medicine and director of Comprehensive Genetics, a medical practice in New York that specializes in prenatal testing.
The tests analyze fragments of DNA from the fetus that are present in the mother’s blood in tiny amounts. The same approach is now also being used to noninvasively determine the gender of the fetus or whether it has Down syndrome. And researchers recently demonstrated that they could even determine a fetus’s entire genome this way.
Ravgen, a small company in Columbia, Md., has been offering its test on a limited basis and charges $950 to $1,650, depending on the circumstances, said Dr. Ravinder Dhallan, the chief executive.
Another test was developed by a company in Silicon Valley called Natera, and is marketed by DNA Diagnostics Center, a leading provider of conventional paternity tests. Thousands of the prenatal tests have been ordered since going on sale last August, executives say. The price is $1,775, compared with around $500 for a conventional postbirth paternity test.
Neither test has received a certification for accuracy that is necessary for use in child custody cases, though Natera has applied. The certifying organization, the AABB, is seriously considering whether it should certify prenatal tests, said Eduardo Nunes, senior director for policy, standards and global development at the organization, formerly known as the American Association of Blood Banks.
Still, some experts urge caution. Natera has not yet published any data about its test in peer-reviewed journals. Ravgen’s paper in The New England Journal of Medicine discussed just 30 samples. (The test correctly distinguished the father from a randomly chosen man in all 30 cases.)
Steve Ruark for The New York Times
Xin Guo, a Ravgen reseacher. The company’s test was used in a murder investigation, though evidence was not introduced at trial.
The tests could generate controversy if they led to more abortions. However, Matthew Rabinowitz, chief executive of Natera, said that if a woman were intent on terminating a pregnancy based on paternity, she could still get an invasive test. And Dr. Dhallan of Ravgen said the test could persuade women who learned they were pregnant after a rape to keep the baby if they learned the rapist was not the father.
Ravgen’s test has been used in a murder case. In 2008, Michael Roseboro, a funeral home director in Lancaster County, Pa., was accused of killing his wife, Jan, whose body was found in the family swimming pool.
To establish a motive, prosecutors wanted to prove that Mr. Roseboro was having an affair with another woman, who was pregnant. But they did not want to wait until the baby was born.
“We became concerned that she might have an abortion, or something would happen and we’d never be able to determine whose child it was,” said Craig Stedman, the district attorney in Lancaster County.
The evidence from the prenatal test was not introduced at trial, however, because Mr. Roseboro eventually conceded that he was the father. Mr. Roseboro, who still proclaims his innocence in his wife’s death, was sentenced to life in prison.
It is possible that early testing could mean more paternal support for a pregnant woman.
One Seattle-area woman said that when she was pregnant, with two possible fathers, “Neither one really wanted to be involved and then find out the baby wasn’t theirs later.”
When the prenatal test showed that the father was her former boyfriend, he attended the delivery and supported the child. The woman spoke on the condition of anonymity, explaining, “I’m not proud of not knowing who my son’s father was.”
In some cases DNA is not destiny. Ms. Herndon’s test showed that the baby was not her ex-boyfriend’s. But they got back together and married, and he accepted the child, who is now 16 months old.
“We view our daughter as ours, mine and my husband’s,” Ms. Herndon said. The biological father sends gifts and pays child support.
