CHAPTER 1
Introduction
Questions are scattered throughout this chapter and the following chapters. Watch for them and think about how they may apply to you and other ones.
Genetic disease is caused by a number of things. Before we knew about cancer being caused partially by environmental factors, we thought many things caused cancer. Genes in cancer cell cause them to multiply many times over forming a tumor. How do these genes change to cause cells to divide uncontrollably?
Mutations are changes in the DNA that can alter the proteins it codes for and, therefore, cause disease depending on what gene is active. Once the gene is located, the normal sequences can be disrupted in a number of ways (see Table 1.1).
Reproductive cells have Ā½ the number of chromosomes. And are made by the ovaries and testes and undergo a process called meiosis leaving the sperm and egg with Ā½ number of chromosomes (23). When fertilization occurs the nucleus of the egg and the head of the sperm create a body cell with 46 chromosomes.
Table 1.1 What changes DNA
At meiosis |
During meiosis the chromosomes can break
By external change
Free radicals attach to the DNA (epigenetics)
External exposure when in the mother uterus
Disrupting the sequences that turn the gene on or off Inherit a mutation from a parent |
Outside influences |
As we all know things that mother injests or breathes in can be harmful to the fetus |
When genes are turned on and off |
Epigenetics examines what happens within the mother between conception and birth.
Free radicals can make changes by holding the DNA |
If, however, a mutation occurred or a mistake in meiosis happens, that it would be passed on to future generations.
Most inherited conditions are placed into one of three categories according to how the mechanism of the inheritance of the specific gene works. They are dominant, recessive, and sex-linked traits. See Table 1.2.
Table 1.2 Three examples of inheritance type
Huntington |
Dominant |
A child with a parent with HD has a 50% chance of inheriting the gene and therefore the condition |
Sickle cell anemia |
Recessive |
If both parents have the gene, there is a 25% chance that the fetus will get both |
Color blindness |
Sex linked |
The gene for color blindness is on the X chromosome and two genes are needed to show the condition, a male can only have one (and therefore has normal vision) |
CHAPTER 2
Prenatal Testing
Major case: After a few months, X and Y become pregnant and they want to know more about their growing fetus. Not just the sex of their baby, quite a bit more of other information. Certain tests are recommended and a genetic counselor may work with the family.
Not so many years ago, when a woman got pregnant she could only guess the sex of her fetus and it was a real surprise to find out on the delivery table.
The first view into the uterus came with the invention of ultrasound. It was modeled after Sonar that was used to identify submarines while they were submerged. This makes sense if we remember the fetus is immersed in amniotic fluid. Without any harm to the fetus or mother, sound waves show a picture in a monitor. The figure below (Figure 2.1) shows a normal fetus at 18 weeks.
Figure 2.1 Drawing of fetus in uterus
(1) placenta; (2) umbilcal cord; (3) amniotic fluid; (4) uterus
At first only the sex, head size, and growth of arms and legs were discernable. Later when the ultrasounds became more sensitive, the heart, lungs, and other internal organs could be seen.
If you are wondering how ultrasound (sonogram) works, it is fairly simple. Sound waves are sent through the motherās abdomen which includes the uterus and the fetus, and surrounding tissue. Then electronic waves are sent back to a screen and a good picture can be seen by the mother and physician.
A number of things can be diagnosed by ultrasound before the fetus is delivered. The obvious would be heart malfunctions (you can see the tiny heart beat), brain size, size of arms and legs, and other physical abnormalities.
Here is where problems can occur. Many ultrasounds are read by doctors with no training in this field. As you can see (Figure 2.2) much of the negative is blurry and difficult to read. Also, if abnormalities are found, the doctor is required to tell the woman what they are and discuss options. At this point it is necessary to clearly explain problems and solutions.
Figure 2.2 Ultrasound of fetusās head
This ultrasound is taken from the top of the skull. The bright white circle is the skull. This type of view is used to determine if the brain is growing correctly
Note: This an ultrasound.
This situation involves one of the most difficult decisions a mother can make. Obviously one option is abortion, and another is to keep the baby and raise it or put the child up for adoption. It would depend on what the mother would want (see Roe v. Wade in Chapter 8).
I am not forgetting the fatherās opinion, but in almost all of the states, laws give a pregnant woman, no matter what her age, the ability to make her own medical decisions. The rationale is that the fetus is in her body and therefore part of it.
In addition, some problems found in ultrasounds can be treated while the fetus is still in the uterus and some surgical procedures can correct spina bifida, hydrocephalus, and others. We have ...