Offer CF carrier screening to all high-risk couples: discuss testing during preconceptional counseling or at the first prenatal visit. (New ACOG Recommendations).

Physicians seeing patients for preconception or prenatal counseling should now be advising them about cystic fibrosis carrier screening, according to the American College of Obstetricians and Gynecologists.

Recommendations released by ACOG in September advise that screening should be offered to all white and other high-risk couples, preferably before pregnancy or at least at the first prenatal visit.

"Physicians are going to have to educate themselves because some of this information is either new or complex, and they will have to find a way to incorporate this into their routine visits," said Dr. Michael Mennuti, ACOG secretary and professor of ob.gyn., human genetics, and pediatrics at the University of Pennsylvania, Philadelphia.

Until now, ACOG has recommended offering cystic fibrosis (CF) carrier screening to couples only if one partner has the disease or a family history of CF. Under the new guidelines, these groups should continue to be offered screening.

The ACOG guidelines come 4 years after a 1997 National Institutes of Health consensus statement recommending that all couples who are planning a pregnancy or seeking prenatal care be screened for CF--a time lag that concerns Dr. Aubrey Milunsky, professor of human genetics, pediatrics, and ob.gyn. and director of the Center for Human Genetics at Boston University.

"This test represents simply one of an increasing number of available tests that are useful to the preconception patient, and it's taking a long time for organizations like ACOG to come out with position papers, which secure the health and welfare of patients at large. This is a major concern," he said.

ACOG's guidelines refine the NIH recommendations by making a distinction between different ethnicities. "The incidence of CF carriers varies between ethnic groups with the most common incidence, roughly 1 in 25, among Caucasians and a much lower incidence in African Americans, Hispanics, and Asians," Dr. Mennuti said.