“Our goal is to help improve our patients’ health by promoting family history as a screening tool,” said W. Allen Hogge, MD, chair of The College’s Committee on Genetics. Certain diseases and conditions run in families, such as breast and colon cancer, heart disease, type 2 diabetes, depression, and thrombophilias (blood clotting conditions). “If we know about the family history, then we can better help our patients identify their own risk factors, decide on certain screenings, and modify their lifestyle to prevent or minimize the problem.
“When a woman is planning a pregnancy, it’s an ideal time to review her family history as well as her partner’s,” said Dr. Hogge. In addition to obtaining the family and medical history of the woman and her male partner, it’s also important to include their ethnic backgrounds, any family or personal negative pregnancy outcomes they’ve had separately or together, such as miscarriages, preterm birth, or birth defects, and any known causes for infertility. Some couples may decide against pregnancy after genetic counseling and testing, choose to use donor sperm or eggs, or opt for preimplantation genetic testing of the embryos.
There are a couple of standard methods that physicians can use to obtain family health histories: a questionnaire or checklist, and a family pedigree. A common screening tool is the family history questionnaire. Patients can fill them out at home which gives them extra time to contact family members and provide more accurate information. The other family history tool is known as a ‘pedigree’ that ideally goes back three generations. The pedigree indicates the ages, health histories, and ethnicities of each family member, as well as dates and causes of death. Of course, family history screening tools can be difficult or impossible to obtain for adopted individuals and their usefulness may be limited for people with very small families.
Although many adult-onset health problems have complex genetic and environmental interactions, obtaining that information in a family history can help patients modify their diet, lose weight, or exercise to improve their outcome or delay the onset of symptoms. “For instance, if you are at high risk for developing heart disease, then you need to watch your blood pressure and keep your cholesterol levels in the healthy range,” said Dr. Hogge.
Committee Opinion #478, “Family History as a Risk Assessment Tool,” is published in the March 2011 issue of Obstetrics & Gynecology.
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The American College of Obstetricians and Gynecologists (www.acog.org) is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 55,000 members, The American College of Obstetricians and Gynecologists strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. Follow us on Twitter at www.twitter.com/acognews.