Case of The Pregnant Teenager with a Genetic Problem

Case of The Pregnant Teenager with a Genetic Problem

Melinda Eades was a 14-year-old adolescent diagnosed at an outpatient neurology clinic with the gene for neurofibromatosis-type 2 (NF2), an autosomal-dominant disorder that causes nervous system tumors that usually demonstrate symptoms during the late-teen years or early 20’s. At the time of diagnosis, genetic counseling was recommended to Melinda’s mother because any children born to Melinda would have a 50% chance of also carrying the NF2 gene. Melinda was quite upset about the genetic testing results and did not seem to comprehend the information, so Mrs. Eades decided to wait a few weeks before making the appointment with the genetic counselor to discuss future issues, such as childbearing decisions, with Melinda. There was no reason to believe that Melinda was sexually active, so it was agreed that Mrs. Eades would contact the clinic for genetic counseling in a month or so. Case of The Pregnant Teenager with a Genetic Problem


Before this appointment was made, however, Melinda went to an OB/GYN clinic on her own for problems with menstruation. Testing revealed that she was approximately 7 weeks pregnant. She was counseled by the clinic nurse about abortions options and was advised to discuss her pregnancy with her parents. When Melinda mentioned that she was recently identified as having the gene for a genetic disorder, the clinic nurse recommended that she return to the neurology clinic for follow up and counseling. Melinda did not seem to understand that her disease was genetically transmissible to her offspring.

After several days of agonizing over her pregnancy, Melinda told her mother. Mrs. Eades was very upset with Melinda and immediately decided that Melinda should have an abortion. When Melinda seemed uncertain whether she wanted to abort the pregnancy, Mrs. Eades told her that any of her offspring would have a 50% chance of having NF2. Melinda was surprised by this information but was still uncertain what she should do. She also wondered why she had not been informed of this earlier.

When Melinda showed up for her appointment at the neurology clinic, she was very confused. She asked Jane Goldstein, the nurse practitioner she previously saw in the clinic, why someone did not tell her that she needed to be careful about becoming pregnant. When she realized that her mother had decided to withhold this information from her for a period of time, Melinda became angry. Case of The Pregnant Teenager with a Genetic Problem

1. Did Melinda have the right to this information, even though she was a minor? Also, why had the nurse conveyed this information to her mother and not to her? Could her mother control her in that manner, even to the point of forcing her to have an abortion, a course of action that Melinda would not likely choose under other circumstances?

2. How should Ms. Golstein proceed with this situation? Given Melinda’s anger and confusion about her situation, what actions should Ms. Goldstein take to provide Melinda with the information she needs to make important choices about her pregnancy. Case of The Pregnant Teenager with a Genetic Problem


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