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Perinatal stroke in baby, prothrombotic gene in mom

Does this affect maternal health insurance?

From the Division of Pediatric Neurology, Department of Neurology (Drs. Golomb, Garg, and Walsh), Department of Neurology (Dr. Williams), Department of Medical Genetics (Dr. Walsh), Roudebush VAMC HSR&D (Dr. Williams), and Regenstrief Institute (Dr. Williams), Indiana University School of Medicine, Indianapolis.

Address correspondence and reprint requests to Dr. Meredith R. Golomb, Indiana University School of Medicine, Building XE, Room 040-K, 575 West Drive, Indianapolis, IN 46202; e-mail: mgolomb{at}iupui.edu

Background: Maternal prothrombotic disorders may contribute to stroke in the fetus before and during birth. Many of the mothers of children with perinatal stroke have no previous history of pathologic thrombosis.

Objective: To determine if finding the Factor V Leiden mutation, prothrombin 20210 G-A gene defect, or methylene tetrahydrofolate reductase C677T mutation in an asymptomatic mother of a child with perinatal stroke would affect that mother's ability to obtain health insurance.

Methods: 1) The authors reviewed the literature on genetic prothrombotic risk factors and health insurance. 2) The authors surveyed the 17 largest insurance carriers in Indiana to find if diagnosing genetic prothrombotic risk factors in asymptomatic mothers of children with perinatal stroke would affect the mothers' health insurance status.

Results: Three articles on genetic prothrombotic risk factors and insurance were identified. Twelve of 17 insurance companies responded to our survey; three had policies on genetic testing. Most companies refused to provide clear, useful information on their policies regarding these risk factors.

Conclusions: The authors are currently unable to counsel their patients' families on the long-term insurance implications of screening for genetic prothrombotic risk factors. The insurance implications of diagnosing healthy women with genetic prothrombotic risk factors need further study.

Supported by NIH NINDS grant K23 NS048024-01 and Clarian Values Grant #VFR-171 (M.R.G.) and NINDS R01 NS 39571 and a VA Health Services Research and Development Career Award (L.S.W.).

Received November 30, 2004. Accepted in final form February 26, 2005.

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				E. S. Roach, M. R. Golomb, R. Adams, J. Biller, S. Daniels, G. deVeber, D. Ferriero, B. V. Jones, F. J. Kirkham, R. M. Scott, et al. Management of Stroke in Infants and Children: A Scientific Statement From a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young Stroke, September 1, 2008; 39(9): 2644 - 2691. [Abstract] [Full Text] [PDF]

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