Prenatal therapy

Today, thanks to improved diagnostic procedures and progress in surgery, therapies on the as yet unborn child can even be performed.
The following possibilities are available:

• Fetal surgery
• Prophylaxy
• Gene therapy
• Medical therapy

Fetal surgery

Surgical interventions can today be undertaken so that severe damage to organ systems can be prevented. An example is the removal of urethral folds that hinder the outflow of fetal urine in the fetus. Without therapy the kidneys would be irreversibly damaged due to the reflux of the urine.

Prophylaxy

Today one knows the interrelationship between neural tube defects and folic acid deficiency. In order to prevent such malformations (e.g., spina bifida, etc.) expectant mothers are recommended to take in sufficient amount of folic acid right at the beginning of the pregnancy. This is best done with a multi-vitamin preparation designed for the needs of pregnancy. Expectant mothers should also be instructed about the damaging consequences of nicotine and alcohol during pregnancy.

Gene therapy

In recent years, attempts have been made to correct functional flaws caused by defective genes by introducing healthy ones. The goal of this therapy is to substitute the defective gene in its function or to supplement the function of a missing gene through introducing normal ones. In order to insert such genes one employs either adeno- or retroviruses as vectors. Such therapy attempts are primarily performed where children without therapy have minimal life expectation such as in the rare severe combined immunodeficiency syndrome (SCID).

In order to introduce the missing gene that contains the information for producing adenosine deaminase (ADA), fetal stem cells are obtained from the fetal bone marrow and contaminated with retroviruses that possess the normal gene for ADA. Afterwards, this is injected into the fetal blood. With this therapy one hopes that the stem cells take up the normal production of ADA afterwards.

Medical therapy

With improved prenatal diagnosis procedures, maternal infections can be detected more rapidly and the resulting damage to the embryo/fetus can thus be minimized through therapy.
Examples of such infections are toxoplasmosis or syphilis. In cases of fetal hypothyroidism, thyroid hormones are also injected into the amniotic cavity in order to reduce the fatal consequences of this disorder.