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Chen Y, Ning W, Shi Y, Chen Y, Zhang W, Li L, Wang X. Maternal prenatal screening programs that predict trisomy 21, trisomy 18, and neural tube defects in offspring. PLoS One 2023; 18:e0281201. [PMID: 36809370 PMCID: PMC9942960 DOI: 10.1371/journal.pone.0281201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/18/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE To determine the efficacy of three different maternal screening programs (first-trimester screening [FTS], individual second-trimester screening [ISTS], and first- and second-trimester combined screening [FSTCS]) in predicting offspring with trisomy 21, trisomy 18, and neural tube defects (NTDs). METHODS A retrospective cohort involving 108,118 pregnant women who received prenatal screening tests during the first (9-13+6 weeks) and second trimester (15-20+6 weeks) in Hangzhou, China from January-December 2019, as follows: FTS, 72,096; ISTS, 36,022; and FSTCS, 67,631 gravidas. RESULT The high and intermediate risk positivity rates for trisomy 21 screening with FSTCS (2.40% and 5.57%) were lower than ISTS (9.02% and 16.14%) and FTS (2.71% and 7.19%); there were statistically significant differences in the positivity rates among the screening programs (all P < 0.05). Detection of trisomy 21 was as follows: ISTS, 68.75%; FSTCS, 63.64%; and FTS, 48.57%. Detection of trisomy 18 was as follows; FTS and FSTCS, 66.67%; and ISTS, 60.00%. There were no statistical differences in the detection rates for trisomy 21 and 18 among the 3 screening programs (all P > 0.05). The positive predictive values (PPVs) for trisomy 21 and 18 were highest with FTS, while the false positive rate (FPR) was lowest with FSTCS. CONCLUSION FSTCS was superior to FTS and ISTS screening and substantially reduced the number of high risk pregnancies for trisomy 21 and 18; however, FSTCS was not significantly different in detecting fetal trisomy 21 and 18 and other confirmed cases with chromosomal abnormalities.
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Affiliation(s)
- Yiming Chen
- Department of Prenatal Diagnosis and Screening Center, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, Zhejiang
- Department of the Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang
- * E-mail:
| | - Wenwen Ning
- Department of the Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang
| | - Yezhen Shi
- Data Analysis Department, Zhejiang Biosan Biochemical Technologies Co, Ltd, Hangzhou, Zhejiang, China
| | - Yijie Chen
- Department of the Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang
| | - Wen Zhang
- Department of Prenatal Diagnosis and Screening Center, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, Zhejiang
| | - Liyao Li
- Department of Prenatal Diagnosis and Screening Center, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, Zhejiang
| | - Xiaoying Wang
- Department of Prenatal Diagnosis and Screening Center, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, Zhejiang
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Akbas M, Koyuncu FM, Bülbül Y, Artunc-Ulkumen B, Çetin A. The impact of invasive prenatal testing on anxiety and sleep quality in pregnant women with a screen-positive result for aneuploidy. J Psychosom Obstet Gynaecol 2021; 42:15-21. [PMID: 31899650 DOI: 10.1080/0167482x.2019.1708320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Prenatal anxiety has negative effects on pregnancy and neonate. Both screening tests and invasive diagnostic tests are associated with elevated anxiety level. But a normal fetal karyotype result could improve the anxiety level in high-risk patients. We hypothesized that patients who prefer follow-up without karyotyping may experience increased anxiety and sleep impairment until delivery. Our aim was to determine the effect of invasive diagnostic test decision on anxiety and sleep quality in women with a positive screening result. METHODS 132 women were included for the study and three groups were described. The invasive group consisted of women who underwent invasive procedure after a screen-positive test result, the follow-up group consisted of women who preferred non-invasive follow-up after a screen-positive result and the control group consisted of women with screen-negative test results. Participants were evaluated with the State-Trait Anxiety Inventory (STAI) and the Pittsburgh Sleep Quality Index (PSQI) after genetic counseling. They were asked for completing the same questionnaires in the third trimester to establish the course of anxiety and sleep quality throughout pregnancy. RESULTS STAI scores were significantly higher in both screen-positive groups than in the control group in the first evaluation (p < 0.001). STAI scores decreased in the invasive group and controls while PSQI scores did not significantly change during the course of the pregnancy. However, the anxiety level and sleep quality were worsened over time in the follow-up group. CONCLUSION Screen-positive women who preferred to follow up had higher anxiety level and worse sleep quality in the later stages of pregnancy. We concluded that invasive prenatal diagnostic tests could improve anxiety and sleep quality in pregnant women with a screen-positive result for aneuploidy.
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Affiliation(s)
- Murat Akbas
- Division of Perinatology, Department of Obstetrics and Gynecology, Manisa Celal Bayar University, Manisa, Turkey
| | - Faik Mumtaz Koyuncu
- Division of Perinatology, Department of Obstetrics and Gynecology, Manisa Celal Bayar University, Manisa, Turkey
| | - Yeşim Bülbül
- Division of Perinatology, Department of Obstetrics and Gynecology, Manisa Celal Bayar University, Manisa, Turkey
| | - Burcu Artunc-Ulkumen
- Division of Perinatology, Department of Obstetrics and Gynecology, Manisa Celal Bayar University, Manisa, Turkey
| | - Alptekin Çetin
- Department of Psychiatry, Uskudar University, NP Istanbul Hospital, Istanbul, Turkey
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Chitayat D, Langlois S, Wilson RD. No. 261-Prenatal Screening for Fetal Aneuploidy in Singleton Pregnancies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 39:e380-e394. [PMID: 28859781 DOI: 10.1016/j.jogc.2017.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To develop a Canadian consensus document on maternal screening for fetal aneuploidy (e.g., Down syndrome and trisomy 18) in singleton pregnancies. OPTIONS Pregnancy screening for fetal aneuploidy started in the mid 1960s, using maternal age as the screening test. New developments in maternal serum and ultrasound screening have made it possible to offer all pregnant patients a non-invasive screening test to assess their risk of having a fetus with aneuploidy to determine whether invasive prenatal diagnostic testing is necessary. This document reviews the options available for non-invasive screening and makes recommendations for Canadian patients and health care workers. OUTCOMES To offer non-invasive screening for fetal aneuploidy (trisomy 13, 18, 21) to all pregnant women. Invasive prenatal diagnosis would be offered to women who screen above a set risk cut-off level on non-invasive screening or to pregnant women whose personal, obstetrical, or family history places them at increased risk. Currently available non-invasive screening options include maternal age combined with one of the following: (1) first trimester screening (nuchal translucency, maternal age, and maternal serum biochemical markers), (2) second trimester serum screening (maternal age and maternal serum biochemical markers), or (3) 2-step integrated screening, which includes first and second trimester serum screening with or without nuchal translucency (integrated prenatal screen, serum integrated prenatal screening, contingent, and sequential). These options are reviewed, and recommendations are made. EVIDENCE Studies published between 1982 and 2009 were retrieved through searches of PubMed or Medline and CINAHL and the Cochrane Library, using appropriate controlled vocabulary and key words (aneuploidy, Down syndrome, trisomy, prenatal screening, genetic health risk, genetic health surveillance, prenatal diagnosis). Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. There were no language restrictions. Searches were updated on a regular basis and incorporated in the guideline to August 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment- related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The previous Society of Obstetricians and Gynaecologists of Canada guidelines regarding prenatal screening were also reviewed in developing this clinical practice guideline. VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS This guideline is intended to reduce the number of prenatal invasive procedures done when maternal age is the only indication. This will have the benefit of reducing the numbers of normal pregnancies lost because of complications of invasive procedures. Any screening test has an inherent false- positive rate, which may result in undue anxiety. It is not possible at this time to undertake a detailed cost-benefit analysis of the implementation of this guideline, since this would require health surveillance and research and health resources not presently available; however, these factors need to be evaluated in a prospective approach by provincial and territorial initiatives. RECOMMENDATIONS
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Archivée: No 261-Dépistage prénatal de l'aneuploïdie fœtale en ce qui concerne les grossesses monofœtales. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:e362-e379. [DOI: 10.1016/j.jogc.2017.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Screening for fetal aneuploidy in pregnant women using cell-free DNA has increased dramatically since the technology became commercially available in 2011. Since that time, numerous trials have demonstrated high sensitivity and specificity to screen for common aneuploidies in high-risk populations. Studies assessing the performance of these tests in low-risk populations have also demonstrated improved detection rates compared with traditional, serum-based screening strategies. Concurrent with the increased use of this technology has been a decrease in invasive procedures (amniocentesis and chorionic villus sampling). As the technology becomes more widely understood, available, and utilized, challenges regarding its clinical implementation have become apparent. Some of these challenges include test failures, false-positive and false-negative results, limitations in positive predictive value in low-prevalence populations, and potential maternal health implications of abnormal results. In addition, commercial laboratories are expanding screening beyond common aneuploidies to include microdeletion screening and whole genome screening. This review article is intended to provide the practicing obstetrician with a summary of the complexities of cell-free DNA screening and the challenges of implementing it in the clinical setting.
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Abstract
Cell-free fetal DNA (cffDNA) is a highly accurate screening test for major aneuploidies. Despite high detection rates and low false-positive rates compared to current screening methods, cffDNA testing is approved for use in only the high-risk population and is expensive for low-risk women because of a lack of insurance coverage. As the technology improves and research demonstrates the efficacy of cffDNA testing in the general population, insurance coverage of this test likely will be extended to all women. At that time, cffDNA testing in most cases will replace current screening methods. Furthermore, cffDNA testing may become a routine diagnostic test, effectively rendering most invasive diagnostic procedures obsolete.
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Guía de práctica clínica: Diagnóstico prenatal de los defectos congénitos. Cribado de anomalías cromosómicas. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.diapre.2012.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Currier R, Wu N, Van Meter K, Goldman S, Lorey F, Flessel M. Integrated and first trimester prenatal screening in California: program implementation and patient choice for follow-up services. Prenat Diagn 2012; 32:1077-83. [PMID: 22903386 DOI: 10.1002/pd.3961] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 07/17/2012] [Accepted: 07/17/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The California Prenatal Screening Program serves over 350,000 women annually. This study examines utilization rates for the various screening options and patient choices regarding follow-up services. METHODS The study tracked patients with first trimester positive results for Down syndrome to examine patient decisions regarding follow-up services and/or additional screening and to identify determinants of patient decisions. For first trimester screen positive women who elected further screening, second trimester integrated screening results were analyzed. The Genetic Disease Screening Program Chromosome Registry was used to identify Down syndrome cases. RESULTS Ethnicity, but not age, was a strong predictor of acceptance of prenatal diagnosis. Approximately 47% of first trimester screen positive women opted for further screening. Among these women, 46% percent received an integrated screen negative result. All but one confirmed Down syndrome case in this cohort were still screen positive. CONCLUSIONS Data from the California Prenatal Screening Program indicate that all of the major screening modalities continue to be utilized. The wide range of choices made by women with screen positive results demonstrate the importance of including multiple options within the Program. Providing integrated screening to first trimester Down syndrome screen positive women reduced the number of unnecessary invasive procedures.
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Affiliation(s)
- Robert Currier
- California Department of Public Health, Genetic Disease Screening Program, Richmond, CA, USA.
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DNA sequencing of maternal plasma reliably identifies trisomy 18 and trisomy 13 as well as Down syndrome: an international collaborative study. Genet Med 2012; 14:296-305. [PMID: 22281937 PMCID: PMC3938175 DOI: 10.1038/gim.2011.73] [Citation(s) in RCA: 367] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose: To determine whether maternal plasma cell–free DNA sequencing can effectively
identify trisomy 18 and 13. Methods: Sixty-two pregnancies with trisomy 18 and 12 with trisomy 13 were selected from a
cohort of 4,664 pregnancies along with matched euploid controls (including 212
additional Down syndrome and matched controls already reported), and their samples
tested using a laboratory-developed, next-generation sequencing test. Interpretation of
the results for chromosome 18 and 13 included adjustment for CG content bias. Results: Among the 99.1% of samples interpreted (1,971/1,988), observed trisomy 18 and 13
detection rates were 100% (59/59) and 91.7% (11/12) at false-positive rates of 0.28% and
0.97%, respectively. Among the 17 samples without an interpretation, three were trisomy
18. If z-score cutoffs for trisomy 18 and 13 were raised slightly, the overall
false-positive rates for the three aneuploidies could be as low as 0.1% (2/1,688) at an
overall detection rate of 98.9% (280/283) for common aneuploidies. An independent
academic laboratory confirmed performance in a subset. Conclusion: Among high-risk pregnancies, sequencing circulating cell–free DNA detects nearly
all cases of Down syndrome, trisomy 18, and trisomy 13, at a low false-positive rate.
This can potentially reduce invasive diagnostic procedures and related fetal losses by
95%. Evidence supports clinical testing for these aneuploidies.
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Chitayat D, Langlois S, Douglas Wilson R. Prenatal screening for fetal aneuploidy in singleton pregnancies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 33:736-750. [PMID: 21749752 DOI: 10.1016/s1701-2163(16)34961-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To develop a Canadian consensus document on maternal screening for fetal aneuploidy (e.g., Down syndrome and trisomy 18) in singleton pregnancies. OPTIONS Pregnancy screening for fetal aneuploidy started in the mid 1960s, using maternal age as the screening test. New developments in maternal serum and ultrasound screening have made it possible to offer all pregnant patients a non-invasive screening test to assess their risk of having a fetus with aneuploidy to determine whether invasive prenatal diagnostic testing is necessary. This document reviews the options available for non-invasive screening and makes recommendations for Canadian patients and health care workers. OUTCOMES To offer non-invasive screening for fetal aneuploidy (trisomy 13, 18, 21) to all pregnant women. Invasive prenatal diagnosis would be offered to women who screen above a set risk cut-off level on non-invasive screening or to pregnant women whose personal, obstetrical, or family history places them at increased risk. Currently available non-invasive screening options include maternal age combined with one of the following: (1) first trimester screening (nuchal translucency, maternal age, and maternal serum biochemical markers), (2) second trimester serum screening (maternal age and maternal serum biochemical markers), or (3) 2-step integrated screening, which includes first and second trimester serum screening with or without nuchal translucency (integrated prenatal screen, serum integrated prenatal screening, contingent, and sequential). These options are reviewed, and recommendations are made. EVIDENCE Studies published between 1982 and 2009 were retrieved through searches of PubMed or Medline and CINAHL and the Cochrane Library, using appropriate controlled vocabulary and key words (aneuploidy, Down syndrome, trisomy, prenatal screening, genetic health risk, genetic health surveillance, prenatal diagnosis). Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. There were no language restrictions. Searches were updated on a regular basis and incorporated in the guideline to August 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The previous Society of Obstetricians and Gynaecologists of Canada guidelines regarding prenatal screening were also reviewed in developing this clinical practice guideline. VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS This guideline is intended to reduce the number of prenatal invasive procedures done when maternal age is the only indication. This will have the benefit of reducing the numbers of normal pregnancies lost because of complications of invasive procedures. Any screening test has an inherent false-positive rate, which may result in undue anxiety. It is not possible at this time to undertake a detailed cost-benefit analysis of the implementation of this guideline, since this would require health surveillance and research and health resources not presently available; however, these factors need to be evaluated in a prospective approach by provincial and territorial initiatives. RECOMMENDATIONS 1. All pregnant women in Canada, regardless of age, should be offered, through an informed counselling process, the option of a prenatal screening test for the most common clinically significant fetal aneuploidies in addition to a second trimester ultrasound for dating, assessment of fetal anatomy, and detection of multiples. (I-A) 2. Counselling must be non-directive and must respect a woman's right to accept or decline any or all of the testing or options offered at any point in the process. (III-A) 3. Maternal age alone is a poor minimum standard for prenatal screening for aneuploidy, and it should not be used a basis for recommending invasive testing when non-invasive prenatal screening for aneuploidy is available. (II-2A) 4. Invasive prenatal diagnosis for cytogenetic analysis should not be performed without multiple marker screening results except for women who are at increased risk of fetal aneuploidy (a) because of ultrasound findings, (b) because the pregnancy was conceived by in vitro fertilization with intracytoplasmic sperm injection, or (c) because the woman or her partner has a history of a previous child or fetus with a chromosomal abnormality or is a carrier of a chromosome rearrangement that increases the risk of having a fetus with a chromosomal abnormality. (II-2E) 5. At minimum, any prenatal screen offered to Canadian women who present for care in the first trimester should have a detection rate of 75% with no more than a 3% false-positive rate. The performance of the screen should be substantiated by annual audit. (III-B) 6. The minimum standard for women presenting in the second trimester should be a screen that has a detection rate of 75% with no more than a 5% false-positive rate. The performance of the screen should be substantiated by annual audit. (III-B) 7. First trimester nuchal translucency should be interpreted for risk assessment only when measured by sonographers or sonologists trained and accredited for this service and when there is ongoing quality assurance (II-2A), and it should not be offered as a screen without biochemical markers in singleton pregnancies. (I-E) 8. Evaluation of the fetal nasal bone in the first trimester should not be incorporated as a screen unless it is performed by sonographers or sonologists trained and accredited for this service and there is ongoing quality assurance. (II-2E) 9. For women who undertake first trimester screening, second trimester serum alpha fetoprotein screening and/or ultrasound examination is recommended to screen for open neural tube defects. (II-1A) 10. Timely referral and access is critical for women and should be facilitated to ensure women are able to undergo the type of screening test they have chosen as first trimester screening. The first steps of integrated screening (with or without nuchal translucency), contingent, or sequential screening are performed in an early and relatively narrow time window. (II-1A) 11. Ultrasound dating should be performed if menstrual or conception dating is unreliable. For any abnormal serum screen calculated on the basis of menstrual dating, an ultrasound should be done to confirm gestational age. (II-1A) 12. The presence or absence of soft markers or anomalies in the 18- to 20-week ultrasound can be used to modify the a priori risk of aneuploidy established by age or prior screening. (II-2B) 13. Information such as gestational dating, maternal weight, ethnicity, insulin-dependent diabetes mellitus, and use of assisted reproduction technologies should be provided to the laboratory to improve accuracy of testing. (II-2A) 14. Health care providers should be aware of the screening modalities available in their province or territory. (III-B) 15. A reliable system needs to be in place ensuring timely reporting of results. (III-C) 16. Screening programs should be implemented with resources that support audited screening and diagnostic laboratory services, ultrasound, genetic counselling services, patient and health care provider education, and high quality diagnostic testing, as well as resources for administration, annual clinical audit, and data management. In addition, there must be the flexibility and funding to adjust the program to new technology and protocols. (II-3B).
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Guanciali-Franchi P, Iezzi I, Palka C, Matarrelli B, Morizio E, Calabrese G, Benn P. Comparison of combined, stepwise sequential, contingent, and integrated screening in 7292 high-risk pregnant women. Prenat Diagn 2011; 31:1077-81. [PMID: 21800336 DOI: 10.1002/pd.2836] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 06/22/2011] [Accepted: 06/24/2011] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare the efficacy of combined, stepwise sequential, and contingent screening versus the integrated test in detecting fetal aneuploidies. STUDY DESIGN First trimester combined test, sequential second trimester, and contingent risks were retrospectively calculated for 7292 unselected pregnant women with singleton pregnancies who had received integrated screening. The first trimester testing was based on nuchal translucency, pregnancy-associated plasma protein-A, and free-beta-human chorionic gonadotrophin (free β-hCG) and the second trimester tests were alpha-fetoprotein, hCG, and unconjugated estriol. A second trimester risk of 1:250 defined a positive result for all protocols with the contingent protocol based on additional second trimester testing for those with risks between 1:30 and 1:1200. RESULTS Among the population submitted for the integrated test, the detection rate was 19/21 (90%) for Down syndrome (DS) and 6/6 (100%) for Edwards syndrome (ES) and the DS false-positive rate (FPR) was 247/7271 (3.4%). Provision of the first trimester combined test alone would have resulted in a 17/21 (81%) detection rate for DS, that of 4/6 (67%) for ES and a DS FPR of 292/7271 (4.0%). The sequential and contingent approaches had the same final detection rates as the integrated test but potentially allowed a high proportion of the affected pregnancies to be detected in the first trimester. The lowest net DS FPR was seen with the contingent approach (2.6%) and using this protocol only 12.7% of women would have required second trimester testing. CONCLUSIONS Integrated, sequential, and contingent screenings are all more efficacious than the combined test. Overall, the contingent approach was the most efficient with a high-detection rate, the lowest FPR, and the least amount of testing.
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Maski M, Rana S, Karumanchi SA. Biomarkers in Obstetric Medicine. Biomarkers 2010. [DOI: 10.1002/9780470918562.ch13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Current Methods of Prenatal Screening for Down Syndrome and Other Fetal Abnormalities. Clin Obstet Gynecol 2008; 51:24-36. [DOI: 10.1097/grf.0b013e318160f274] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Benn PA, Campbell WA, Zelop CM, Ingardia C, Egan JFX. Stepwise sequential screening for fetal aneuploidy. Am J Obstet Gynecol 2007; 197:312.e1-5. [PMID: 17826434 DOI: 10.1016/j.ajog.2007.06.054] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Revised: 05/01/2007] [Accepted: 06/28/2007] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate stepwise sequential screening for fetal aneuploidy. STUDY DESIGN Women who received first-trimester screening were also offered second-trimester tests with second-trimester risks that were based on both sets of markers. Screen-positive rates, use of second-trimester testing and invasive testing, sensitivity, and changes in risks were evaluated. RESULTS Of 1528 women who received first-trimester screening, 133 women (8.7%) had an indication for invasive testing that was based on first-trimester results alone; 1173 women (76.8%) received second-trimester tests, which reduced the net number of women with an indication for invasive testing to 105 (6.9%). In unaffected pregnancies, the addition of the second-trimester testing reduced the median Down syndrome risk from 1:2368 to 1:10,301. Six of 10 chromosome abnormalities (60%) were identified by first-trimester screening, and 9 of 10 chromosome abnormalities (90%) were identified by sequential screening. CONCLUSION Sequential screening can be introduced successfully into clinical practice, is effective, and can reduce the number of invasive tests that are performed.
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Affiliation(s)
- Peter A Benn
- Division of Human Genetics, Department of Genetics and Developmental Biology, University of Connecticut Health Center, Farmington, CT, USA
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Summers AM, Langlois S, Wyatt P, Douglas Wilson R. Prenatal Screening for Fetal Aneuploidy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2007; 29:146-161. [PMID: 17346485 DOI: 10.1016/s1701-2163(16)32379-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.
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Bianchi DW. Will epigenetic allelic ratio analysis turn prenatal diagnosis of trisomy 18 on its EAR? Clin Chem 2006; 52:2182-3. [PMID: 17138850 DOI: 10.1373/clinchem.2006.079129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Maymon R, Sharony R, Grinshpun-Cohen J, Itzhaky D, Herman A, Reish O. The best marker combination using the integrated screening test approach for detecting various chromosomal aneuploidies. J Perinat Med 2005; 33:392-8. [PMID: 16238533 DOI: 10.1515/jpm.2005.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To evaluate the cross-trimester multiple marker correlation and the minimum marker combination needed for detecting various chromosomal aneuploidies. MATERIALS AND METHODS Parturient women with singleton pregnancies who underwent non-interventional sequential screening test and followed prospectively were recruited. They all underwent first trimester combined nuchal translucency (NT), pregnancy-associated plasma protein-A (PAPP-A), and free beta-human chorionic gonadotrophin (f-betahCG), followed by second trimester measurement of unconjugated estriol (uE3), human chorionic gonadotrophin (hCG) and alpha-fetoprotein (AFP). Pearson correlation was applied to compute any cross-trimester marker correlation and logistic regression analysis was used to determine the minimum marker combination for detecting various categories of chromosomal aneuploidies. RESULTS The current study included 552 normal and 43 chromosomal-affected pregnancies (24 Down's syndrome [DS], 7 Turner's syndrome, 8 Edward's syndrome, 4 Klinefelter syndrome and 5 triploidy) for which the results of both the screening tests and the pregnancy outcome were available. In the normal cases, a significant correlation was found between f-betahCG and hCG (r=0.52), as well as between PAPP-A and uE3 (r=0.174). In DS pregnancies, the NT correlated with both hCG (r=0.45) and uE3 (r=-0.39). In Turner's syndrome, uE3 correlated both with PAPP-A (r=0.97) and f-betahCG (r=0.97). No other significant correlations were found. Furthermore, with the exception of f-betahCG and hCG in the unaffected cases, all other markers correlation appeared very weak. For detecting all the above categories of aneuploidies, the combination of NT, PAPP-A and uE3 and the maternal age background risk were found adequate, with a 74% detection rate (DR) for a 5% false positive rate (FPR). For DS only, the combination of maternal age-related background risk and the combination of NT, PAPP-A, hCG and AFP yielded a 79% DR for a 5% FPR. CONCLUSIONS The current study agrees with a previous report that, overall, there is no strong correlation between first and second trimester markers. The extension of the integrated test for detecting various categories of common chromosomal aneuploidies using NT, PAPP-A and uE3 deserves further evaluation.
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Affiliation(s)
- Ron Maymon
- Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Israel.
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Abstract
This article provides clinicians with an overview of current methods for prenatal genetic screening and diagnosis. Topics include developments in prenatal screening procedures such as ethnicity-based carrier testing, maternal serum screening, and ultrasonography. Diagnostic alternatives to amniocentesis include chorionic villus sampling and preimplantation diagnosis. Future endeavors such as three-dimensional ultrasonography and fetal cell sorting are discussed.
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Affiliation(s)
- Jennifer A Bubb
- Center for Human Genetics, University Hospitals of Cleveland, 11100 Euclid Avenue, LKS 1500, Cleveland, OH 44106, USA.
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Current awareness in prenatal diagnosis. Prenat Diagn 2003; 23:435-41. [PMID: 12778892 DOI: 10.1002/pd.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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