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Claudel N, Anselem O, Buron-Fouque C, Khattabi LE, Laguillier-Morizot C, Jordan P, Tsatsaris V, Guibourdenche J, Athiel Y. Usefulness of early morphological ultrasound in association with cell-free DNA testing in case of atypical serum markers in first trimester of pregnancy: A retrospective study over 5 years. J Gynecol Obstet Hum Reprod 2024; 53:102745. [PMID: 38367703 DOI: 10.1016/j.jogoh.2024.102745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Early morphologic ultrasound, generally carried out in case of atypical first trimester serum markers (PAPP-A and/or free hCGβ <0.30 MoM), has not been re-evaluated since the possibility of performing a cell-free fetal DNA analysis in this indication. Our objective was to evaluate the usefulness of early morphological ultrasound in case of atypical profile of serum markers performed in association with Non-Invasive Prenatal Testing (NIPT). METHODS This was a single-center retrospective study in a tertiary maternity. Between January 2017 and December 2021, women with an atypical first trimester serum markers and low/intermediate risk for trisomy 21 (<1/50) were included. The clinical data, results of first trimester serum markers, NIPT, early morphological ultrasound and subsequent ultrasounds and other investigations (amniocentesis, pregnancy outcomes) were analyzed. RESULTS After exclusion of women with high-risk of trisomy 21 and lost to follow-up, 163 women were included. In 72 % of cases (117/163), women had a low risk of trisomy 21, and 39 % (59/163) had an early morphological ultrasound. Early morphological ultrasound was useful to detect severe IUGR leading to the suspicion of triploidy (3/163, 1.8 %). In all other situations, it did not allow earlier management. After analysis of the 3 triploidy cases, a collapsed profile for both serum markers was demonstrated (<0.25 MoM). CONCLUSIONS Systematic early morphological ultrasound in case of an atypical serum marker profile seems useless considering the performance of NIPT. An ultrasound restricted to women with both markers below 0.25 MoM would allow the early detection of triploidy.
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Affiliation(s)
- Noémie Claudel
- Maternité Port-Royal, Groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, 75014, France
| | - Olivia Anselem
- Maternité Port-Royal, Groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, 75014, France; Université Paris Cité, Paris, France
| | - Charlotte Buron-Fouque
- Maternité Port-Royal, Groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, 75014, France
| | - Laila El Khattabi
- NIPT plateform, Department of Cytogenetics, AP-HP, Hôpital Cochin, Paris, France
| | | | - Pénélope Jordan
- NIPT plateform, Department of Cytogenetics, AP-HP, Hôpital Cochin, Paris, France
| | - Vassilis Tsatsaris
- Maternité Port-Royal, Groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, 75014, France; Université Paris Cité, Paris, France
| | - Jean Guibourdenche
- Université Paris Cité, Paris, France; Department of Hormonology, Hôpital Cochin, AP-HP, Paris, France
| | - Yoann Athiel
- Maternité Port-Royal, Groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, 75014, France; Université Paris Cité, Paris, France.
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Hajri T, Massoud M, Vergne M, Descargues P, Allias F, You B, Lotz JP, Haesebaert J, Bolze PA, Golfier F, Massardier J. Multiple pregnancy with complete hydatidiform mole and coexisting normal fetus in a retrospective cohort of 141 patients. Am J Obstet Gynecol 2024; 230:362.e1-362.e8. [PMID: 37722570 DOI: 10.1016/j.ajog.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/18/2023] [Accepted: 09/08/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Multiple pregnancy with a complete hydatidiform mole and a normal fetus is prone to severe obstetrical complications and malignant transformation after birth. Prognostic information is limited for this rare form of gestational trophoblastic disease. OBJECTIVE This study aimed to determine obstetrical outcomes and the risk of gestational trophoblastic neoplasia in women with multiple pregnancy with complete hydatidiform mole and coexisting normal fetus, and to identify risk factors for poor obstetrical and oncological outcomes to improve patient information and management. STUDY DESIGN This was a retrospective national cohort study of 11,411 records from the French National Center for Trophoblastic Disease registered between January 2001 and January 2022. RESULTS Among 11,411 molar pregnancies, 141 involved histologically confirmed multiple pregnancy with complete hydatidiform mole and coexisting normal fetus. Roughly a quarter of women (23%; 33/141) decided to terminate pregnancy because of presumed poor prognosis or by choice. Among the 77% of women (108/141) who continued their pregnancy, 16% of pregnancies (17/108) were terminated because of maternal complications, and 37% (40/108) ended in spontaneous miscarriage before 24 weeks' gestation. The median gestational age at delivery in the remaining 47% of pregnancies (51/108) was 32 weeks. The overall neonatal survival rate at day 8 was 36% (39/108; 95% confidence interval, 27-46) after excluding elective pregnancy terminations. Patients with free beta human chorionic gonadotropin levels <10 multiples of the median were significantly more likely to reach 24 weeks' gestation compared with those with free beta human chorionic gonadotropin levels >10 multiples of the median (odds ratio, 7.0; 95% confidence interval, 1.3-36.5; P=.022). A lower free beta human chorionic gonadotropin level was also associated with better early neonatal survival (the median free beta human chorionic gonadotropin level was 9.4 multiples of the median in patients whose child was alive at day 8 vs 20.0 multiples of the median in those whose child was deceased; P=.02). The overall rate of gestational trophoblastic neoplasia after a multiple pregnancy with complete hydatidiform mole and a normal fetus was 26% (35/136; 95% confidence interval, 19-34). All 35 patients had low-risk International Federation of Gynecology and Obstetrics scores, and the cure rate was 100%. Termination of pregnancy on patient request was not associated with lower risk of gestational trophoblastic neoplasia. Maternal complications such as preeclampsia and postpartum hemorrhage were not associated with higher risk of gestational trophoblastic neoplasia, and neither were high human chorionic gonadotropin levels or newborn survival at day 8. CONCLUSION Multiple pregnancy with complete hydatidiform mole and coexisting fetus carries a high risk of obstetrical complications. In patients who continued their pregnancy, approximately one-third of neonates were alive at day 8, and roughly 1 in 4 patients developed gestational trophoblastic neoplasia. Therefore, the risk of malignant transformation appears to be higher compared with singleton complete moles. Low levels of free beta human chorionic gonadotropin may be indicative of better early neonatal survival, and this relationship warrants further study.
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Affiliation(s)
- Touria Hajri
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France
| | - Mona Massoud
- Department of Obstetrics and Gynecology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon, France
| | - Margot Vergne
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France
| | - Pierre Descargues
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Obstetrics and Gynecology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon, France
| | - Fabienne Allias
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Pathology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon, France
| | - Benoit You
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Medical Oncology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Investigation Center for Treatments in Oncology and Hematology of Lyon (CITOHL), Lyon, France
| | - Jean-Pierre Lotz
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Medical Oncology and Cellular Therapy, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Tenon University Hospital, Alliance for Cancer Research (APREC), Paris, France
| | - Julie Haesebaert
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Research on Healthcare Performance (RESHAPE), Inserm U1290, Université Claude Bernard Lyon 1, France
| | - Pierre-Adrien Bolze
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Obstetrics and Gynecology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon, France
| | - François Golfier
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Obstetrics and Gynecology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon, France
| | - Jerome Massardier
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Obstetrics and Gynecology, Hospices Civils de Lyon, Femme Mere Enfant University Hospital, Lyon, France.
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Roland E, Voirin-Mathieu E, Verchain S, Odaert H, Dreux S, Renom G. [Discordant Down syndrome risk calculation with low maternal serum markers: About five cases of digynic triploidies]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:172-175. [PMID: 36462714 DOI: 10.1016/j.gofs.2022.11.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE We compare the risk of Down syndrome among five patients carrying a foetus with digynic triploidy and suggest a course of action for these particular serological profiles. METHODS The concentrations of the different markers used are transformed into multiples of the median by using each of the three software types present on the French market which then determine the risk of Down syndrome. RESULTS For comparable biochemical and ultrasound profiles, the risk of Down syndrome turns out to be vastly different depending on the type of software employed. The relevance of an immediate diagnostic procedure, of a cell free DNA test or of a basic ultrasound follow-up then arises, leading to a potentially variable care pathway for the patient. CONCLUSIONS This study confirms that for this type of biochemical profile, the laboratory's advisory service is fundamental, that a control ultrasound is essential and that an invasive procedure must be used almost invariably due to the extremely substantial risk factors.
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Affiliation(s)
- E Roland
- Laboratoire de dépistage périnatal, centre de biologie pathologie génétique, CHU, CS 70002, 59037 Lille cedex, France; ABA: Association des Biologistes Agréés pour le dépistage de la trisomie 21 fœtale, France
| | - E Voirin-Mathieu
- Laboratoire de biochimie prénatale, hôpital Robert Debré, 48, boulevard Sérurier, 75935 Paris cedex 19, France; ABA: Association des Biologistes Agréés pour le dépistage de la trisomie 21 fœtale, France
| | - S Verchain
- Laboratoire de biologie, centre hospitalier, 3, boulevard Besnier, CS 90006, 62022 Arras cedex, France; ABA: Association des Biologistes Agréés pour le dépistage de la trisomie 21 fœtale, France
| | - H Odaert
- Laboratoire diagnovie-biogroup, 121, avenue Jean Jaurès, 59790 Ronchin, France; ABA: Association des Biologistes Agréés pour le dépistage de la trisomie 21 fœtale, France
| | - S Dreux
- Laboratoire de biochimie prénatale, hôpital Robert Debré, 48, boulevard Sérurier, 75935 Paris cedex 19, France; ABA: Association des Biologistes Agréés pour le dépistage de la trisomie 21 fœtale, France
| | - G Renom
- Laboratoire de dépistage périnatal, centre de biologie pathologie génétique, CHU, CS 70002, 59037 Lille cedex, France; ABA: Association des Biologistes Agréés pour le dépistage de la trisomie 21 fœtale, France.
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Pérennec A, Reignier A, Goronflot T, Gourraud PA, Masson D, Barrière P, Fréour T, Lefebvre T. Association between blastocyst morphology and maternal first trimester serum markers in ongoing pregnancies obtained after single fresh blastocyst transfer. Eur J Obstet Gynecol Reprod Biol 2020; 258:63-69. [PMID: 33421812 DOI: 10.1016/j.ejogrb.2020.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 12/08/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Is there an association between blastocyst morphology and maternal first trimester serum markers in In Vitro Fertilization (IVF) pregnancies obtained after fresh single blastocyst transfer? STUDY DESIGN This bi-centric retrospective study was conducted between January 2012 and August 2018. We included 122 women aged from 18 to 43 years-old, whose pregnancy progressed at least beyond 13 weeks after a single blastocyst transfer and who participated in the first trimester combined screening test. Day 5 and day 6 blastocysts were evaluated according to Gardner and Schoolcraft classification. Patients were classified into three groups according to blastocysts morphological quality: excellent (≥ 3AA), good (3-6AB, 3-6BA, B2), and medium to poor (3-6BB, 3-6AC, 3-6CA, B1, 3-6CB, 3-6BC). First trimester serum markers were measured in maternal blood between 9 and 11 + 6 gestational weeks. Univariate and multivariate analyses were performed. RESULTS Female body mass index, smoking status, type of infertility, geographical origin, anti-mullerian hormone level, ovarian stimulation characteristics, pregnancy outcomes and obstetrical complications were comparable between the three groups. Patient's age was not distributed evenly across groups, with women in group "Medium to Poor" appearing to be slightly younger than in other groups. There were no significant differences in mean first trimester serum markers between the three groups (PAPP-A: excellent: 1.23 ± 0.59 MoM; good: 1.45 ± 0.71 MoM; medium to poor: 1.22 ± 0.52 MoM; p = 0,20; free beta-HCG: excellent: 1.66 ± 1.38 MoM; good: 1.19 ± 0.76 MoM; medium to poor: 1.81 ± 1.34 MoM; p = 0,12). No significant difference was found either between mean first trimester serum markers and inner cell mass morphology (PAPP-A: grade A: 1.23 ± 0.58 MoM; grade B: 1.26 ± 0.60 MoM; medium to poor: 1.64 ± 0.87 MoM; p = 0,67 ; free beta-HCG: grade A: 1.66 ± 1.36 MoM; grade B: 1.52 ± 1.10 MoM; medium to poor: 1.57 ± 0.39 MoM p = 0,60), trophectoderm cells morphology (PAPP-A: grade A: 1.25 ± 0.63 MoM; grade B: 1.26 ± 0.51 MoM; medium to poor: not comparable; p = 0,66; free beta-HCG: grade A: 1.60 ± 1.34 MoM; grade B: 1.69 ± 1.14 MoM; medium to poor: not comparable; p = 0,25), or blastocoel expansion (PAPP-A: B1: 1.08 ± 0.51MoM; B2: 1.57 ± 0.70 MoM; B3: 1.26 ± 0.61 MoM; B4: 1.28 ± 0.62 MoM; B5: 1.04 ± 0.38 MoM; p = 0,22; free beta-HCG: B1: 2.01 ± 1.88 MoM; B2: 1.07 ± 0.49 MoM; B3: 1.43 ± 0.87 MoM; B4: 1.68 ± 1.28 MoM ; B5: 1.82 ± 2.03 MoM; p = 0,48). After adjustment on potential confounding factors (female age, type of gonadotropin, parity, number of oocytes retrieved and occurrence of ovarian hyperstimulation syndrome), we did not observe any association between PAPP-A or free beta-HCG levels and blastocyst morphology. CONCLUSION Our study concluded that first trimester serum markers were not associated with blastocyst morphological characteristics. Although this needs further confirmation, this suggests that blastocyst morphology would not have an impact on placentation. Therefore, these findings are reassuring for couples undergoing IVF and blastocyst transfer.
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Affiliation(s)
- Audrey Pérennec
- Department of Biology and Reproductive Medicine, University Hospital of Nantes, 44000, Nantes, France
| | - Arnaud Reignier
- Department of Biology and Reproductive Medicine, University Hospital of Nantes, 44000, Nantes, France; Faculty of Medicine, University of Nantes, 44000, Nantes, France; Center for Research in Transplantation and Immunology UMR 1064, INSERM, University of Nantes, 44000, Nantes, France
| | - Thomas Goronflot
- University Hospital of Nantes, INSERM, CIC 1413, PHU 11: Santé Publique, Clinique des données, 44000, Nantes, France
| | - Pierre-Antoine Gourraud
- Faculty of Medicine, University of Nantes, 44000, Nantes, France; Center for Research in Transplantation and Immunology UMR 1064, INSERM, University of Nantes, 44000, Nantes, France; University Hospital of Nantes, INSERM, CIC 1413, PHU 11: Santé Publique, Clinique des données, 44000, Nantes, France
| | - Damien Masson
- Department of Biochemistry, University Hospital of Nantes, 44000, Nantes, France
| | - Paul Barrière
- Department of Biology and Reproductive Medicine, University Hospital of Nantes, 44000, Nantes, France; Faculty of Medicine, University of Nantes, 44000, Nantes, France; Center for Research in Transplantation and Immunology UMR 1064, INSERM, University of Nantes, 44000, Nantes, France
| | - Thomas Fréour
- Department of Biology and Reproductive Medicine, University Hospital of Nantes, 44000, Nantes, France; Faculty of Medicine, University of Nantes, 44000, Nantes, France; Center for Research in Transplantation and Immunology UMR 1064, INSERM, University of Nantes, 44000, Nantes, France.
| | - Tiphaine Lefebvre
- Department of Biology and Reproductive Medicine, University Hospital of Nantes, 44000, Nantes, France; Faculty of Medicine, University of Nantes, 44000, Nantes, France
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Carrara J, Vivanti A, Jani JC, Demain A, Costa JM, Benachi A. Usefulness and reliability of cell free fetal DNA screening for main trisomies in case of atypical profile on first trimester maternal serum screening. J Transl Med 2019; 17:398. [PMID: 31779618 PMCID: PMC6883576 DOI: 10.1186/s12967-019-02152-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 11/22/2019] [Indexed: 11/20/2022] Open
Abstract
Background Patients with atypical values of HCG and/or PAPP-A are at higher risk of chromosomal abnormality and vascular complications of pregnancy. The performance of cfDNA in this particular population has not yet been evaluated. Objectives The primary objective was to evaluate the usefulness and reliability of cfDNA in screening for trisomy 21, 18 and 13 for patients with HCG < 0.25 multiple of median (MoM), HCG > 5.0 MoM and/or PAPP-A < 0.25 MoM, PAPP-A > 2.5 MoM. The secondary objective was to evaluate the contribution of cfDNA assay for the prediction of pregnancy’s vascular complications. Method Between June 2016 and July 2017, we analysed a women cohort from all over France who had at least one first trimester serum biomarker outside of normal range, in a retrospective, observational and multicentre study. Patients were included if they had a single pregnancy, normal first trimester ultrasound examination, whatever the result of the combined first trimester screening test was. The cfDNA was analysed by massive parallel sequencing technique. The accuracy of cfDNA assay was evaluated by calculation of sensitivity and specificity, and multivariate regression analysis was used to search for predictive factors for pregnancy’s vascular complications. Results Among the 498 patients who underwent a cfDNA assay in this context, twenty-one (4.2%) were excluded because of loss to follow-up. Out of 477, test failure occurred for four patients initially, reduced to two patients (0.4%) after redrawn. CfDNA was positive for Trisomy 21 (n = 19), Trisomy 18 (n = 6) and Trisomy 13 (n = 1) and negative in 449. The sensitivity of cfDNA assay for trisomy 21 screening was 100% (19/19) (IC 95% 82.4–100) and specificity 100% (458/458) (IC 95% 99.2–100). Among the 447 patients included for prediction of vascular complications, there were four cases of pregnancy induced hypertension and 10 cases of preeclampsia, for which no predictive factor was identified. Intra Uterine growth restriction under 5th percentile (n = 44, 9.8%) was significantly associated with a low fetal fraction (OR = 0.87, IC 95% 0.79–0.96, p = 0.006). Conclusion cfDNA assay is an effective and reliable tool for women with atypical profile of first trimester serum biomarkers.
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Affiliation(s)
- Julie Carrara
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, AP-HP, 157 Rue de la Porte de Trivaux, 92140, Clamart, France. .,Université Paris Saclay, 91190, Saint-Aubin, France.
| | - Alexandre Vivanti
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, AP-HP, 157 Rue de la Porte de Trivaux, 92140, Clamart, France.,Université Paris Saclay, 91190, Saint-Aubin, France
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Adèle Demain
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, AP-HP, 157 Rue de la Porte de Trivaux, 92140, Clamart, France
| | | | - Alexandra Benachi
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, AP-HP, 157 Rue de la Porte de Trivaux, 92140, Clamart, France.,Université Paris Saclay, 91190, Saint-Aubin, France
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Malan V, Bussières L, Winer N, Jais JP, Baptiste A, Le Lorc’h M, Elie C, O’Gorman N, Fries N, Houfflin-Debarge V, Sentilhes L, Vekemans M, Ville Y, Salomon LJ. Effect of Cell-Free DNA Screening vs Direct Invasive Diagnosis on Miscarriage Rates in Women With Pregnancies at High Risk of Trisomy 21: A Randomized Clinical Trial. JAMA 2018; 320:557-565. [PMID: 30120476 PMCID: PMC6583003 DOI: 10.1001/jama.2018.9396] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
IMPORTANCE Cell-free DNA (cfDNA) tests are increasingly being offered to women in the first trimester of pregnancies at a high risk of trisomy 21 to decrease the number of required invasive fetal karyotyping procedures and their associated miscarriages. The effect of this strategy has not been evaluated. OBJECTIVE To compare the rates of miscarriage following invasive procedures only in the case of positive cfDNA test results vs immediate invasive testing procedures (amniocentesis or chorionic villus sampling) in women with pregnancies at high risk of trisomy 21 as identified by first-trimester combined screening. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted from April 8, 2014, to April 7, 2016, in 57 centers in France among 2111 women with pregnancies with a risk of trisomy 21 between 1 in 5 and 1 in 250 following combined first-trimester screening. INTERVENTIONS Patients were randomized to receive either cfDNA testing followed by invasive testing procedures only when cfDNA tests results were positive (n = 1034) or to receive immediate invasive testing procedures (n = 1017). The cfDNA testing was performed using an in-house validated method based on next-generation sequencing. MAIN OUTCOMES AND MEASURES The primary outcome was number of miscarriages before 24 weeks' gestation. Secondary outcomes included cfDNA testing detection rate for trisomy 21. The primary outcome underwent 1-sided testing; secondary outcomes underwent 2-sided testing. RESULTS Among 2051 women who were randomized and analyzed (mean age, 36.3 [SD, 5.0] years), 1997 (97.4%) completed the trial. The miscarriage rate was not significantly different between groups at 8 (0.8%) vs 8 (0.8%), for a risk difference of -0.03% (1-sided 95% CI, -0.68% to ∞; P = .47). The cfDNA detection rate for trisomy 21 was 100% (95% CI, 87.2%-100%). CONCLUSIONS AND RELEVANCE Among women with pregnancies at high risk of trisomy 21, offering cfDNA screening, followed by invasive testing if cfDNA test results were positive, compared with invasive testing procedures alone, did not result in a significant reduction in miscarriage before 24 weeks. The study may have been underpowered to detect clinically important differences in miscarriage rates. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02127515.
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Affiliation(s)
- Valérie Malan
- Department of Histology-Embryology and Cytogenetics, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
- INSERM U1163, Hôpital Necker–Enfants Malades, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Laurence Bussières
- Department of Obstetrics and Gynecology, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
- Clinical Unit Research/Clinic Investigation Center, Paris Descartes, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, CHU de Nantes, UMR 1280 PHAN (Physiologie des Adaptations Nutritionnelles), INRA University, Nantes, France
- Groupe de Recherche en Obstétrique et Gynécologie (GROG), Paris, France
| | - Jean-Philippe Jais
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
- Department of Biostatistics and Medical Informatics, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
| | - Amandine Baptiste
- Clinical Unit Research/Clinic Investigation Center, Paris Descartes, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
| | - Marc Le Lorc’h
- Department of Histology-Embryology and Cytogenetics, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
| | - Caroline Elie
- Clinical Unit Research/Clinic Investigation Center, Paris Descartes, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
| | - Neil O’Gorman
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
- Department of Obstetrics and Gynecology, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
| | - Nicolas Fries
- Department of Obstetrics and Gynecology, CHU de Montpellier, Montpellier, France
- Collège Français d’Echographie Fœtale (CFEF), Chateaubriand, France
| | - Véronique Houfflin-Debarge
- Groupe de Recherche en Obstétrique et Gynécologie (GROG), Paris, France
- Department of Obstetrics and Gynecology, CHU de Lille, Lille, France
| | - Loic Sentilhes
- Groupe de Recherche en Obstétrique et Gynécologie (GROG), Paris, France
- Department of Obstetrics and Gynecology, CHU d’Angers, Angers, France
- Department of Obstetrics and Gynecology, CHU de Bordeaux, Bordeaux, France
| | - Michel Vekemans
- Department of Histology-Embryology and Cytogenetics, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Yves Ville
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
- Department of Obstetrics and Gynecology, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
| | - Laurent J. Salomon
- Paris Descartes University, Sorbonne Paris Cité, Institut Imagine, Paris, France
- Department of Obstetrics and Gynecology, Hôpital Necker–Enfants Malades, AP-HP, Paris, France
- Groupe de Recherche en Obstétrique et Gynécologie (GROG), Paris, France
- Collège Français d’Echographie Fœtale (CFEF), Chateaubriand, France
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Bardy-Evrard C, Mattuizzi A, Coatleven F, Nithart A, Evrard G, Benachi A, Nisand I, Sentilhes L. [Overview of feelings and practices of gynecologists and obstetricians for the noninvasive prenatal testing in France]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2018; 46:34-40. [PMID: 29233528 DOI: 10.1016/j.gofs.2017.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate the feelings and practices of French obstetrician-gynecologists in prescribing the noninvasive prenatal testing (NIPT) before the release of the French High Authority of Health recommendations. METHODS Descriptive, declarative and transversal study, analyzing the feelings and practices of obstetrician-gynecologists, members of the French College of Gynecologists and Obstetricians (CNGOF) between February and May 2017 using an online questionnaire. Practitioners' feedback was self-assessed for several clinical situations using a numerical scale ranging from 1 to 10. This experience was rated as "good" (grades 6 to 10) or "bad" (grades 1-5). RESULTS Overall, 529 practitioners (29.2%) of 1812 CNGOF members, answered the online questionnaire. A "good" feeling was found for more than 65% of the practitioners audited. Feelings were significantly better for obstetricians, sonographers (P<0.05) and CPDPN members (P=0.003) compared to other practitioners. Situations where the DPNI was proposed "systematically" were risks greater than 1/250 (70.9%), between 1/250 and 1/500 (59.4%), greater than 1/250 associated with history of spontaneous miscarriages and/or fetal death in utero (66%), greater than 1/250 associated with pregnancy resulting from PMA (68.3%), history of fetal aneuploidy (54%) and a parent carrying a Robertsonian translocation (51.6%). CONCLUSION This study highlights a good overall feeling of the practitioners with the NIPT.
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Affiliation(s)
- C Bardy-Evrard
- Service de gynécologie-obstétrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
| | - A Mattuizzi
- Service de gynécologie-obstétrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - F Coatleven
- Service de gynécologie-obstétrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - A Nithart
- Service de gynécologie-obstétrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - G Evrard
- Service des urgences adultes, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - A Benachi
- Service de gynécologie-obstétrique et médecine de la reproduction, CHU Antoine-Béclère, AP-HP, 92140 Clamart, France; Collège national des gynécologues obstétriciens français, 75012 Paris, France
| | - I Nisand
- Collège national des gynécologues obstétriciens français, 75012 Paris, France; Service de gynécologie-obstétrique, CHU de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France; Collège national des gynécologues obstétriciens français, 75012 Paris, France
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Herman score in prenatal screening for Down syndrome: Can a junior assess a senior? Diagn Interv Imaging 2017; 98:155-160. [DOI: 10.1016/j.diii.2016.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/18/2016] [Accepted: 03/25/2016] [Indexed: 11/21/2022]
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Belloin C, Jacquemard F, Bernabé-Dupont C, Viot G, Lohmann L, Grangé G. [The noninvasive prenatal testing for Down's Syndrome. Retrospective study of 8821 patients]. ACTA ACUST UNITED AC 2016; 45:1127-1132. [PMID: 27091545 DOI: 10.1016/j.jgyn.2016.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/20/2016] [Accepted: 01/28/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To demonstrate the decrease in intrauterine invasive procedures through analysis of DNA fetoplacental free circulating in maternal blood: Non Invasive Prenatal Test (NIPT), in Prenatal Diagnosis Center of American Hospital of Paris (AHP). MATERIALS AND METHODS Retrospective descriptive study of 8821 patients in Prenatal Diagnosis Center at the AHP between 01/01/2012 and 09/25/2014. The NIPT is available to patients since 1st January 2013. RESULTS The number of invasive procedures decreased significantly (P<0.0001) between 2012 (n=1177, i.e. 42 % of the global activity of the Prenatal Diagnosis Center at the AHP in 2012) and 2013 (n=987 or 28.5 %) and between 2013 and 2014 (n=599 or 23.4 %). The NIPT calculated performance statistics are: sensitivity≥99.9 %; specificity=99.8 %; Positive Predictive Value=90.4 %; Negative Predictive Value≥99.9 %; False Positives=3. While the actual screening statistic values are: sensitivity≥95.4 %; specificity=82.5 %; Positive Predictive Value=6.5 %; Negative Predictive Value=99.9 %; False Positives=1197. The NIPT has reduced the number of invasive procedures at the Prenatal Diagnosis Center at the AHP. The NIPT performances are superior to those of the actual screening.
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Affiliation(s)
- C Belloin
- Centre de diagnostic prénatal, hôpital américain de Paris, 63, boulevard Victor-Hugo, 92200 Neuilly-sur-Seine, France.
| | - F Jacquemard
- Centre de diagnostic prénatal, hôpital américain de Paris, 63, boulevard Victor-Hugo, 92200 Neuilly-sur-Seine, France
| | - C Bernabé-Dupont
- Centre de diagnostic prénatal, hôpital américain de Paris, 63, boulevard Victor-Hugo, 92200 Neuilly-sur-Seine, France
| | - G Viot
- Centre de diagnostic prénatal, hôpital américain de Paris, 63, boulevard Victor-Hugo, 92200 Neuilly-sur-Seine, France; Maternité Port-Royal, 53, avenue de l'Observatoire, 75014 Paris, France
| | - L Lohmann
- Centre de diagnostic prénatal, hôpital américain de Paris, 63, boulevard Victor-Hugo, 92200 Neuilly-sur-Seine, France
| | - G Grangé
- Maternité Port-Royal, 53, avenue de l'Observatoire, 75014 Paris, France
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