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Parijs I, Brison N, Vancoillie L, Baetens M, Blaumeiser B, Boulanger S, Désir J, Dimitrov B, Fieremans N, Janssens K, Janssens S, Marichal A, Menten B, Meunier C, Van Berkel K, Van Den Bogaert A, Devriendt K, Van Den Bogaert K, Vermeesch JR. Population screening for 15q11-q13 duplications: corroboration of the difference in impact between maternally and paternally inherited alleles. Eur J Hum Genet 2024; 32:31-36. [PMID: 37029316 PMCID: PMC10772068 DOI: 10.1038/s41431-023-01336-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/28/2023] [Accepted: 03/09/2023] [Indexed: 04/09/2023] Open
Abstract
Maternally inherited 15q11-q13 duplications are generally found to cause more severe neurodevelopmental anomalies compared to paternally inherited duplications. However, this assessment is mainly inferred from the study of patient populations, causing an ascertainment bias towards patients at the more severe end of the phenotypic spectrum. Here, we analyze the low coverage genome-wide cell-free DNA sequencing data obtained from pregnant women during non-invasive prenatal screening (NIPS). We detect 23 15q11-q13 duplications in 333,187 pregnant women (0.0069%), with an approximately equal distribution between maternal and paternal duplications. Maternally inherited duplications are always associated with a clinical phenotype (ranging from learning difficulties to intellectual impairment, epilepsy and psychiatric disorders), while paternal duplications are normal or associated with milder phenotypes (mild learning difficulties and dyslexia). This data corroborates the difference in impact between paternally and maternally inherited 15q11-q13 duplications, contributing to the improvement of genetic counselling. We recommend reporting 15q11-q13 duplications identified during genome-wide NIPS with appropriate genetic counselling for these pregnant women in the interest of both mothers and future children.
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Affiliation(s)
- Ilse Parijs
- Center for Human Genetics, University Hospitals Leuven-KU Leuven, Leuven, Belgium
| | - Nathalie Brison
- Center for Human Genetics, University Hospitals Leuven-KU Leuven, Leuven, Belgium
| | - Leen Vancoillie
- Center for Human Genetics, University Hospitals Leuven-KU Leuven, Leuven, Belgium
| | - Machteld Baetens
- Center of Medical Genetics, University Hospital Ghent, Ghent, Belgium
| | - Bettina Blaumeiser
- Center of Medical Genetics, University and University Hospital Antwerp, Antwerp, Belgium
| | - Sébastien Boulanger
- Center for Medical Genetics, Institut de Pathologie et de Génétique Gosselies, Charleroi, Belgium
| | - Julie Désir
- Center for Medical Genetics, Institut de Pathologie et de Génétique Gosselies, Charleroi, Belgium
| | - Boyan Dimitrov
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Clinical Sciences, research group Reproduction and Genetics, Center for Medical Genetics, Brussels, Belgium
| | - Nathalie Fieremans
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Clinical Sciences, research group Reproduction and Genetics, Center for Medical Genetics, Brussels, Belgium
| | - Katrien Janssens
- Center of Medical Genetics, University and University Hospital Antwerp, Antwerp, Belgium
| | - Sandra Janssens
- Center of Medical Genetics, University Hospital Ghent, Ghent, Belgium
| | - Axel Marichal
- Center for Medical Genetics, Institut de Pathologie et de Génétique Gosselies, Charleroi, Belgium
| | - Björn Menten
- Center of Medical Genetics, University Hospital Ghent, Ghent, Belgium
| | - Colombine Meunier
- Center for Medical Genetics, Institut de Pathologie et de Génétique Gosselies, Charleroi, Belgium
| | - Kim Van Berkel
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Clinical Sciences, research group Reproduction and Genetics, Center for Medical Genetics, Brussels, Belgium
| | - Ann Van Den Bogaert
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Clinical Sciences, research group Reproduction and Genetics, Center for Medical Genetics, Brussels, Belgium
| | - Koenraad Devriendt
- Center for Human Genetics, University Hospitals Leuven-KU Leuven, Leuven, Belgium
| | - Kris Van Den Bogaert
- Center for Human Genetics, University Hospitals Leuven-KU Leuven, Leuven, Belgium
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Svirsky R, Sharabi-Nov A, Sagi T, Meiri H, Adi O, Kugler N, Maymon R. High sensitivity and specificity in fetal gender identification in the first trimester, using ultrasound and Noninvasive Prenatal Screening (NIPS) in twin pregnancies, a prospective study. BMC Pregnancy Childbirth 2023; 23:812. [PMID: 37993805 PMCID: PMC10664379 DOI: 10.1186/s12884-023-06133-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Determination of the fetal gender in the first trimester is important in twin pregnancy cases of familial X-linked genetic syndromes and helps determine chorionicity. We assessed and compared the accuracy of first-trimester ultrasound scans, and cell-free fetal DNA (CfDNA) in determining fetal gender in the first trimester of twin pregnancies. METHODS Women with twin pregnancies were recruited prospectively during the first trimester. Fetal gender was determined using both ultrasound scans and CfDNA screening. Both results were compared to the newborn gender after delivery. RESULTS A total of 113 women with twin pregnancies were enrolled. There was 100% sensitivity and specificity in Y chromosome detection using CfDNA. Gender assignment using ultrasound in any first-trimester scans was 79.7%. Accuracy level increased from 54.2% in CRL 45-54 mm to 87.7% in CRL 55-67 mm and 91.5% in CRL 67-87 mm. Male fetuses had significantly higher chances of a gender assignment error compared to female fetuses, odds ratio = 23.574 (CI 7.346 - 75.656). CONCLUSIONS CfDNA is highly sensitive and specific in determining the presence of the Y chromosome in twin pregnancies in the first trimester. Between CRL 55-87 mm, ultrasound scanning offers a highly accurate determination of fetal gender in twin pregnancies.
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Affiliation(s)
- Ran Svirsky
- Department of Obstetrics and Gynecology, Genetic Unit, Samson Assuta Ashdod University Hospital, Ashdod, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
- Department of Obstetrics and Gynecology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.
| | - Adi Sharabi-Nov
- Department of Statistics, Ziv Medical Center, Safed and Tel Hai Academic College, Tel Hai, Israel
| | - Tal Sagi
- Department of Obstetrics and Gynecology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Hamutal Meiri
- PreTwin Screen Consortium and TeleMarpe Ltd, Tel Aviv, Israel
| | - Orenstein Adi
- Department of Obstetrics and Gynecology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Nadav Kugler
- Department of Obstetrics and Gynecology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Maymon
- Department of Obstetrics and Gynecology, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Wei L, Zhang J, Shi N, Luo C, Bo L, Lu X, Gao S, Mao C. Association of maternal risk factors with fetal aneuploidy and the accuracy of prenatal aneuploidy screening: a correlation analysis based on 12,186 karyotype reports. BMC Pregnancy Childbirth 2023; 23:136. [PMID: 36864406 PMCID: PMC9979483 DOI: 10.1186/s12884-023-05461-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/21/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND NIPT is becoming increasingly important as its use becomes more widespread in China. More details are urgently needed on the correlation between maternal risk factors and fetal aneuploidy, and how these factors affect the accuracy of prenatal aneuploidy screening. METHODS Information on the pregnant women was collected, including maternal age, gestational age, specific medical history and results of prenatal aneuploidy screening. Additionally, the OR, validity and predictive value were also calculated. RESULTS A total of 12,186 analysable karyotype reports were collected with 372 (3.05%) fetal aneuploidies, including 161 (1.32%) T21, 81 (0.66%) T18, 41 (0.34%) T13 and 89 (0.73%) SCAs. The OR was highest for maternal age less than 20 years (6.65), followed by over 40 years (3.59) and 35-39 years (2.48). T13 (16.95) and T18 (9.40) were more frequent in the over-40 group (P < 0.01); T13 (3.62/5.76) and SCAs (2.49/3.95) in the 35-39 group (P < 0.01). Cases with a history of fetal malformation had the highest OR (35.94), followed by RSA (13.08): the former was more likely to have T13 (50.65) (P < 0.01) and the latter more likely to have T18 (20.50) (P < 0.01). The sensitivity of primary screening was 73.24% and the NPV was 98.23%. The TPR for NIPT was 100.00% and the respective PPVs for T21, T18, T13 and SCAs were 89.92, 69.77, 53.49 and 43.24%, respectively. The accuracy of NIPT increased with increasing gestational age (0.81). In contrast, the accuracy of NIPT decreased with maternal age (1.12) and IVF-ET history (4.15). CONCLUSIONS ①Pregnant patients with maternal age below 20 years had higher risk of aneuploidy, especially in T13; ②A history of fetal malformations is more risky than RSA, with the former more likely to have T13 and the latter more likely to have T18; ③Primary screening essentially achieves the goal of identifying a normal karyotype, and NIPT can accurately screen for fetal aneuploidy; ④A number of maternal risk factors may influence the accuracy of NIPT diagnosis, including older age, premature testing, or a history of IVF-ET. In conclusion, this study provides a reliable theoretical basis for optimizing prenatal aneuploidy screening strategies and improving population quality.
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Affiliation(s)
- Lun Wei
- grid.429222.d0000 0004 1798 0228Reproductive Medicine Center, First Affiliated Hospital of Soochow University, No.899 Pinghai Road, Suzhou, 215006 Jiangsu China
| | - Jiakai Zhang
- grid.263761.70000 0001 0198 0694Marxism Research Institute, Soochow University, Suzhou, 215123 Jiangsu China ,Suzhou High School Affiliated to Xi’an Jiaotong University, Suzhou, Jiangsu China
| | - Ningxian Shi
- grid.411634.50000 0004 0632 4559Department of Gynecology and Obstetrics, Sihong County People’s Hospital, Suqian, Jiangsu China
| | - Chao Luo
- grid.429222.d0000 0004 1798 0228Reproductive Medicine Center, First Affiliated Hospital of Soochow University, No.899 Pinghai Road, Suzhou, 215006 Jiangsu China
| | - Le Bo
- grid.429222.d0000 0004 1798 0228Reproductive Medicine Center, First Affiliated Hospital of Soochow University, No.899 Pinghai Road, Suzhou, 215006 Jiangsu China
| | - Xuanping Lu
- grid.429222.d0000 0004 1798 0228Reproductive Medicine Center, First Affiliated Hospital of Soochow University, No.899 Pinghai Road, Suzhou, 215006 Jiangsu China
| | - Shasha Gao
- grid.429222.d0000 0004 1798 0228Reproductive Medicine Center, First Affiliated Hospital of Soochow University, No.899 Pinghai Road, Suzhou, 215006 Jiangsu China
| | - Caiping Mao
- Reproductive Medicine Center, First Affiliated Hospital of Soochow University, No.899 Pinghai Road, Suzhou, 215006, Jiangsu, China.
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Provenzano A, Farina A, Seidenari A, Azzaroli F, Serra C, Della Gatta A, Zuffardi O, Giglio SR. Prenatal Noninvasive Trio-WES in a Case of Pregnancy-Related Liver Disorder. Diagnostics (Basel) 2021; 11:diagnostics11101904. [PMID: 34679599 PMCID: PMC8534548 DOI: 10.3390/diagnostics11101904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 01/16/2023] Open
Abstract
Liver disease in pregnancy may present as an acute condition related to the gestational period, characterized by pruritus, jaundice, and abnormal liver function. The disease may be misdiagnosed with other liver diseases, some of which may have consequences for fetal health. It is therefore advisable to implement rapid diagnostic strategies to provide information for the management of pregnancy in these conditions. We report the case of a healthy woman with a twin pregnancy from homologous in vitro fertilization (IVF), who in the third trimester presented jaundice and malaise. Biochemical investigations and liver hyperechogenicity raised the suspicion of acute fatty liver disease of pregnancy (AFLP). Non-invasive prenatal whole-exome sequencing (WES) in the trio identified the Phe305Ile heterozygous variant in the ATP8B1 gene. Considering the twin pregnancy, the percentage of the variant versus the wild allele was of 31%, suggesting heterozygosity present in the mother alone. This analysis showed that the mother was affected by benign recurrent intrahepatic cholestasis of pregnancy (ICP1: # 147480) and indicated the opportunity to anticipate childbirth to avoid worsening of the mother’s health. WES after the birth of the twins confirmed the molecular data.
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Affiliation(s)
- Aldesia Provenzano
- Medical Genetics Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50139 Florence, Italy
- Correspondence:
| | - Antonio Farina
- Division of Obstetrics and Prenatal Medicine, IRCCS Sant’Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy; (A.F.); (A.S.); (A.D.G.)
| | - Anna Seidenari
- Division of Obstetrics and Prenatal Medicine, IRCCS Sant’Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy; (A.F.); (A.S.); (A.D.G.)
| | - Francesco Azzaroli
- Division of Internal Medicine, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Carla Serra
- Department of Organ Failure and Transplantation, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy;
| | - Anna Della Gatta
- Division of Obstetrics and Prenatal Medicine, IRCCS Sant’Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy; (A.F.); (A.S.); (A.D.G.)
| | - Orsetta Zuffardi
- Medical Genetics Unit, Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Sabrina Rita Giglio
- Medical Genetics Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09126 Cagliari, Italy;
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Ju J, Li J, Liu S, Zhang H, Xu J, Lin Y, Gao Y, Zhou Y, Jin X. Estimation of cell-free fetal DNA fraction from maternal plasma based on linkage disequilibrium information. NPJ Genom Med 2021; 6:85. [PMID: 34642337 PMCID: PMC8511193 DOI: 10.1038/s41525-021-00247-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 09/23/2021] [Indexed: 11/21/2022] Open
Abstract
Cell-free fetal DNA fraction (FF) in maternal plasma is a key parameter affecting the performance of noninvasive prenatal testing (NIPT). Accurate quantitation of FF plays a pivotal role in these tests. However, there are few methods that could determine FF with high accuracy using shallow-depth whole-genome sequencing data. In this study, we hypothesized that the actual FF in maternal plasma should be proportional to the discrepancy rate between the observed genotypes and inferred genotypes based on the linkage disequilibrium rule in certain polymorphism sites. Based on this hypothesis, we developed a method named Linkage Disequilibrium information-based cell-free Fetal DNA Fraction (LDFF) to accurately quantify FF in maternal plasma. This method achieves a high performance and outperforms existing methods in the fetal DNA fraction estimation. As LDFF is a gender-independent method and developed on shallow-depth samples, it can be easily incorporated into routine NIPT test and may enhance the current NIPT performance.
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Affiliation(s)
- Jia Ju
- College of Life Sciences, University of Chinese Academy of Sciences, 100049, Beijing, China
- BGI-Shenzhen, 518083, Shenzhen, Guangdong, China
| | - Jia Li
- BGI-genomics, BGI-Shenzhen, 518083, Shenzhen, Guangdong, China
| | - Siyang Liu
- BGI-Shenzhen, 518083, Shenzhen, Guangdong, China
| | | | - Jinjin Xu
- BGI-Shenzhen, 518083, Shenzhen, Guangdong, China
| | - Yu Lin
- BGI-Shenzhen, 518083, Shenzhen, Guangdong, China
| | - Ya Gao
- BGI-Shenzhen, 518083, Shenzhen, Guangdong, China
| | - Yulin Zhou
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine & School of Public Health, Xiamen University, 361102, Xiamen, Fujian, China.
| | - Xin Jin
- BGI-Shenzhen, 518083, Shenzhen, Guangdong, China.
- School of Medicine, South China University of Technology, 510006, Guangzhou, Guangdong, China.
- Guangdong Provincial Key Laboratory of Human Disease Genomics, Shenzhen Key Laboratory of Genomics, BGI-Shenzhen, 518083, Shenzhen, China.
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Rafalko J, Caldwell S, Soster E, Almasri E, McLennan G, Liu T, Weinblatt V, Cacheris P, McCullough R. Application of mosaicism ratio to multifetal gestations. PLoS One 2021; 16:e0248467. [PMID: 33711042 PMCID: PMC7954340 DOI: 10.1371/journal.pone.0248467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/28/2021] [Indexed: 12/02/2022] Open
Abstract
Mosaicism ratio, or MR, is a laboratory metric that can be calculated using massively parallel sequencing data from cell-free DNA (cfDNA) screening. MR compares the amount of cfDNA present from a particular chromosome or chromosomal region to the overall fetal fraction of the specimen. In singleton gestations, MR may be used to refine the positive predictive value of an abnormal cfDNA screening result by identifying cases that could be impacted by various biological factors, such as placental mosaicism or prior co-twin demise. The current study was designed to examine the behavior of mosaicism ratio (MR) in multifetal gestations. Multifetal cfDNA specimens with positive results for trisomies 21, 18, or 13 and confirmed diagnostic outcomes were compiled to examine MR of the aneuploid chromosome based on the number of affected fetuses/placentas. A second multifetal cohort was assembled to analyze the MR of the Y chromosome in cases with at least one male fetus. For aneuploid cases, the average MR of affected singletons (used as a biological proxy for two affected twins) was significantly higher than the average MR for twins in which one fetus was affected. The average MR of the aneuploid chromosome for one affected twin was 52%, 42%, and 48% of that of singleton gestations for trisomy 21, 18, and 13 cases, respectively. MR cutoffs of 0.7 for trisomy 21, and 0.5 for trisomies 18 and 13 may help predict whether one versus both twins are affected with aneuploidy when clinical concern arises. For male cases, the Y MR of XX/XY gestations was 48% of the Y MR for XY/XY gestations. Using a Y MR cutoff of 0.8 allowed determination of XX/XY versus XY/XY gestations with 92.3-94.9% accuracy. Based on the data presented, MR may have utility in the analysis and interpretation of cfDNA data from multifetal gestations.
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Affiliation(s)
- Jill Rafalko
- Laboratory Corporation of America, La Jolla, California, United States of America
| | - Samantha Caldwell
- Laboratory Corporation of America, La Jolla, California, United States of America
| | - Erica Soster
- Laboratory Corporation of America, La Jolla, California, United States of America
| | - Eyad Almasri
- Laboratory Corporation of America, La Jolla, California, United States of America
| | - Graham McLennan
- Laboratory Corporation of America, La Jolla, California, United States of America
| | - Tong Liu
- Laboratory Corporation of America, La Jolla, California, United States of America
| | - Vivian Weinblatt
- Laboratory Corporation of America, La Jolla, California, United States of America
| | - Philip Cacheris
- Laboratory Corporation of America, La Jolla, California, United States of America
| | - Ron McCullough
- Laboratory Corporation of America, La Jolla, California, United States of America
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7
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Motevasselian M, Saleh Gargari S, Younesi S, Pooransari P, Saadati P, Mirzamoradi M, Savad S, Taheri Amin MM, Modarresi MH, Afrakhteh M, Ghafouri-Fard S. Non-invasive prenatal test to screen common trisomies in twin pregnancies. Mol Cytogenet 2020; 13:5. [PMID: 32042312 PMCID: PMC7003371 DOI: 10.1186/s13039-020-0475-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/24/2020] [Indexed: 02/06/2023] Open
Abstract
Objectives Recent years have witnessed a shift from invasive methods of prenatal screening to non-invasive strategies. Accordingly, non-invasive prenatal testing (NIPT) using cell-free fetal DNA in maternal plasma has gained a considerable deal of interest from both geneticists and obstetricians. Efficacy of this method in identification of common aneuploidies has been extensively assessed in singleton pregnancies. However, a limited number of studies have addressed the twin pregnancies. In this context, the present study is aimed at identification of the efficacy of NIPT in twin pregnancies. Methods NIPT was performed on twin pregnancies to screen trisomies 13, 18 and 21. Pregnant women referring to Nilou Clinical Laboratory between March 2016 and December 2018 were included in this research. Results In the current study, a total 356 twin pregnancies were screened in search for trisomies 13, 18 and 21. 6 cases exhibited positive NIPT results in which the presence of trisomies 13, 18 and 21 was confirmed by fetal karyotype in 1, 2 and 2 cases, respectively. One twin pregnancy showed normal karyotype. The combined false-positive rate for these trisomies was 0.28%. No false negative case was observed. The combined sensitivity and specificity of NIPT in twin pregnancies were 100 and 99.7%, respectively. Conclusion The results of the current study verify the feasibility, sensitivity and specificity of NIPT in twin pregnancies.
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Affiliation(s)
- Mahtab Motevasselian
- 1Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soraya Saleh Gargari
- 1Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sarang Younesi
- Prenatal Screening Department of Nilou Laboratory, Tehran, Iran
| | - Parichehr Pooransari
- 1Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Masoomeh Mirzamoradi
- 1Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Savad
- Prenatal Screening Department of Nilou Laboratory, Tehran, Iran
| | | | - Mohammad-Hossein Modarresi
- 3Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Afrakhteh
- 1Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soudeh Ghafouri-Fard
- 4Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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