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van Prooyen Schuurman L, Sistermans EA, Van Opstal D, Henneman L, Bekker MN, Bax CJ, Pieters MJ, Bouman K, de Munnik S, den Hollander NS, Diderich KE, Faas BH, Feenstra I, Go AT, Hoffer MJ, Joosten M, Komdeur FL, Lichtenbelt KD, Lombardi MP, Polak MG, Jehee FS, Schuring-Blom H, Stevens SJ, Srebniak MI, Suijkerbuijk RF, Tan-Sindhunata GM, van der Meij KR, van Maarle MC, Vernimmen V, van Zelderen-Bhola SL, van Ravesteyn NT, Knapen MF, Macville MV, Galjaard RJH. Clinical impact of additional findings detected by genome-wide non-invasive prenatal testing: Follow-up results of the TRIDENT-2 study. Am J Hum Genet 2022; 109:1344. [PMID: 35803237 PMCID: PMC9300874 DOI: 10.1016/j.ajhg.2022.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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van Prooyen Schuurman L, Sistermans EA, Van Opstal D, Henneman L, Bekker MN, Bax CJ, Pieters MJ, Bouman K, de Munnik S, den Hollander NS, Diderich KE, Faas BH, Feenstra I, Go AT, Hoffer MJ, Joosten M, Komdeur FL, Lichtenbelt KD, Lombardi MP, Polak MG, Jehee FS, Schuring-Blom H, Stevens SJ, Srebniak MI, Suijkerbuijk RF, Tan-Sindhunata GM, van der Meij KR, van Maarle MC, Vernimmen V, van Zelderen-Bhola SL, van Ravesteyn NT, Knapen MF, Macville MV, Galjaard RJH. Clinical impact of additional findings detected by genome-wide non-invasive prenatal testing: Follow-up results of the TRIDENT-2 study. Am J Hum Genet 2022; 109:1140-1152. [PMID: 35659929 PMCID: PMC9247828 DOI: 10.1016/j.ajhg.2022.04.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/29/2022] [Indexed: 12/17/2022] Open
Abstract
In the TRIDENT-2 study, all pregnant women in the Netherlands are offered genome-wide non-invasive prenatal testing (GW-NIPT) with a choice of receiving either full screening or screening solely for common trisomies. Previous data showed that GW-NIPT can reliably detect common trisomies in the general obstetric population and that this test can also detect other chromosomal abnormalities (additional findings). However, evidence regarding the clinical impact of screening for additional findings is lacking. Therefore, we present follow-up results of the TRIDENT-2 study to determine this clinical impact based on the laboratory and perinatal outcomes of cases with additional findings. Between April 2017 and April 2019, additional findings were detected in 402/110,739 pregnancies (0.36%). For 358 cases, the origin was proven to be either fetal (n = 79; 22.1%), (assumed) confined placental mosaicism (CPM) (n = 189; 52.8%), or maternal (n = 90; 25.1%). For the remaining 44 (10.9%), the origin of the aberration could not be determined. Most fetal chromosomal aberrations were pathogenic and associated with severe clinical phenotypes (61/79; 77.2%). For CPM cases, occurrence of pre-eclampsia (8.5% [16/189] vs 0.5% [754/159,924]; RR 18.5), and birth weight <2.3rd percentile (13.6% [24/177] vs 2.5% [3,892/155,491]; RR 5.5) were significantly increased compared to the general obstetric population. Of the 90 maternal findings, 12 (13.3%) were malignancies and 32 (35.6%) (mosaic) pathogenic copy number variants, mostly associated with mild or no clinical phenotypes. Data from this large cohort study provide crucial information for deciding if and how to implement GW-NIPT in screening programs. Additionally, these data can inform the challenging interpretation, counseling, and follow-up of additional findings.
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van der Meij KR, Sistermans EA, Macville MV, Stevens SJ, Bax CJ, Bekker MN, Bilardo CM, Boon EM, Boter M, Diderich KE, de Die-Smulders CE, Duin LK, Faas BH, Feenstra I, Haak MC, Hoffer MJ, den Hollander NS, Hollink IH, Jehee FS, Knapen MF, Kooper AJ, van Langen IM, Lichtenbelt KD, Linskens IH, van Maarle MC, Oepkes D, Pieters MJ, Schuring-Blom GH, Sikkel E, Sikkema-Raddatz B, Smeets DF, Srebniak MI, Suijkerbuijk RF, Tan-Sindhunata GM, van der Ven AJE, van Zelderen-Bhola SL, Henneman L, Galjaard RJH, Van Opstal D, Weiss MM. TRIDENT-2: National Implementation of Genome-wide Non-invasive Prenatal Testing as a First-Tier Screening Test in the Netherlands. Am J Hum Genet 2019; 105:1091-1101. [PMID: 31708118 DOI: 10.1016/j.ajhg.2019.10.005] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/02/2019] [Indexed: 12/30/2022] Open
Abstract
The Netherlands launched a nationwide implementation study on non-invasive prenatal testing (NIPT) as a first-tier test offered to all pregnant women. This started on April 1, 2017 as the TRIDENT-2 study, licensed by the Dutch Ministry of Health. In the first year, NIPT was performed in 73,239 pregnancies (42% of all pregnancies), 7,239 (4%) chose first-trimester combined testing, and 54% did not participate. The number of trisomies 21 (239, 0.33%), 18 (49, 0.07%), and 13 (55, 0.08%) found in this study is comparable to earlier studies, but the Positive Predictive Values (PPV)-96% for trisomy 21, 98% for trisomy 18, and 53% for trisomy 13-were higher than expected. Findings other than trisomy 21, 18, or 13 were reported on request of the pregnant women; 78% of women chose to have these reported. The number of additional findings was 207 (0.36%); these included other trisomies (101, 0.18%, PPV 6%, many of the remaining 94% of cases are likely confined placental mosaics and possibly clinically significant), structural chromosomal aberrations (95, 0.16%, PPV 32%,) and complex abnormal profiles indicative of maternal malignancies (11, 0.02%, PPV 64%). The implementation of genome-wide NIPT is under debate because the benefits of detecting other fetal chromosomal aberrations must be balanced against the risks of discordant positives, parental anxiety, and a potential increase in (invasive) diagnostic procedures. Our first-year data, including clinical data and laboratory follow-up data, will fuel this debate. Furthermore, we describe how NIPT can successfully be embedded into a national screening program with a single chain for prenatal care including counseling, testing, and follow-up.
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Van Opstal D, Diderich KE, Joosten M, Govaerts LC, Polak J, Boter M, Saris JJ, Cheung WY, van Veen S, van de Helm R, Go AT, Knapen MF, Papatsonis DN, Dijkman A, de Vries F, Galjaard RH, Hoefsloot LH, Srebniak MI. Unexpected finding of uniparental disomy mosaicism in term placentas: Is it a common feature in trisomic placentas? Prenat Diagn 2018; 38:911-919. [PMID: 30187503 PMCID: PMC6282787 DOI: 10.1002/pd.5354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/22/2018] [Accepted: 08/26/2018] [Indexed: 11/16/2022]
Abstract
Objective Non‐invasive prenatal testing (NIPT) detects placental chromosome aberrations. When amniocentesis reveals a normal karyotype, confined placental mosaicism (CPM) may be assumed. In order to confirm this, placental cytogenetic studies were performed. Method NIPT was conducted in the course of the Dutch TRIDENT study. Placentas of 10 cases with NIPT results indicating an autosomal trisomy and showing a normal (N = 9) or low mosaic karyotype (N = 1) in amniotic fluid (AF) were investigated. The cytotrophoblast as well as the mesenchymal core of two to four placental chorionic villi biopsies were studied with single nucleotide polymorphism (SNP) array. Clinical outcome data were collected. Results In 10/10 cases, CPM was proven. In 3/10 cases trisomy/uniparental disomy (UPD)/biparental disomy (BPD) mosaicism was discovered. In 2/3 cases, all three cell lines were present in the placenta, whereas BPD was found in AF. In 1/3 cases trisomy 22/UPD22 was present in AF while trisomy 22/BPD22 mosaicism was found in the placenta. Five of 10 pregnancies were affected with pre‐eclampsia, low birth weight, preterm delivery, and/or congenital malformations. Conclusion The presence of trisomy/UPD/BPD mosaicism in 3/10 cases that we investigated proves that trisomic zygote rescue may involve multiple rescue events during early embryogenesis. UPD mosaicism, when present in crucial fetal tissues, may explain the abnormal phenotype in undiagnosed cases. What's already known about this topic?
Trisomic zygote rescue is the main mechanism for uniparental disomy (UPD) formation. Confined placental mosaicism (CPM) is the major source of discordant NIPT results. CPM is associated with a risk for adverse pregnancy outcome.
What does this study add?
Trisomic zygote rescue may involve multiple rescue events based on the co‐occurrence of a trisomy‐, UPD‐, and BPD‐cell line in half of the rescued cases as revealed by placental studies.
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Affiliation(s)
- Diane Van Opstal
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | - Karin E.M. Diderich
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | - Marieke Joosten
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | | | - Joke Polak
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | - Marjan Boter
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | - Jasper J. Saris
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | - Wai Yee Cheung
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | - Stefanie van Veen
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | - Robert van de Helm
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | - Attie T.J.I. Go
- Department of Obstetrics and Prenatal MedicineErasmus Medical CenterRotterdamThe Netherlands
| | - Maarten F.C.M. Knapen
- Department of Obstetrics and Prenatal MedicineErasmus Medical CenterRotterdamThe Netherlands
| | | | - Anneke Dijkman
- Department of Obstetrics and GynecologyReinier de Graaf GroepDelftThe Netherlands
| | - Femke de Vries
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
| | | | - Lies H. Hoefsloot
- Department of Clinical GeneticsErasmus Medical CenterRotterdamThe Netherlands
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Srebniak MI, Knapen MF, Polak M, Joosten M, Diderich KE, Govaerts LC, Boter M, Kromosoeto JN, van Hassel DAC, Huijbregts G, van IJcken WF, Heydanus R, Dijkman A, Toolenaar T, de Vries FA, Knijnenburg J, Go AT, Galjaard RJH, Van Opstal D. The influence of SNP-based chromosomal microarray and NIPT on the diagnostic yield in 10,000 fetuses with and without fetal ultrasound anomalies. Hum Mutat 2017; 38:880-888. [DOI: 10.1002/humu.23232] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/24/2017] [Accepted: 04/09/2017] [Indexed: 12/11/2022]
Affiliation(s)
| | - Maarten F.C.M. Knapen
- Department of Obstetrics and Gynecology; Erasmus Medical Centre; Rotterdam The Netherlands
- Foundation Prenatal Screening Southwest region of the Netherlands; Rotterdam The Netherlands
| | - Marike Polak
- Institute of Psychology; Erasmus University Rotterdam; Rotterdam The Netherlands
| | - Marieke Joosten
- Department of Clinical Genetics; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Karin E.M. Diderich
- Department of Clinical Genetics; Erasmus Medical Centre; Rotterdam The Netherlands
| | | | - Marjan Boter
- Department of Clinical Genetics; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Joan N.R. Kromosoeto
- Department of Clinical Genetics; Erasmus Medical Centre; Rotterdam The Netherlands
| | | | - Gido Huijbregts
- Department of Clinical Genetics; Erasmus Medical Centre; Rotterdam The Netherlands
| | | | - Roger Heydanus
- Department of Obstetrics and Gynecology; Amphia Hospital; Breda The Netherlands
| | - Anneke Dijkman
- Department of Obstetrics and Gynecology; Reinier de Graaf Gasthuis; Delft The Netherlands
| | - Toon Toolenaar
- Department of Gynecology; Albert Schweitzer Hospital Dordrecht; Dordrecht The Netherlands
| | - Femke A.T. de Vries
- Department of Clinical Genetics; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Jeroen Knijnenburg
- Department of Clinical Genetics; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Attie T.J.I. Go
- Department of Obstetrics and Gynecology; Erasmus Medical Centre; Rotterdam The Netherlands
| | | | - Diane Van Opstal
- Department of Clinical Genetics; Erasmus Medical Centre; Rotterdam The Netherlands
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Verhagen JM, Diderich KE, Oudesluijs G, Mancini GM, Eggink AJ, Verkleij-Hagoort AC, Groenenberg IA, Willems PJ, du Plessis FA, de Man SA, Srebniak MI, van Opstal D, Hulsman LO, van Zutven LJ, Wessels MW. Phenotypic variability of atypical 22q11.2 deletions not includingTBX1. Am J Med Genet A 2012; 158A:2412-20. [DOI: 10.1002/ajmg.a.35517] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 05/10/2012] [Indexed: 11/09/2022]
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