1
|
Donze SH, Srebniak MI, Diderich KEM, van den Born M, Galjaard RJ, Govaerts LCP, van der Schoot V, Knapen MFCM, Joosten M, Van Opstal D. Limited additional value of karyotyping cultured amniotic fluid cell colonies in addition to microarray on uncultured cells for confirmation of abnormal non-invasive prenatal testing results. Prenat Diagn 2024; 44:401-408. [PMID: 38141050 DOI: 10.1002/pd.6499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/18/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Non-invasive prenatal testing (NIPT) allows the detection of placental chromosome aberrations. To verify whether the fetus also has the chromosome aberration, diagnostic follow-up testing is required. The aim of this retrospective study was to assess the added value of analyzing amniotic fluid (AF) cell cultures in addition to uncultured AF cells for the detection of fetal mosaicism. METHOD NIPT was performed as part of the Dutch TRIDENT study. Cytogenetic studies in uncultured AF were performed using single nucleotide polymorphism (SNP)-array. Cultured AF cell colonies (in situ method) were investigated with fluorescent in situ hybridization and/or karyotyping. Clinical outcome data were collected in cases with discordant results. RESULTS Between April 2014 and December 2021, 368 amniocenteses were performed after a chromosomal aberration was detected with NIPT. Excluding 134 cases of common aneuploidies (confirmed by quantitative fluorescence polymerase chain reaction), 29 cases with investigation of uncultured cells only and 1 case without informed consent, 204 cases were eligible for this study. In 196 (96%) cases, the results in uncultured and cultured cells were concordant normal, abnormal or mosaic. Five cases (2%) showed mosaicism in cultured AF cells, whereas uncultured AF cells were normal. Two (1%) of these, one mosaic trisomy 13 and one mosaic trisomy 16, were considered true fetal mosaics. CONCLUSION The added value of investigating AF cell cultures in addition to uncultured cells is limited to two of 204 (1%) cases in which true fetal mosaicsm would otherwise be missed. The clinical relevance of one (trisomy 13) remained unknown and the other case also showed ultrasound anomalies, which determined pregnancy management. This seems to justify limiting prenatal cytogenetic confirmatory testing to SNP arrays on uncultured AF cells, considerably shortening the reporting time.
Collapse
Affiliation(s)
- Stephany H Donze
- Department of Clinical Genetics, ErasmusMC, University Medical Center, Rotterdam, The Netherlands
| | - Malgorzata I Srebniak
- Department of Clinical Genetics, ErasmusMC, University Medical Center, Rotterdam, The Netherlands
| | - Karin E M Diderich
- Department of Clinical Genetics, ErasmusMC, University Medical Center, Rotterdam, The Netherlands
| | - Myrthe van den Born
- Department of Clinical Genetics, ErasmusMC, University Medical Center, Rotterdam, The Netherlands
| | - Robert-Jan Galjaard
- Department of Clinical Genetics, ErasmusMC, University Medical Center, Rotterdam, The Netherlands
| | - Lutgarde C P Govaerts
- Department of Clinical Genetics, ErasmusMC, University Medical Center, Rotterdam, The Netherlands
| | - Vyne van der Schoot
- Department of Clinical Genetics, ErasmusMC, University Medical Center, Rotterdam, The Netherlands
| | - Maarten F C M Knapen
- Department of Obstetrics and Prenatal Medicine, ErasmusMC, University Medical Center, Rotterdam, The Netherlands
| | - Marieke Joosten
- Department of Clinical Genetics, ErasmusMC, University Medical Center, Rotterdam, The Netherlands
| | - Diane Van Opstal
- Department of Clinical Genetics, ErasmusMC, University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
2
|
Eggenhuizen GM, Go ATJI, Sauter Z, Hoffer MJV, Haak MC, Geeven G, Diderich KEM, Joosten M, van den Born M, Srebniak MI, Van Opstal D. The role of confined placental mosaicism in fetal growth restriction: A retrospective cohort study. Prenat Diagn 2024; 44:289-296. [PMID: 38342960 DOI: 10.1002/pd.6533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/10/2024] [Accepted: 01/23/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE To evaluate which cytogenetic characteristics of confined placental mosaicism (CPM) detected in the first trimester chorionic villi and/or placentas in terms of chromosome aberration, cell lineage involved and trisomy origin will lead to fetal growth restriction and low birthweight. METHODS Cohort study using routinely collected perinatal data and cytogenetic data of non-invasive prenatal testing, the first trimester chorionic villi sampling and postnatal placentas. RESULTS 215 CPM cases were found. Fetal growth restriction (FGR) and low birthweight below the 10th percentile (BW < p10) were seen in 34.0% and 23.1%, respectively. Excluding cases of trisomy 16, 29.1% showed FGR and 17.9% had a BW < p10. The highest rate of FGR and BW < p10 was found in CPM type 3, but differences with type 1 and 2 were not significant. FGR and BW < p10 were significantly more often observed in cases with meiotic trisomies. CONCLUSION There is an association between CPM and FGR and BW < p10. This association is not restricted to trisomy 16, neither to CPM type 3, nor to CPM involving a meiotic trisomy. Pregnancies with all CPM types and origins should be considered to be at increased risk of FGR and low BW < p10. A close prenatal fetal monitoring is indicated in all cases of CPM.
Collapse
Affiliation(s)
- Geerke M Eggenhuizen
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Attie T J I Go
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Zoë Sauter
- Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Mariëtte J V Hoffer
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique C Haak
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Geert Geeven
- Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Karin E M Diderich
- Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marieke Joosten
- Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Myrthe van den Born
- Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Malgorzata I Srebniak
- Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Diane Van Opstal
- Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
3
|
Borrell A, Figueras F. Placental and genetic origins of fetal growth restriction are independent and may overlap. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:317-319. [PMID: 37428946 DOI: 10.1002/uog.26304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 07/12/2023]
Affiliation(s)
- A Borrell
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic Barcelona, Barcelona, Catalonia, Spain
- Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - F Figueras
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic Barcelona, Barcelona, Catalonia, Spain
- Universitat de Barcelona, Barcelona, Catalonia, Spain
| |
Collapse
|
4
|
Dyhr JJ, Linderoth IR, Hansen DN, Frøkjaer JB, Peters DA, Sinding M, Sørensen A. Confined placental mosaicism: placental size and function evaluated on magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:130-136. [PMID: 36730148 DOI: 10.1002/uog.26174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Evidence regarding placental function in pregnancies complicated by confined placental mosaicism (CPM) is conflicting. We aimed to compare placental function between CPM and non-CPM pregnancies prenatally and at birth. A secondary objective was to evaluate the relationship between placental function and chromosomal subtype of CPM. METHODS This was a retrospective study of pregnancies with CPM and control pregnancies delivered at a tertiary hospital in Denmark between 2014 and 2017. Placental volume and placental transverse relaxation time (T2*) were estimated on magnetic resonance imaging (MRI), fetal weight and uterine artery pulsatility index (UtA-PI) were estimated on ultrasound and fetoplacental ratio was assessed on MRI and at birth. These estimates of placental function were adjusted for gestational age and compared between groups using the Wilcoxon rank-sum test. Within the group of CPM pregnancies, measures of placental function were compared between those at high risk (chromosome numbers 2, 3, 7, 13 and 16) and those at low risk (chromosome numbers 5, 18 and 45X). RESULTS A total of 90 pregnancies were included, of which 12 had CPM and 78 were controls. MRI and ultrasound examinations were performed at a median gestational age of 32.6 weeks (interquartile range, 24.7-35.3 weeks). On MRI assessment, CPM placentae were characterized by a lower placental T2* Z-score (P = 0.004), a lower fetoplacental ratio (P = 0.03) and a higher UtA-PI Z-score (P = 0.03), compared with non-CPM placentae. At birth, the fetoplacental ratio was significantly lower (P = 0.02) and placental weight Z-score was higher (P = 0.01) in CPM pregnancies compared with non-CPM pregnancies. High-risk CPM pregnancies showed a reduced placental T2* Z-score (P = 0.003), lower birth-weight Z-score (P = 0.041), earlier gestational age at delivery (P = 0.019) and higher UtA-PI Z-score (P = 0.028) compared with low-risk CPM pregnancies. Low-risk CPM pregnancies did not differ in any of these parameters from non-CPM pregnancies. CONCLUSIONS CPM pregnancies are characterized by an enlarged and dysfunctional placenta. Placental function was highly related to the chromosomal type of CPM; placental dysfunction was seen predominantly in high-risk CPM pregnancies in which chromosomes 2, 3, 7, 13 or 16 were involved. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- J J Dyhr
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - I R Linderoth
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - D N Hansen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - J B Frøkjaer
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - D A Peters
- Department of Clinical Engineering, Central Denmark Region, Aarhus, Denmark
| | - M Sinding
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - A Sørensen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
5
|
Spinillo SL, Farina A, Sotiriadis A, Pozzoni M, Giglio S, Papale M, Candiani M, Cavoretto PI. Pregnancy outcome of confined placental mosaicism: meta-analysis of cohort studies. Am J Obstet Gynecol 2022; 227:714-727.e1. [PMID: 35934121 DOI: 10.1016/j.ajog.2022.07.034] [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: 05/04/2022] [Revised: 07/13/2022] [Accepted: 07/20/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to assess the rate of adverse obstetrical and neonatal outcomes in pregnancies diagnosed with confined placental mosaicism relative to that of unaffected controls. DATA SOURCES Web-based databases were searched using relevant key words, and articles published from 1980 to February 2022 were retrieved. STUDY ELIGIBILITY CRITERIA Observational studies in English language including ≥10 cases of singleton pregnancies with diagnosis of confined placental mosaicism were included. The diagnosis was established after detection of any chromosomal abnormality at chorionic villus sampling for any indication, followed by normal karyotype from amniotic fluid or neonatal leukocyte culture. METHODS Two authors independently screened the references for eligibility, data extraction, and assessment of methodological quality using the Newcastle-Ottawa scale. All available obstetrical and neonatal outcomes were recorded. Random-effect meta-analysis was performed to estimate pooled odds ratios and 95% confidence intervals of available outcomes in pregnancies with and without confined placental mosaicism. Statistical heterogeneity was evaluated with I2 statistics (International Prospective Register of Systematic Reviews registration number: CRD42021260319). RESULTS Of the 80 articles reviewed, 8 retrospective matched-cohort studies (708 cases of confined placental mosaicism and 11,599 unaffected controls) compared cases with and without confined placental mosaicism and were included in the meta-analysis. The risk of delivering small-for-gestational-age neonates was significantly increased in confined placental mosaicism pregnancies according to crude analysis (odds ratio, 2.45; 95% confidence interval, 1.23-4.89; I2=72%) and to sensitivity analysis of high-quality studies (odds ratio, 3.65; 95% confidence interval, 2.43-5.57; I2=0%). Similarly, confined placental mosaicism resulted in an increased risk of birthweight below the third centile (odds ratio, 5.33; 95% confidence interval, 1.19-24.19; I2= 83%). Subgroup analysis revealed that the risk of delivering small-for-gestational-age neonates was 3-fold higher for confined placental mosaicism excluding trisomy 16, and 11-fold higher for cases including trisomy 16 only vs unaffected controls, respectively. No difference was found in the risk of low birthweight and preterm birth (at <37 weeks' gestation). Other outcomes were insufficiently reported, therefore they were not analyzed. CONCLUSION Pregnant women prenatally diagnosed with confined placental mosaicism have an increased risk of impaired fetal growth, suggesting the need for intensified antenatal surveillance.
Collapse
Affiliation(s)
- Silvia L Spinillo
- Department of Gynecology and Obstetrics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Farina
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery, (DIMEC) IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alexandros Sotiriadis
- Faculty of Medicine, Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Ippokrateio Hospital of Thessaloniki, Thessaloniki, Greece
| | - Mirko Pozzoni
- Department of Gynecology and Obstetrics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Sabrina Giglio
- Departments of Medical Science and Public Health and Medical Genetics, Binaghi Hospital, Cagliari, Italy
| | - Margherita Papale
- Department of Gynecology and Obstetrics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Candiani
- Department of Gynecology and Obstetrics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo I Cavoretto
- Department of Gynecology and Obstetrics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
| |
Collapse
|
6
|
Eren Karanis MI, Zamani AG. Localized Placental Mesenchymal Dysplasia in Monochorionic Diamniotic Twin Placenta with Beckwith-Wiedemann Syndrome. Fetal Pediatr Pathol 2022; 41:657-664. [PMID: 33356737 DOI: 10.1080/15513815.2020.1865492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
IntroductionPlacental mesenchymal dysplasia (PMD) is often associated with Beckwith-Wiedemann syndrome. Case report: A 27-year-old woman with preeclampsia prematurely delivered twin girls. One side of the placenta was larger with numerous grape-like vesicles, histologically with large, cystic, stem villi with cisterns without syncytiotrophoblastic hyperplasia. This side showed mosaicism for chromosome 11 by FISH and hypomethylation at ICR2 by MLPA. The smaller side of the placenta was normal macroscopically, microscopically, and karyotypically. There was symmetric growth restriction, macroglossia and hypoglycemia of the girl corresponding to the abnormal placental side, and lesser symmetric growth restriction and mild hypoglycemia in the other girl. Conclusion: Localized placental mesenchymal dysplasia can occur in monochorionic diamniotic twin placenta with Beckwith-Wiedemann syndrome. Fetal affects may be asymmetric. PMD can be associated with mosaicism monosomy of chromosome 11.
Collapse
Affiliation(s)
| | - Ayse Gül Zamani
- Medical Genetics, Necmettin Erbakan University Meram Medical Faculty Hospital, Konya, Turkey
| |
Collapse
|
7
|
Harasim T, Neuhann T, Behnecke A, Stampfer M, Holinski-Feder E, Abicht A. Initial Clinical Experience with NIPT for Rare Autosomal Aneuploidies and Large Copy Number Variations. J Clin Med 2022; 11:jcm11020372. [PMID: 35054066 PMCID: PMC8777675 DOI: 10.3390/jcm11020372] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Amniocentesis, chorionic villi sampling and first trimester combined testing are able to screen for common trisomies 13, 18, and 21 and other atypical chromosomal anomalies (ACA). The most frequent atypical aberrations reported are rare autosomal aneuploidies (RAA) and copy number variations (CNV), which are deletions or duplications of various sizes. We evaluated the clinical outcome of non-invasive prenatal testing (NIPT) results positive for RAA and large CNVs to determine the clinical significance of these abnormal results. METHODS Genome-wide NIPT was performed on 3664 eligible patient samples at a single genetics center. For patients with positive NIPT reports, the prescribing physician was asked retrospectively to provide clinical follow-up information using a standardized questionnaire. RESULTS RAAs and CNVs (>7 Mb) were detected in 0.5%, and 0.2% of tested cases, respectively. Follow up on pregnancies with an NIPT-positive result for RAA revealed signs of placental insufficiency or intra-uterine death in 50% of the cases and normal outcome at the time of birth in the other 50% of cases. We showed that CNV testing by NIPT allows for the detection of unbalanced translocations and relevant maternal health conditions. CONCLUSION NIPT for aneuploidies of all autosomes and large CNVs of at least 7 Mb has a low "non-reportable"-rate (<0.2%) and allows the detection of additional conditions of clinical significance.
Collapse
|
8
|
Gou L, Fang Y, Wang N, Zhang M, Liu T, Wang Y, Hu S, Zhang Y, Wu Q, Wang Y, Suo F, Gu M. Clinical management of pregnancies with positive screening results for rare autosomal aneuploidies at a single center. J Int Med Res 2021; 48:300060520966877. [PMID: 33167762 PMCID: PMC7658522 DOI: 10.1177/0300060520966877] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective To review our experiences on clinical management of pregnancies with positive noninvasive prenatal testing (NIPT) results for rare autosomal aneuploidies (RAAs) at a single center. Methods We performed a retrospective study and reviewed data from 18,016 pregnancies undergoing NIPT at a single center in China from March 2017 to February 2020. Depending on the patient’s choice, women with positive screening results for RAAs underwent chromosomal microarray analysis for invasive prenatal diagnosis. Results Thirty-three positive cases for RAAs were identified, with a positive screening rate of 0.18%. The most common RAA was trisomy 7 (33.3%), while trisomies for other chromosomes were less frequent. Monosomies involving chromosomes 16, 14, and 22 were observed. Twenty-eight cases of RAAs underwent invasive diagnosis. Abnormal pregnancy outcomes were observed in four cases, including true fetal mosaicism (n=1), partial uniparental disomy (n=1), miscarriage (n=1), and structural anomalies on ultrasound (n=1). Conclusions RAAs at NIPT might be associated with fetal uniparental disomy, mosaic aneuploidy, and poor pregnancy outcomes, but most positive cases have normal pregnancy outcomes. For RAAs, genetic counseling on the potential risks of abnormal NIPT results, as well as on benefits and limitations of invasive prenatal diagnosis, might help guide clinical management.
Collapse
Affiliation(s)
- Lingshan Gou
- Center for Genetic Medicine, Maternity and Child Health Care Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yuan Fang
- Center for Genetic Medicine, Maternity and Child Health Care Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Na Wang
- DAAN Gene Co., Ltd. of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Man Zhang
- Zhejiang Biosan Biochemical Technologies Co., Ltd., Hangzhou, Zhejiang, China
| | - Tianya Liu
- Department of Pharmacy, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yi Wang
- Center for Genetic Medicine, Maternity and Child Health Care Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shunan Hu
- Office of Scientific Research & Henan Provincial Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yan Zhang
- Center for Genetic Medicine, Maternity and Child Health Care Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Qin Wu
- Zhejiang Biosan Biochemical Technologies Co., Ltd., Hangzhou, Zhejiang, China
| | - Yifan Wang
- Department of Ultrasound, Maternity and Child Health Care Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Feng Suo
- Center for Genetic Medicine, Maternity and Child Health Care Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Maosheng Gu
- Center for Genetic Medicine, Maternity and Child Health Care Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, China
| |
Collapse
|
9
|
Eggenhuizen GM, Go A, Koster MPH, Baart EB, Galjaard RJ. Confined placental mosaicism and the association with pregnancy outcome and fetal growth: a review of the literature. Hum Reprod Update 2021; 27:885-903. [PMID: 33984128 PMCID: PMC8382909 DOI: 10.1093/humupd/dmab009] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/30/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chromosomal mosaicism can be detected in different stages of early life: in cleavage stage embryos, in blastocysts and biopsied cells from blastocysts during preimplantation genetic testing for aneuploidies (PGT-A) and later during prenatal testing, as well as after birth in cord blood. Mosaicism at all different stages can be associated with adverse pregnancy outcomes. There is an onward discussion about whether blastocysts diagnosed as chromosomally mosaic by PGT-A should be considered safe for transfer. An accurate diagnosis of mosaicism remains technically challenging and the fate of abnormal cells within an embryo remains largely unknown. However, if aneuploid cells persist in the extraembryonic tissues, they can give rise to confined placental mosaicism (CPM). Non-invasive prenatal testing (NIPT) uses cell-free (cf) DNA released from the placenta in maternal blood, facilitating the detection of CPM. In literature, conflicting evidence is found about whether CPM is associated with fetal growth restriction (FGR) and/or other pregnancy outcomes. This makes counselling for patients by clinicians challenging and more knowledge is needed for clinical decision and policy making. OBJECTIVE AND RATIONALE The objective of this review is to evaluate the association between CPM and prenatal growth and adverse pregnancy outcomes. All relevant literature has been reviewed in order to achieve an overview on merged results exploring the relation between CPM and FGR and other adverse pregnancy outcomes. SEARCH METHODS The following Medical Subject Headings (MESH) terms and all their synonyms were used: placental, trophoblast, cytotrophoblast, mosaicism, trisomy, fetal growth, birth weight, small for gestational age and fetal development. A search in Embase, PubMed, Medline Ovid, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar databases was conducted. Relevant articles published until 16 July 2020 were critically analyzed and discussed. OUTCOMES There were 823 articles found and screened based on their title/abstract. From these, 213 articles were selected and full text versions were obtained for a second selection, after which 70 publications were included and 328 cases (fetuses) were analyzed. For CPM in eight different chromosomes (of the total 14 analyzed), there was sufficient evidence that birth weight was often below the 5th percentile of fetal growth standards. FGR was reported in 71.7% of CPM cases and preterm birth (<37 weeks of delivery) was reported in 31.0% of cases. A high rate of structural fetal anomalies, 24.2%, in cases with CPM was also identified. High levels of mosaicism in CVS and presence of uniparental disomy (UPD) were significantly associated with adverse pregnancy outcomes. WIDER IMPLICATIONS Based on the literature, the advice to clinicians is to monitor fetal growth intensively from first trimester onwards in case of CPM, especially when chromosome 2, 3, 7, 13, 15, 16 and 22 are involved. In addition to this, it is advised to examine the fetuses thoroughly for structural fetal anomalies and raise awareness of a higher chance of (possibly extreme) premature birth. Despite prematurity in nearly a fifth of cases, the long-term follow-up of CPM life borns seems to be positive. More understanding of the biological mechanisms behind CPM will help in prioritizing embryos for transfer after the detection of mosaicism in embryos through PGT-A.
Collapse
Affiliation(s)
- Geerke M Eggenhuizen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam 3015CN, The Netherlands
| | - Attie Go
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam 3015CN, The Netherlands
| | - Maria P H Koster
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam 3015CN, The Netherlands
| | - Esther B Baart
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam 3015CN, The Netherlands.,Department of Developmental Biology, Erasmus MC, University Medical Center, Rotterdam 3015CN, The Netherlands
| | - Robert Jan Galjaard
- Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam 3015CN, The Netherlands
| |
Collapse
|
10
|
Del Gobbo GF, Yin Y, Choufani S, Butcher EA, Wei J, Rajcan-Separovic E, Bos H, von Dadelszen P, Weksberg R, Robinson WP, Yuen RKC. Genomic imbalances in the placenta are associated with poor fetal growth. Mol Med 2021; 27:3. [PMID: 33413077 PMCID: PMC7792164 DOI: 10.1186/s10020-020-00253-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022] Open
Abstract
Background Fetal growth restriction (FGR) is associated with increased risks for complications before, during, and after birth, in addition to risk of disease through to adulthood. Although placental insufficiency, failure to supply the fetus with adequate nutrients, underlies most cases of FGR, its causes are diverse and not fully understood. One of the few diagnosable causes of placental insufficiency in ongoing pregnancies is the presence of large chromosomal imbalances such as trisomy confined to the placenta; however, the impact of smaller copy number variants (CNVs) has not yet been adequately addressed. In this study, we confirm the importance of placental aneuploidy, and assess the potential contribution of CNVs to fetal growth. Methods We used molecular-cytogenetic approaches to identify aneuploidy in placentas from 101 infants born small-for-gestational age (SGA), typically used as a surrogate for FGR, and from 173 non-SGA controls from uncomplicated pregnancies. We confirmed aneuploidies and assessed mosaicism by microsatellite genotyping. We then profiled CNVs using high-resolution microarrays in a subset of 53 SGA and 61 control euploid placentas, and compared the load, impact, gene enrichment and clinical relevance of CNVs between groups. Candidate CNVs were confirmed using quantitative PCR. Results Aneuploidy was over tenfold more frequent in SGA-associated placentas compared to controls (11.9% vs. 1.1%; p = 0.0002, OR = 11.4, 95% CI 2.5–107.4), was confined to the placenta, and typically involved autosomes, whereas only sex chromosome abnormalities were observed in controls. We found no significant difference in CNV load or number of placental-expressed or imprinted genes in CNVs between SGA and controls, however, a rare and likely clinically-relevant germline CNV was identified in 5.7% of SGA cases. These CNVs involved candidate genes INHBB, HSD11B2, CTCF, and CSMD3. Conclusions We conclude that placental genomic imbalances at the cytogenetic and submicroscopic level may underlie up to ~ 18% of SGA cases in our population. This work contributes to the understanding of the underlying causes of placental insufficiency and FGR, which is important for counselling and prediction of long term outcomes for affected cases.
Collapse
Affiliation(s)
- Giulia F Del Gobbo
- BC Children's Hospital Research Institute, 950 W 28th Ave, Vancouver, V5Z 4H4, Canada.,Department of Medical Genetics, University of British Columbia, 4500 Oak St, Vancouver, V6H 3N1, Canada
| | - Yue Yin
- Genetics and Genome Biology Program, The Hospital for Sick Children, 686 Bay St, Toronto, M5G 0A4, Canada
| | - Sanaa Choufani
- Genetics and Genome Biology Program, The Hospital for Sick Children, 686 Bay St, Toronto, M5G 0A4, Canada
| | - Emma A Butcher
- Genetics and Genome Biology Program, The Hospital for Sick Children, 686 Bay St, Toronto, M5G 0A4, Canada
| | - John Wei
- The Centre for Applied Genomics, Genetics and Genome Biology, The Hospital for Sick Children, 686 Bay St, Toronto, M5G 0A4, Canada
| | - Evica Rajcan-Separovic
- Department of Pathology and Laboratory Medicine, University of British Columbia, 2211 Wesbrook Mall, Vancouver, V6T 2B5, Canada
| | - Hayley Bos
- Department of Perinatology, Victoria General Hospital, 1 Hospital Way, Victoria, V8Z 6R5, Canada.,Department of Obstetrics & Gynecology, University of British Columbia, Suite 930, 1125 Howe St, Vancouver, BC, V6Z 2K8, Canada
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, SE1 7EU, UK
| | - Rosanna Weksberg
- Genetics and Genome Biology Program, The Hospital for Sick Children, 686 Bay St, Toronto, M5G 0A4, Canada.,Department of Molecular Genetics, Institute of Medical Sciences, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada.,Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Suite 940, 525 University Avenue, Toronto, ON, M5G 1X8, Canada.,Department of Paediatrics, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Wendy P Robinson
- BC Children's Hospital Research Institute, 950 W 28th Ave, Vancouver, V5Z 4H4, Canada. .,Department of Medical Genetics, University of British Columbia, 4500 Oak St, Vancouver, V6H 3N1, Canada.
| | - Ryan K C Yuen
- The Centre for Applied Genomics, Genetics and Genome Biology, The Hospital for Sick Children, 686 Bay St, Toronto, M5G 0A4, Canada. .,Department of Molecular Genetics, University of Toronto, 1 King's College Circle, Toronto, M5S 1A8, Canada.
| |
Collapse
|
11
|
Bianchi DW, Deprest J, Levy B, Chitty LS, Ghidini A, Hui L, van Mieghem T, George ST. The 2019 Malcolm Ferguson-Smith Young Investigator Award. Prenat Diagn 2020; 40:763-765. [PMID: 32597540 DOI: 10.1002/pd.5763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Diana W Bianchi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Jan Deprest
- Departments of Obstetrics and Gynaecology, University Hospitals, Leuven, Belgium
| | - Brynn Levy
- Departments of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | - Lyn S Chitty
- Genetic and Genomic Medicine, University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Alessandro Ghidini
- Antenatal Testing Center, Inova Alexandria Hospital, Alexandria, VA, USA
| | - Lisa Hui
- Departments of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | | | | |
Collapse
|
12
|
Bardos J, Fiorentino D, Longman RE, Paidas M. Immunological Role of the Maternal Uterine Microbiome in Pregnancy: Pregnancies Pathologies and Alterated Microbiota. Front Immunol 2020; 10:2823. [PMID: 31969875 PMCID: PMC6960114 DOI: 10.3389/fimmu.2019.02823] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/15/2019] [Indexed: 12/18/2022] Open
Abstract
Understanding what happens at the time of embryo implantation has been the subject of significant research. Investigators from many differing fields including maternal fetal medicine, microbiology, genetics, reproductive endocrinology and immunology have all been studying the moment the embryo interacts with the maternal endometrium. A perfect relationship between the uterus and the embryo, mediated by a tightly controlled interaction between the embryo and the endometrium, is required for successful implantation. Any factors affecting this communication, such as altered microbiome may lead to poor reproductive outcomes. Current theories suggest that altered microbiota may trigger an inflammatory response in the endometrium that affects the success of embryo implantation, as inflammatory mediators are tightly regulated during the adhesion of the blastocyst to the epithelial endometrial wall. In this review, we will highlight the various microbiome found during the periconceptual period, the microbiomes interaction with immunological responses surrounding the time of implantation, its effect on implantation, placentation and ultimately maternal and neonatal outcomes.
Collapse
Affiliation(s)
- Jonah Bardos
- Department of Obstetrics and Gynecology, Miller School of Medicine, University of Miami, Miami, FL, United States.,Division of Clinical and Translational Genetics, Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Desiree Fiorentino
- Department of Obstetrics and Gynecology, Miller School of Medicine, University of Miami, Miami, FL, United States.,Division of Clinical and Translational Genetics, Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Ryan E Longman
- Department of Obstetrics and Gynecology, Miller School of Medicine, University of Miami, Miami, FL, United States.,Division of Clinical and Translational Genetics, Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Michael Paidas
- Department of Obstetrics and Gynecology, Miller School of Medicine, University of Miami, Miami, FL, United States
| |
Collapse
|
13
|
|
14
|
Type 3 confined placental mosaicisms excluding trisomies 16 are also associated with adverse pregnancy outcomes. Genet Med 2019; 22:446-447. [DOI: 10.1038/s41436-019-0664-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/17/2019] [Indexed: 11/09/2022] Open
|
15
|
Grau Madsen S, Uldbjerg N, Sunde L, Becher N. Prognosis for pregnancies with trisomy 16 confined to the placenta: A Danish cohort study. Prenat Diagn 2019; 38:1103-1110. [PMID: 30328629 DOI: 10.1002/pd.5370] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 09/30/2018] [Accepted: 10/04/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the risk of adverse pregnancy outcome when trisomy 16 confined to the placenta is diagnosed and to identify possible prognostic markers for adverse outcomes in these pregnancies. METHOD Registered cases (n = 49) of trisomy 16 diagnosed prenatally in Denmark from 1990 to 2013 were included. RESULTS Twenty-five of the pregnancies intended to be continued had confined placental trisomy 16 mosaicism (CPM16). Adverse pregnancy outcome was seen in 17 CPM16 pregnancies (68%), ranging from mild small for gestational age (SGA) to fetal malformations and intrauterine demise. For cases ascertained by combined first trimester screening, the median concentration of pregnancy associated plasma protein A (PAPP-A) was 0.17 MoM (IQR: 0.11 MoM). Adverse pregnancy outcome showed a trend toward an association with a high frequency of trisomic cells. Eight children (32%) were born at term with a normal birth weight and no malformations. CONCLUSION The risk of adverse pregnancy outcome in case of CPM16 is correlated to ascertainment by combined first trimester screening and tends to be associated with a high frequency of trisomic cells in the placenta. We recommend that variables including ascertainment, the frequency of trisomic cells, and the maternal serum concentration of PAPP-A are taken into consideration when evaluating the prognosis in CPM16 while acknowledging that these factors are strongly correlated.
Collapse
Affiliation(s)
- Sandra Grau Madsen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Sunde
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Naja Becher
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark.,Center for Fetal Diagnostics, Aarhus University Hospital, Denmark
| | | | | |
Collapse
|
16
|
Bianchi DW, Ghidini A, Levy B, Deprest J, van Mieghem T, Chitty LS, Hui L, McLean-Inglis A. The 2018 Malcolm Ferguson-Smith Young Investigator Award. Prenat Diagn 2019; 39:835-837. [PMID: 31414475 DOI: 10.1002/pd.5533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Diana W Bianchi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Alessandro Ghidini
- Department of Obstetrics and Gynecology, Inova Alexandria Hospital, Alexandria, VA, USA
| | - Brynn Levy
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | - Jan Deprest
- Academic Department of Development and Regeneration, Woman and Child, Biomedical Sciences, and Clinical Department of Obstetrics and Gynaecology, KU Leuven, Leuven, Belgium
| | - Tim van Mieghem
- Departments of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Canada
| | - Lyn S Chitty
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Lisa Hui
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
| | | |
Collapse
|
17
|
Wilkins-Haug L, Zhang C, Cerveira E, Ryan M, Mil-Homens A, Zhu Q, Reddi H, Lee C, Bianchi DW. Biological explanations for discordant noninvasive prenatal test results: Preliminary data and lessons learned. Prenat Diagn 2019; 38:445-458. [PMID: 29633279 DOI: 10.1002/pd.5260] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/25/2018] [Accepted: 03/29/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Maternal plasma cell-free DNA (cfDNA) analysis is a powerful screening tool for Down syndrome. In a pilot series, we examined biologic causes of discordance between the cfDNA test results and the fetal karyotype. We also explored the feasibility of obtaining trio biospecimens by using parental engagement. METHODS A convenience sample of women with discordant cfDNA results were recruited by their care providers. We provided shipping materials and instructions for biospecimen collection. Maternal, newborn, and placental samples were examined with droplet digital PCR. RESULTS Thirteen of 15 women successfully had biospecimens obtained remotely. High-quality DNA was extracted in 12 of 13 women. Presumed biologic etiologies for discordance were identified in 7 of 12 women: 3 cases from additional clinical review (male renal transplant, vanishing twin, and colon cancer) and 4 cases from additional laboratory investigation using droplet digital PCR (3 with confined placental mosaicism and 1 with true fetal mosaicism). CONCLUSIONS Understanding the biology behind cfDNA-fetal karyotype discordancy is useful for follow-up clinical care. Our study suggests that most cases could be resolved by using a trio biospecimen protocol and parental involvement. To improve accuracy, additional sequencing of biospecimens will be required.
Collapse
Affiliation(s)
- Louise Wilkins-Haug
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Eliza Cerveira
- Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Mallory Ryan
- Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Adam Mil-Homens
- Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Qihui Zhu
- Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Honey Reddi
- Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Charles Lee
- Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Diana W Bianchi
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA, USA.,Prenatal Genomics and Therapy Section, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
18
|
Geok-Huey N, Kuo PL, Chang CH. False positive result in non-invasive prenatal screening (NIPS). Taiwan J Obstet Gynecol 2018; 57:772-773. [PMID: 30342672 DOI: 10.1016/j.tjog.2018.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- New Geok-Huey
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan
| | - Pao-Lin Kuo
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan
| | - Chiung-Hsin Chang
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan.
| |
Collapse
|
19
|
Bianchi DW, Ghidini A, Levy B, Deprest J, Van Mieghem T, Chitty LS, McLean-Inglis AJL. The 2017 Malcolm Ferguson-Smith Young Investigator Award. Prenat Diagn 2018; 38:545-546. [PMID: 29952009 DOI: 10.1002/pd.5289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Diana W Bianchi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | | | - Brynn Levy
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | - Jan Deprest
- Academic Department of Development and Regeneration, Woman and Child, Biomedical Sciences, and Clinical Department of Obstetrics and Gynaecology, KU Leuven, Leuven, Belgium
| | - Tim Van Mieghem
- Departments of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Canada
| | - Lyn S Chitty
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | | |
Collapse
|
20
|
Pertile MD, Halks-Miller M, Flowers N, Barbacioru C, Kinnings SL, Vavrek D, Seltzer WK, Bianchi DW. Rare autosomal trisomies, revealed by maternal plasma DNA sequencing, suggest increased risk of feto-placental disease. Sci Transl Med 2018; 9:9/405/eaan1240. [PMID: 28855395 PMCID: PMC10040211 DOI: 10.1126/scitranslmed.aan1240] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/22/2017] [Accepted: 08/10/2017] [Indexed: 12/13/2022]
Abstract
Whole-genome sequencing (WGS) of maternal plasma cell-free DNA (cfDNA) can potentially evaluate all 24 chromosomes to identify abnormalities of the placenta, fetus, or pregnant woman. Current bioinformatics algorithms typically only report on chromosomes 21, 18, 13, X, and Y; sequencing results from other chromosomes may be masked. We hypothesized that by systematically analyzing WGS data from all chromosomes, we could identify rare autosomal trisomies (RATs) to improve understanding of feto-placental biology. We analyzed two independent cohorts from clinical laboratories, both of which used a similar quality control parameter, normalized chromosome denominator quality. The entire data set included 89,817 samples. Samples flagged for analysis and classified as abnormal were 328 of 72,932 (0.45%) and 71 of 16,885 (0.42%) in cohorts 1 and 2, respectively. Clinical outcome data were available for 57 of 71 (80%) of abnormal cases in cohort 2. Visual analysis of WGS data demonstrated RATs, copy number variants, and extensive genome-wide imbalances. Trisomies 7, 15, 16, and 22 were the most frequently observed RATs in both cohorts. Cytogenetic or pregnancy outcome data were available in 52 of 60 (87%) of cases with RATs in cohort 2. Cases with RATs detected were associated with miscarriage, true fetal mosaicism, and confirmed or suspected uniparental disomy. Comparing the trisomic fraction with the fetal fraction allowed estimation of possible mosaicism. Analysis and reporting of aneuploidies in all chromosomes can clarify cases in which cfDNA findings on selected "target" chromosomes (21, 18, and 13) are discordant with the fetal karyotype and may identify pregnancies at risk of miscarriage and other complications.
Collapse
Affiliation(s)
- Mark D Pertile
- Victorian Clinical Genetics Services, Murdoch Childrens Research Institute, Melbourne, Victoria 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria 3010, Australia
| | | | - Nicola Flowers
- Victorian Clinical Genetics Services, Murdoch Childrens Research Institute, Melbourne, Victoria 3052, Australia
| | | | | | | | | | - Diana W Bianchi
- Tufts Medical Center and Tufts University School of Medicine, Boston, MA 02111, USA. .,National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| |
Collapse
|
21
|
Toutain J, Goutte-Gattat D, Horovitz J, Saura R. Confined placental mosaicism revisited: Impact on pregnancy characteristics and outcome. PLoS One 2018; 13:e0195905. [PMID: 29649318 PMCID: PMC5897023 DOI: 10.1371/journal.pone.0195905] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/02/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We wanted to re-evaluate the influence of confined placental mosaicism subtypes (type 2 and type 3) on pregnancy characteristics and outcome. MATERIAL AND METHODS From July 2009 to December 2015, 5512 chorionic villus samplings were performed in our Fetal Medicine Center. Conventional karyotyping was performed after long-term and short-term cultured villi to define type 2 or type 3 confined placental mosaicisms. Karyotype after amniocentesis was performed to exclude true fetal mosaicism, when appropriate. Pregnancy characteristics and outcomes were collected and compared to a control population. RESULTS Thirty-six (0.65%) confined placental mosaicisms were observed (13 type 2 and 23 type 3). Nuchal translucency was not increased for type 2 and type 3 confined placental mosaicisms. Pregnancy characteristics and outcomes were comparable between type 2 confined placental mosaicisms and the control population. In type 3 confined placental mosaicisms, median first trimester serum pregnancy-associated plasma protein A was lower than for the control population (p<0.001), preterm births were noticed in 56% (p<0.001), small for gestational age newborns in 74% (p<0.001), and adverse pregnancy outcome was reported in 35% (p<0.01). CONCLUSION Although type 2 confined placental mosaicisms appeared to have no influence on pregnancy characteristics and outcome, type 3 confined placental mosaicisms were associated with low levels of first trimester serum pregnancy-associated plasma protein A, preterm birth, small for gestational age newborns, and adverse pregnancy outcomes.
Collapse
Affiliation(s)
- Jérôme Toutain
- CHU de Bordeaux, Service de Génétique Médicale, Bordeaux, France
| | | | | | | |
Collapse
|
22
|
Benn P, Grati FR. Genome-wide non-invasive prenatal screening for all cytogenetically visible imbalances. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:429-433. [PMID: 29363829 DOI: 10.1002/uog.19014] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/28/2017] [Accepted: 01/15/2018] [Indexed: 06/07/2023]
Affiliation(s)
- P Benn
- Department of Genetics and Genome Sciences, University of Connecticut Health Center, Farmington, CT, USA
| | - F R Grati
- TOMA, Advanced Biomedical Assays S.p.A, Busto Arsizio, Varese, Italy
| |
Collapse
|
23
|
Van Opstal D, van Maarle MC, Lichtenbelt K, Weiss MM, Schuring-Blom H, Bhola SL, Hoffer MJV, Huijsdens-van Amsterdam K, Macville MV, Kooper AJA, Faas BHW, Govaerts L, Tan-Sindhunata GM, den Hollander N, Feenstra I, Galjaard RJH, Oepkes D, Ghesquiere S, Brouwer RWW, Beulen L, Bollen S, Elferink MG, Straver R, Henneman L, Page-Christiaens GC, Sistermans EA. Origin and clinical relevance of chromosomal aberrations other than the common trisomies detected by genome-wide NIPS: results of the TRIDENT study. Genet Med 2018; 20:480-485. [PMID: 29121006 PMCID: PMC5929118 DOI: 10.1038/gim.2017.132] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/30/2017] [Indexed: 12/23/2022] Open
Abstract
PurposeNoninvasive prenatal screening (NIPS) using cell-free DNA in maternal blood is highly sensitive for detecting fetal trisomies 21, 18, and 13. Using a genome-wide approach, other chromosome anomalies can also be detected. We report on the origin, frequency, and clinical significance of these other chromosome aberrations found in pregnancies at risk for trisomy 21, 18, or 13.MethodsWhole-genome shallow massively parallel sequencing was used and all autosomes were analyzed.ResultsIn 78 of 2,527 cases (3.1%) NIPS was indicative of trisomy 21, 18, or 13, and in 41 (1.6%) of other chromosome aberrations. The latter were of fetal (n = 10), placental (n = 22), maternal (n = 1) or unknown (n = 7). One case lacked cytogenetic follow-up. Nine of the 10 fetal cases were associated with an abnormal phenotype. Thirteen of the 22 (59%) placental aberrations were associated with fetal congenital anomalies and/or poor fetal growth (
Collapse
Affiliation(s)
- Diane Van Opstal
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Merel C van Maarle
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, Amsterdam, The Netherlands
| | - Klaske Lichtenbelt
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marjan M Weiss
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Heleen Schuring-Blom
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Shama L Bhola
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Mariette J V Hoffer
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Merryn V Macville
- Department of Clinical Genetics, Maastricht UMC+, Maastricht, The Netherlands
| | - Angelique J A Kooper
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Brigitte H W Faas
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lutgarde Govaerts
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gita M Tan-Sindhunata
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Ilse Feenstra
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Dick Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Stijn Ghesquiere
- Department of Clinical Genetics, Maastricht UMC+, Maastricht, The Netherlands
| | - Rutger W W Brouwer
- Erasmus Center for Biomics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lean Beulen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sander Bollen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin G Elferink
- Department of Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roy Straver
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Erik A Sistermans
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
24
|
Vogel I, Petersen OB, Christensen R, Hyett J, Lou S, Vestergaard EM. Chromosomal microarray as primary diagnostic genomic tool for pregnancies at increased risk within a population-based combined first-trimester screening program. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:480-486. [PMID: 28608362 DOI: 10.1002/uog.17548] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/24/2017] [Accepted: 06/02/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate the performance of high-resolution chromosomal microarray (CMA) as the standard diagnostic approach for genomic imbalances in pregnancies with increased risk based on combined first-trimester screening (cFTS). METHODS This was a retrospective study of genomic findings in a cohort of 575 consecutive pregnancies undergoing invasive testing because of a cFTS risk ≥ 1:300 on a publicly funded population-based screening program in the Central and Northern Regions of Denmark, between September 2015 and September 2016. Women with fetal nuchal translucency thickness ≥ 3.5 mm or opting for non-invasive prenatal testing (NIPT) were excluded. Comparative genomic hybridization was performed using a 180-K oligonucleotide array on DNA extracted directly from chorionic villus/amniocentesis samples. Genomic outcomes were reported in relation to cFTS findings. RESULTS Of the 575 pregnancies that underwent invasive testing, CMA detected 22 (3.8% (95% CI, 2.5-5.7%)) cases of trisomies 21, 18 and 13, 14 (2.4% (95% CI, 1.4-4.0%)) cases of other types of aneuploidy and 15 (2.6% (95% CI, 1.5-4.3%)) cases with a pathogenic or probably pathogenic copy number variant (CNV). Of the 15 CNVs, three were > 10 Mb and would probably have been detected by chromosomal analysis, but the other 12 would most probably not have been detected using conventional cytogenetic techniques; therefore, the overall detection rate of CMA (8.9% (95% CI, 6.8-11.5%)) was significantly higher than that estimated for conventional cytogenetic analysis (6.8% (95% CI, 5.0-9.1%)) (P = 0.0049). Reducing the cFTS risk threshold for invasive diagnostic testing to 1 in 100 or 1 in 50 would have led, respectively, to 60% or 100% of the pathogenic CNVs being missed. CONCLUSIONS CMA is a valuable diagnostic technique that can identify an increased number of genomic aberrations in pregnancies at increased risk on cFTS. Limiting diagnostic testing to pregnancies with a risk above 1 in 100 or 1 in 50, as proposed in contingent NIPT/invasive testing models, would lead to a significant proportion of pathogenic CNVs being missed at first-trimester screening. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- I Vogel
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
- Center for Prenatal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
- Institute of Biomedicine, Aarhus University Hospital, Aarhus, Denmark
| | - O B Petersen
- Center for Prenatal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - R Christensen
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
- Institute of Biomedicine, Aarhus University Hospital, Aarhus, Denmark
| | - J Hyett
- Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, Australia
| | - S Lou
- Center for Prenatal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
- DEFACTUM, Central Denmark Region, Denmark
| | - E M Vestergaard
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
- Center for Prenatal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
- Institute of Biomedicine, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
25
|
Margot H, Chansel-Debordeaux L, Pennamen P, Papaxanthos A, Toutain J. [Risk of confined placental mosaicism after assisted reproductive technologies]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2018; 46:57-59. [PMID: 29292097 DOI: 10.1016/j.gofs.2017.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Indexed: 06/07/2023]
Affiliation(s)
- H Margot
- Génétique médicale, CHU de Bordeaux, 33000 Bordeaux, France
| | - L Chansel-Debordeaux
- Biologie de la reproduction, CHU de Bordeaux, 33000 Bordeaux, France; University of Bordeaux, 33000 Bordeaux, France
| | - P Pennamen
- Génétique médicale, CHU de Bordeaux, 33000 Bordeaux, France; University of Bordeaux, 33000 Bordeaux, France
| | - A Papaxanthos
- Biologie de la reproduction, CHU de Bordeaux, 33000 Bordeaux, France
| | - J Toutain
- Génétique médicale, CHU de Bordeaux, 33000 Bordeaux, France.
| |
Collapse
|
26
|
Ghidini A, Bianchi DW, Levy B, Deprest J, van Mieghem T, Chitty LS, McLean-Inglis A. The 2016 Malcolm Ferguson-Smith Young Investigator Award. Prenat Diagn 2017. [DOI: 10.1002/pd.5074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Brynn Levy
- Clinical Cytogenetics Laboratory; Columbia University; New York NY USA
| | - Jan Deprest
- Clinical Department of Obstetrics and Gynaecology; University Hospitals Leuven & Academic Department Development and Regeneration, Cluster Woman & Child, Biomedical Sciences; KU Leuven Leuven Belgium
| | | | - Lyn S. Chitty
- University College London NHS Foundation Trust; London UK
| | | |
Collapse
|
27
|
Ghidini A, Bianchi DW, Levy B, Deprest J, van Mieghem T, Chitty LS, McLean-Inglis A. The 2015 Malcolm Ferguson-Smith Young Investigator Award. Prenat Diagn 2016; 36:599-600. [PMID: 27381265 DOI: 10.1002/pd.4855] [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]
Affiliation(s)
| | | | - Brynn Levy
- Clinical Cytogenetics Laboratory, Columbia University, New York, USA
| | | | | | - Lyn S Chitty
- University College London NHS Foundation Trust, London, United Kingdom
| | | |
Collapse
|
28
|
Lebo RV, Novak RW, Wolfe K, Michelson M, Robinson H, Mancuso MS. Discordant circulating fetal DNA and subsequent cytogenetics reveal false negative, placental mosaic, and fetal mosaic cfDNA genotypes. J Transl Med 2015; 13:260. [PMID: 26260800 PMCID: PMC4531495 DOI: 10.1186/s12967-015-0569-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 06/10/2015] [Indexed: 01/09/2023] Open
Abstract
Background The American College of Obstetrics and Gynecology (ACOG) and Maternal Fetal Medicine (MFM) Societies recommended that abnormal cfDNA fetal results should be confirmed by amniocentesis and karyotyping. Our results demonstrate that normal cfDNA results inconsistent with high-resolution abnormal ultrasounds should be confirmed by karyotyping following a substantial frequency of incorrect cfDNA results. Methods Historical review of our ~4,000 signed prenatal karyotypes found ~24% of reported abnormalities would not have been detected by cfDNA. Akron Children’s Hospital Cytogenetics Laboratory has completed 28 abnormal cfDNA cases among the 112 amniocenteses karyotyped. Results Following abnormal cfDNA results our karyotypes confirmed only 60% of the cfDNA results were consistent. Our cases found a normal cfDNA test result followed by a 20 weeks anatomical ultrasound detected a false negative trisomy 18 cfDNA result. One cfDNA result that reported trisomy 21 in the fetus was confirmed by karyotyping which also added an originally undetected balanced reciprocal translocation. Another reported karyotyped case followed by a repeated microarray of pure fetal DNA, together revealed one phenotypically normal newborn with a complex mosaic karyotype substantially decreasing the newborn’s eventual reproductive fitness. This second case establishes the importance of karyotyping the placenta and cord or peripheral blood when inconsistent or mosaic results are identified following an abnormal cfDNA result with a normal newborn phenotype without a prenatal karyotype. Conclusions These Maternal Fetal Medicine referrals demonstrate that positive NIPT results identify an increased abnormal karyotypic frequency as well as a substantial proportion of discordant fetal results. Our results found: (1) a normal NIPT test result followed by a 20 week anatomical ultrasound detected a false negative trisomy 18 NIPT result, (2) a substantial proportion of abnormal NIPT tests identify chromosomal mosaicism that may or may not be confined to the placenta, (3) follow up karyotyping should be completed on the newborn placenta and peripheral blood when the amniocyte karyotype does not confirm the NIPT reported abnormality in order to identify ongoing risk of developing mosaic symptoms, and (4) karyotyping all high risk fetuses tested by amniocentesis defines the 24% of chromosome abnormalities not currently screened by NIPT. Electronic supplementary material The online version of this article (doi:10.1186/s12967-015-0569-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Roger V Lebo
- Department of Pathology and Laboratory Medicine, Akron Children's Hospital, One Perkins Square, Akron, OH, 44308, USA.
| | - Robert W Novak
- Department of Pathology and Laboratory Medicine, Akron Children's Hospital, One Perkins Square, Akron, OH, 44308, USA.
| | - Katherine Wolfe
- Maternal Fetal Medicine, Akron Children's Hospital, One Perkins Square, Akron, OH, 44308, USA.
| | - Melonie Michelson
- Maternal Fetal Medicine, Akron Children's Hospital, One Perkins Square, Akron, OH, 44308, USA.
| | - Haynes Robinson
- Maternal Fetal Medicine, Akron Children's Hospital, One Perkins Square, Akron, OH, 44308, USA.
| | - Melissa S Mancuso
- Maternal Fetal Medicine, Akron Children's Hospital, One Perkins Square, Akron, OH, 44308, USA.
| |
Collapse
|
29
|
Bianchi DW, Chitty LS, Deprest J, Faas BHW, Ghidini A, Cousens RKJ. The 2014 Malcolm Ferguson-Smith Young Investigator Award. Prenat Diagn 2015; 35:515-6. [PMID: 26041253 DOI: 10.1002/pd.4612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Lyn S Chitty
- University College London NHS Foundation Trust, London, UK
| | - Jan Deprest
- University Hospital Gasthuisberg, Leuven, Belgium
| | | | | | | |
Collapse
|
30
|
Toutain J, Van-Gils J, Horovitz J, Saura R. Comment on "QF-PCR as a substitute for karyotyping of cytotrophoblast for the analysis of chorionic villi: advantages and limitations from a cytogenetic retrospective audit of 44 727 first-trimester prenatal diagnoses". Prenat Diagn 2014; 33:1115-6. [PMID: 23868568 DOI: 10.1002/pd.4202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 07/13/2013] [Indexed: 11/09/2022]
|
31
|
Bianchi DW, Chitty LS, Deprest J, Faas BHW, Ghidini A, Cousens RKJ. The 2013 Malcolm Ferguson-Smith Young Investigator Award. Prenat Diagn 2014; 34:717-8. [DOI: 10.1002/pd.4440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Lyn S. Chitty
- University College London NHS Foundation Trust; London UK
| | - Jan Deprest
- University Hospital Gasthuisberg; Leuven Belgium
| | | | | | | |
Collapse
|
32
|
Jorge P, Mota-Freitas MM, Santos R, Silva ML, Soares G, Fortuna AM. A 26-Year Experience in Chorionic Villus Sampling Prenatal Genetic Diagnosis. J Clin Med 2014; 3:838-48. [PMID: 26237480 PMCID: PMC4449647 DOI: 10.3390/jcm3030838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 06/20/2014] [Accepted: 06/23/2014] [Indexed: 12/04/2022] Open
Abstract
This report describes the trends of chorionic villus sampling (CVS) referred for prenatal genetic diagnosis in the past two and a half decades in a Portuguese Center. Our cohort of 491 CVS was mostly performed by the transcervical method at the 12th gestational week. Data collected within the framework of this study relate to the following: sampling method, referral reason versus abnormality and incidence of procedure-related pregnancy loss, that declined to about 0.5% over the last 15 years. The year 2000 represented a change in referral reasons for chorionic tissue collection, shifting from almost exclusively for cytogenetic testing to an increasing number of molecular tests for monogenic disorders. Herein, success rates as well as cytogenetic and/or molecular DNA results are presented. These latter include not only tests for several monogenic disorders, but also aneuploidy and maternal cell contamination screening. This retrospective analysis reiterates that CVS is a safe and reliable first trimester technique for prenatal diagnosis in high genetic risk pregnancies.
Collapse
Affiliation(s)
- Paula Jorge
- Center of Medical Genetics Doutor Jacinto Magalhães, Oporto Hospital Center, C.H.P., EPE, Praça Pedro Nunes, 88, 4099-028 Porto, Portugal.
- Unit for Multidisciplinary Research in Biomedicine, UMIB, ICBAS-UP, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal.
| | - Maria Manuela Mota-Freitas
- Center of Medical Genetics Doutor Jacinto Magalhães, Oporto Hospital Center, C.H.P., EPE, Praça Pedro Nunes, 88, 4099-028 Porto, Portugal.
- Unit for Multidisciplinary Research in Biomedicine, UMIB, ICBAS-UP, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal.
| | - Rosário Santos
- Center of Medical Genetics Doutor Jacinto Magalhães, Oporto Hospital Center, C.H.P., EPE, Praça Pedro Nunes, 88, 4099-028 Porto, Portugal.
- Unit for Multidisciplinary Research in Biomedicine, UMIB, ICBAS-UP, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal.
| | - Maria Luz Silva
- Center of Medical Genetics Doutor Jacinto Magalhães, Oporto Hospital Center, C.H.P., EPE, Praça Pedro Nunes, 88, 4099-028 Porto, Portugal.
| | - Gabriela Soares
- Center of Medical Genetics Doutor Jacinto Magalhães, Oporto Hospital Center, C.H.P., EPE, Praça Pedro Nunes, 88, 4099-028 Porto, Portugal.
| | - Ana Maria Fortuna
- Center of Medical Genetics Doutor Jacinto Magalhães, Oporto Hospital Center, C.H.P., EPE, Praça Pedro Nunes, 88, 4099-028 Porto, Portugal.
- Unit for Multidisciplinary Research in Biomedicine, UMIB, ICBAS-UP, Rua Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal.
| |
Collapse
|
33
|
Bug S, Solfrank B, Schmitz F, Pricelius J, Stecher M, Craig A, Botcherby M, Nevinny-Stickel-Hinzpeter C. Diagnostic utility of novel combined arrays for genome-wide simultaneous detection of aneuploidy and uniparental isodisomy in losses of pregnancy. Mol Cytogenet 2014; 7:43. [PMID: 25013457 PMCID: PMC4090657 DOI: 10.1186/1755-8166-7-43] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 05/27/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND This proof-of-principle study demonstrates the usefulness and robustness of a novel array based method for the elucidation of genetic causes underlying early pregnancy loss. A combined microarray utilizing comparative genomic hybridization and single nucleotide polymorphism detection (CGH + SNP) was used for parallel genome-wide identification of copy number and heterozygosity status of 70 products of conception. Results of samples with previously determined aneuploidies were juxtaposed to those of a second cohort appearing normal after routine genetic diagnostics. RESULTS All chromosomal imbalances were confirmed, in one sample of the aneuploid panel additional monosomy X was discovered. Genome-wide uniparental disomy causing a complete hydatidiform mole was identified in another sample. No specimen featured microaberrations of obvious clinical relevance. Among cases with presumable euploidy, one microdeletion and a single region of homozygosity were assigned unclear clinical significance. CONCLUSIONS The results prove the utility of combined imbalance and homozygosity mapping for routine workup of these challenging specimens. Moreover parallel screening at submicroscopic resolution facilitates the detection of novel genetic alterations underlying spontaneous abortion.
Collapse
Affiliation(s)
- Stefanie Bug
- synlab Medizinisches Versorgungszentrum Humane Genetik München, Lindwurmstraße 23, D-80337 Munich, Germany
| | - Beate Solfrank
- synlab Medizinisches Versorgungszentrum Humane Genetik München, Lindwurmstraße 23, D-80337 Munich, Germany
| | - Felizitas Schmitz
- synlab Medizinisches Versorgungszentrum Humane Genetik München, Lindwurmstraße 23, D-80337 Munich, Germany
| | - Jana Pricelius
- synlab Medizinisches Versorgungszentrum Humane Genetik München, Lindwurmstraße 23, D-80337 Munich, Germany
| | - Mona Stecher
- synlab Medizinisches Versorgungszentrum Humane Genetik München, Lindwurmstraße 23, D-80337 Munich, Germany
| | - Andrew Craig
- BlueGnome Ltd, An Illumina Company, Cambridge, UK
| | | | | |
Collapse
|
34
|
Battaglia P, Baroncini A, Mattarozzi A, Baccolini I, Capucci A, Spada F, Pompilii E, Pittalis MC. Cytogenetic follow-up of chromosomal mosaicism detected in first-trimester prenatal diagnosis. Prenat Diagn 2014; 34:739-47. [PMID: 24633594 DOI: 10.1002/pd.4358] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/05/2014] [Accepted: 03/08/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To contribute to the risk assessment of true fetal mosaicism after detection of a mosaic chromosomal anomaly in chorionic villus samples (CVS) in order to enable more effective counseling and pregnancy management. METHODS We retrospectively reviewed 7112 consecutive CVS analyzed on both direct preparations and cultured cells. In 135 out of the 177 cases of mosaicism, we performed cytogenetic follow-up and determined the frequency of confined placental mosaicism (CPM) and true fetal mosaicism according to type and distribution of the cytogenetic abnormality. RESULTS True fetal mosaicism was detected in 38 out of 135 cases (28.15%), confirming the higher incidence of CPM (71.85%). Confirmation rate of CV mosaicism depends on the combination of placental cell lineages affected, chromosome involved and mosaic versus non-mosaic chromosomal anomaly. The overall probability of fetal involvement significantly rises with involvement of mesenchymal cells: 5.88% abnormal cytotrophoblast, 20.96% abnormal mesenchyme and 58.97% anomalies in both tissues. CONCLUSION Most of the mosaic findings at CVS are unreliable indicators of the fetal karyotype. Our study contributes to large series with cytogenetic information from the different tissues along the cytotrophoblast-extraembrional mesoderm-fetus axis in order to infer clinical relevance of the findings and to enable more effective genetic counseling.
Collapse
Affiliation(s)
- Paola Battaglia
- Unit of Medical Genetics, S. Maria della Scaletta Hospital, Imola, Italy
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Placental mosaicism for Trisomy 13: a challenge in providing the cell-free fetal DNA testing. J Assist Reprod Genet 2014; 31:589-94. [PMID: 24497298 DOI: 10.1007/s10815-014-0182-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 01/22/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE We investigated the disagreement between the positive cell-free fetal DNA test for trisomy 13 and the standard cytogenetic diagnosis of one case. METHODS Cell-free fetal DNA testing was performed by massively parallel sequencing. We used conventional cytogenetic analysis to confirm the commercial cell-free fetal DNA testing. Additionally, postnatal fluorescent in situ hybridization (FISH) testing was performed on placental tissues. RESULTS The cell-free fetal DNA testing result was positive for trisomy 13. G-banded analysis of amniotic fluid was normal, 46, XY. FISH testing of tissues from four quadrants of the placenta demonstrated mosaicism for trisomy 13. CONCLUSIONS A positive cell-free fetal DNA testing result may not be representative of the fetal karyotype because of placental mosaicism. Cytogenetic analysis should be performed when abnormal cell-free fetal DNA test results are obtained.
Collapse
|
36
|
Taglauer ES, Wilkins-Haug L, Bianchi DW. Review: cell-free fetal DNA in the maternal circulation as an indication of placental health and disease. Placenta 2013; 35 Suppl:S64-8. [PMID: 24388429 DOI: 10.1016/j.placenta.2013.11.014] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 11/20/2013] [Accepted: 11/21/2013] [Indexed: 01/13/2023]
Abstract
In human pregnancy, the constant turnover of villous trophoblast results in extrusion of apoptotic material into the maternal circulation. This material includes cell-free (cf) DNA, which is commonly referred to as "fetal", but is actually derived from the placenta. As the release of cf DNA is closely tied to placental morphogenesis, conditions associated with abnormal placentation, such as preeclampsia, are associated with high DNA levels in the blood of pregnant women. Over the past five years, the development and commercial availability of techniques of massively parallel DNA sequencing have facilitated noninvasive prenatal testing (NIPT) for fetal trisomies 13, 18, and 21. Clinical experience accrued over the past two years has highlighted the importance of the fetal fraction (ff) in cf DNA analysis. The ff is the amount of cell-free fetal DNA in a given sample divided by the total amount of cell-free DNA. At any gestational age, ff has a bell-shaped distribution that peaks between 10 and 20% at 10-21 weeks. ff is affected by maternal body mass index, gestational age, fetal aneuploidy, and whether the gestation is a singleton or multiple. In approximately 0.1% of clinical cases, the NIPT result and a subsequent diagnostic karyotype are discordant; confined placental mosaicism has been increasingly reported as an underlying biologic explanation. Cell-free fetal DNA is a new biomarker that can provide information about the placenta and potentially be used to predict clinical problems. Knowledge gaps still exist with regard to what affects production, metabolism, and clearance of feto-placental DNA.
Collapse
Affiliation(s)
- E S Taglauer
- Department of Pediatrics, Floating Hospital for Children, Boston, MA, USA
| | - L Wilkins-Haug
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Womens' Hospital, Boston, MA, USA
| | - D W Bianchi
- Mother Infant Research Institute at Tufts Medical Center and Floating Hospital for Children, 800 Washington Street, Box 394, Boston, MA 02111, USA.
| |
Collapse
|
37
|
Hatt L, Brinch M, Singh R, Møller K, Lauridsen RH, Uldbjerg N, Huppertz B, Christensen B, Kølvraa S. Characterization of Fetal Cells from the Maternal Circulation by Microarray Gene Expression Analysis - Could the Extravillous Trophoblasts Be a Target for Future Cell-Based Non-Invasive Prenatal Diagnosis? Fetal Diagn Ther 2013; 35:218-27. [DOI: 10.1159/000356073] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 10/01/2013] [Indexed: 12/16/2022]
|
38
|
Baffero GM, Somigliana E, Crovetto F, Paffoni A, Persico N, Guerneri S, Lalatta F, Fogliani R, Fedele L. Author's reply regarding "Confined placental mosaicism at chorionic villous sampling: risk factors and pregnancy outcome". Prenat Diagn 2013; 33:303-4. [PMID: 23456997 DOI: 10.1002/pd.4046] [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: 11/07/2022]
|
39
|
Benn P, Cuckle H, Pergament E. Non-invasive prenatal testing for aneuploidy: current status and future prospects. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:15-33. [PMID: 23765643 DOI: 10.1002/uog.12513] [Citation(s) in RCA: 225] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 05/13/2013] [Accepted: 05/14/2013] [Indexed: 05/09/2023]
Abstract
Non-invasive prenatal testing (NIPT) for aneuploidy using cell-free DNA in maternal plasma is revolutionizing prenatal screening and diagnosis. We review NIPT in the context of established screening and invasive technologies, the range of cytogenetic abnormalities detectable, cost, counseling and ethical issues. Current NIPT approaches involve whole-genome sequencing, targeted sequencing and assessment of single nucleotide polymorphism (SNP) differences between mother and fetus. Clinical trials have demonstrated the efficacy of NIPT for Down and Edwards syndromes, and possibly Patau syndrome, in high-risk women. Universal NIPT is not cost-effective, but using NIPT contingently in women found at moderate or high risk by conventional screening is cost-effective. Positive NIPT results must be confirmed using invasive techniques. Established screening, fetal ultrasound and invasive procedures with microarray testing allow the detection of a broad range of additional abnormalities not yet detectable by NIPT. NIPT approaches that take advantage of SNP information potentially allow the identification of parent of origin for imbalances, triploidy, uniparental disomy and consanguinity, and separate evaluation of dizygotic twins. Fetal fraction enrichment, improved sequencing and selected analysis of the most informative sequences should result in tests for additional chromosomal abnormalities. Providing adequate prenatal counseling poses a substantial challenge given the broad range of prenatal testing options now available.
Collapse
Affiliation(s)
- P Benn
- Department of Genetics and Developmental Biology, University of Connecticut Health Center, Farmington, CT, USA.
| | | | | |
Collapse
|
40
|
Bianchi DW, Chitty LS, Deprest J, Ghidini A, Shaffer LG, Cousens RKJ. The 2012 Malcolm Ferguson-Smith Young Investigator Award. Prenat Diagn 2013; 33:619-20. [DOI: 10.1002/pd.4169] [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]
Affiliation(s)
| | - Lyn S. Chitty
- University College London NHS Foundation Trust; London UK
| | - Jan Deprest
- University Hospital Gasthuisberg; Leuven Belgium
| | | | | | | |
Collapse
|
41
|
Toutain J, Horovitz J, Saura R. Comment on "Confined placental mosaicism at chorionic villous sampling: risk factors and pregnancy outcome". Prenat Diagn 2013; 33:301-2. [PMID: 23456996 DOI: 10.1002/pd.4022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
42
|
Toutain J, Prochazkova-Carlotti M, Cappellen D, Jarne A, Chevret E, Ferrer J, Idrissi Y, Pelluard F, Carles D, Maugey-Laulon B, Lacombe D, Horovitz J, Merlio JP, Saura R. Reduced placental telomere length during pregnancies complicated by intrauterine growth restriction. PLoS One 2013; 8:e54013. [PMID: 23326560 PMCID: PMC3543434 DOI: 10.1371/journal.pone.0054013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 12/05/2012] [Indexed: 11/19/2022] Open
Abstract
Objectives Recent studies have shown that telomere length was significantly reduced in placentas collected at delivery from pregnancies complicated by intrauterine growth restriction secondary to placental insufficiency. Placental telomere length measurement during ongoing pregnancies complicated by intrauterine growth restriction has never been reported. This was the main objective of our study. Methods In our center, late chorionic villus samplings were performed between 18 and 37 weeks of amenorrhea in 24 subjects with severe intrauterine growth restriction (cases) and in 28 subjects with other indications for prenatal diagnosis (controls). Placental insufficiency was assessed by histo-pathological examination. Relative measurement of telomere length was carried out prospectively by quantitative Fluorescent In Situ Hybridization using fluorescent Peptide Nucleic Acid probes on interphase nuclei obtained from long-term cultured villi and with an automated epifluorescent microscope. A quantitative Polymerase Chain Reaction technique was performed to confirm the quantitative Fluorescent In Situ Hybridization results. The number of copies of gene loci encoding the RNA template (hTERC) and the catalytic subunit (hTERT) of the enzyme complex telomerase were also estimated in these placentas by Fluorescent In Situ Hybridization. Results Mean fluorescence intensity of telomere probes estimated by quantitative Fluorescent In Situ Hybridization was significantly less for cases compared to controls (p<0.001). This result indicated that mean telomere length was significantly reduced in placentas during pregnancies complicated by intrauterine growth restriction. Reduced telomere length was confirmed by the quantitative Polymerase Chain Reaction technique. No copy number variation of the hTERC and hTERT loci was noticed for cases, or for controls. Conclusion This study clearly demonstrates a reduction of placental telomere length in ongoing pregnancies (from 18 to 37 weeks of amenorrhea) complicated by severe intrauterine growth restriction secondary to placental insufficiency.
Collapse
Affiliation(s)
- Jérôme Toutain
- EA 2406 Histologie et pathologie moléculaire des tumeurs, Université Bordeaux Segalen, Bordeaux, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Baffero GM, Somigliana E, Crovetto F, Paffoni A, Persico N, Guerneri S, Lalatta F, Fogliani R, Fedele L. Confined placental mosaicism at chorionic villous sampling: risk factors and pregnancy outcome. Prenat Diagn 2012; 32:1102-8. [PMID: 22961322 DOI: 10.1002/pd.3965] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 07/31/2012] [Accepted: 08/01/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aims to investigate the clinical relevance of confined placental mosaicism (CPM) detected at chorionic villous sampling (CVS) and to identify risk factors for this condition. METHOD Women diagnosed with CPM between January 2005 and December 2009 were identified. They were matched to women with unremarkable CVS in a 1 : 2 ratio by study period and contacted by phone for interview. RESULTS One hundred fifteen exposed and 230 unexposed women were selected. Baseline characteristics did not differ between the study groups apart from maternal body mass index, which is mildly higher in the CPM group (+0.6 kg/m(2), p = 0.047), and maternal age, which is higher in women with type III CPM (39.7 ± 2.6 vs 37.1 ± 3.2 years, p = 0.005). A higher frequency of gestational hypertension was observed in exposed women (10% vs 2%) (p = 0.003). Small for gestational age newborns were more frequent in women with type I CPM (15% vs 5%, p = 0.03). The incidence of other main complications of pregnancy (stillbirth, prematurity, preeclampsia and gestational diabetes mellitus) was similar. Neonatal complications and subsequent infant health and development did not also differ. CONCLUSION Women with the diagnosis of CPM at CVS can be generally reassured regarding the course of pregnancy and infant health and development.
Collapse
|
44
|
Molecular genetics of preeclampsia and HELLP syndrome - a review. Biochim Biophys Acta Mol Basis Dis 2012; 1822:1960-9. [PMID: 22917566 DOI: 10.1016/j.bbadis.2012.08.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 08/06/2012] [Accepted: 08/07/2012] [Indexed: 11/24/2022]
Abstract
Preeclampsia is characterised by new onset hypertension and proteinuria and is a major obstetrical problem for both mother and foetus. Haemolysis elevated liver enzymes and low platelets (HELLP) syndrome is an obstetrical emergency and most cases occur in the presence of preeclampsia. Preeclampsia and HELLP are complicated syndromes with a wide variety in severity of clinical symptoms and gestational age at onset. The pathophysiology depends not only on periconceptional conditions and the foetal and placental genotype, but also on the capability of the maternal system to deal with pregnancy. Genetically, preeclampsia is a complex disorder and despite numerous efforts no clear mode of inheritance has been established. A minor fraction of HELLP cases is caused by foetal homozygous LCHAD deficiency, but for most cases the genetic background has not been elucidated yet. At least 178 genes have been described in relation to preeclampsia or HELLP syndrome. Confined placental mosaicism (CPM) is documented to cause early onset preeclampsia in some cases; the overall contribution of CPM to the occurrence of preeclampsia has not been adequately investigated yet. This article is part of a Special Issue entitled: Molecular Genetics of Human Reproductive Failure.
Collapse
|
45
|
Machevin-Surugue E, Serero S, Leroy AC, Mulot V, Larose C. [Answer to reflections on the "Feasibility of chorionic villus sampling outside referral diagnosis centers"]. ACTA ACUST UNITED AC 2012; 41:198-9. [PMID: 22325020 DOI: 10.1016/j.jgyn.2012.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 01/04/2012] [Indexed: 11/25/2022]
|
46
|
Toutain J, Soler G, Horovitz J, Saura R. Prenatal diagnosis on chorionic villi using molecular techniques should be performed from mesenchymal core rather than from direct villi. Prenat Diagn 2011; 31:1111-2; author reply 1113. [DOI: 10.1002/pd.2776] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
47
|
Bianchi DW, Chitty LS, Deprest J, Ghidini A, Shaffer LG, Hughes REM. The 2010 Malcolm Ferguson-Smith Young Investigator Award. Prenat Diagn 2011; 31:923-4. [DOI: 10.1002/pd.2841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Lyn S. Chitty
- University College London NHS Foundation Trust; London UK
| | - Jan Deprest
- University Hospital Gasthuisberg; Leuven Belgium
| | | | | | | |
Collapse
|
48
|
Goodfellow LR, Batra G, Hall V, McHale E, Heazell AEP. A case of confined placental mosaicism with double trisomy associated with stillbirth. Placenta 2011; 32:699-703. [PMID: 21733574 DOI: 10.1016/j.placenta.2011.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Revised: 06/10/2011] [Accepted: 06/13/2011] [Indexed: 10/18/2022]
Abstract
We present a case of stillbirth in which the fetus was well grown and karyotypically normal, but the placenta was morphologically abnormal and had confined placental mosaicism (CPM) for a double trisomy of chromosomes 12 and 15. A compilation of published cases of CPM reveals that whilst approximately 80% of pregnancies progress normally, there is an association with abnormal placental morphology, intrauterine growth restriction, fetal abnormalities and stillbirth. This case highlights the potential adverse effects of CPM and the benefit of placental examination in determining the cause of stillbirth.
Collapse
Affiliation(s)
- L R Goodfellow
- Maternal and Fetal Health Research Centre, Manchester Academic Health Sciences Centre, 5th floor (Research), St Mary's Hospital, Oxford Road, Manchester M13 9WL, UK.
| | - G Batra
- Department of Paediatric and Perinatal Pathology, Central Manchester University Hospitals Foundation Trust, Manchester, UK
| | - V Hall
- Department of Obstetrics and Gynaecology, Macclesfield District General Hospital, Macclesfield, UK
| | - E McHale
- Department of Cytogenetics, Central Manchester University Hospitals Foundation Trust, Manchester, UK
| | - A E P Heazell
- Maternal and Fetal Health Research Centre, Manchester Academic Health Sciences Centre, 5th floor (Research), St Mary's Hospital, Oxford Road, Manchester M13 9WL, UK
| |
Collapse
|
49
|
Saura R, Toutain J, Horovitz J. [Reflections on the "feasibility of chorionic villus sampling outside referral prenatal diagnosis centers"]. ACTA ACUST UNITED AC 2011; 40:481-2. [PMID: 21676556 DOI: 10.1016/j.jgyn.2011.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 05/16/2011] [Indexed: 12/01/2022]
|
50
|
Labeau-Gaüzere C, Horovitz J, Brun JL, Saura R, Toutain J. [Confined placental mosaicisms a priori from meiotic origin: analysis of 10 cases]. ACTA ACUST UNITED AC 2011; 39:117-20. [PMID: 21316283 DOI: 10.1016/j.gyobfe.2010.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 12/27/2010] [Indexed: 10/18/2022]
Abstract
This retrospective monocenter study focused on confined placental mosaicisms a priori from meiotic origin (i.e. non-mosaic type 3 confined placental mosaicisms). From a series of 14,967 chorionic villus samplings performed in our Fetal Medicine Center, 10 non-mosaic type 3 confined placental mosaicisms were identified. These abnormalities only involved chromosomes 15, 16 or 22. Pregnancies complicated by these confined placental mosaicisms were associated with prematurity and neonatal hypotrophy. Thus, when a confined placental mosaicism is suspected, this retrospective study highlighted the need to characterize the type of confined placental mosaicism to prevent the probable intra-uterine growth retardation and to adapt the obstetrical monitoring if necessary.
Collapse
Affiliation(s)
- C Labeau-Gaüzere
- Service de gynécologie-obstétrique, maternité Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | | | | | | | | |
Collapse
|