Associations between nausea and vomiting in pregnancy, disgust sensitivity, and first-trimester maternal serum free β-hCG and PAPP-A

Elevated levels of nausea and vomiting in pregnancy (NVP) and disgust sensitivity have been observed in the first trimester and both are thought to have a protective function for the mother and her fetus. Their aetiology is not clear, however, with previous studies attributing elevated NVP and disgust to various factors including endocrine changes, immunological changes, and psychological variables. To date, no study has directly assessed the relationship between disgust and NVP. Here, we prospectively collected two independent samples (S1 and S2; n₁ = 201, n₂ = 391) of women in the first trimester of pregnancy, who completed the Index of Nausea, Vomiting, and Retching and the Disgust Scale-Revised. We also measured free β-human chorionic gonadotropin (hCG) and pregnancy-associated plasma protein A (PAPP-A) in maternal serum. Our results did not confirm any association between NVP and disgust; in addition, they indicate that NVP and disgust may have different proximate causes. Disgust sensitivity was significantly negatively correlated with free β-hCG and (only in S1) with PAPP-A. In contrast, NVP was significantly positively associated with free β-hCG levels and (only in S1) with PAPP-A. While low hCG levels seem to be an important indicator for activation of the behavioral immune system in the first trimester, increased hCG levels play a role in stronger symptoms of NVP, a result consistent with previous studies. Levels of PAPP-A are likely part of a larger network of immunological and endocrine responses and do not appear to provide sufficient information for predicting women's NVP and disgust sensitivity.

A Prospective Study on Correlation of First Trimester Crown-Rump Length With Birth Weight

Background

Ultrasound examination has been a crucial part of the evaluation of fetal health during pregnancy. It has become more accurate over the past few decades as a result of advances in radiodiagnostic imaging. While obstetric ultrasonography in the first trimester has been utilized extensively for gestational age assessment and confirmation of fetal viability, the imaging technique has seen little exposure in predicting pregnancy outcomes. This study was thus undertaken to find out any possible association between one of the first trimester parameters, i.e. crown-rump length (CRL) noted at the beginning of a pregnancy, and the birth weight of the neonate.

Methods

This prospective cohort study conducted at a teaching hospital in India spanning over a period of eighteen months included women with a spontaneously conceived intrauterine pregnancy at six to ten weeks period of gestation as calculated from the last menstrual period. Transvaginal sonography was performed for all such women and the CRL was noted. These CRL values were then compared to a standard nomogram and assigned to either of three categories i.e. CRL <5^th centile, 5^th to 95^th centile, or >95^th centile. The women were then followed up at the hospital with standard care till the end of their pregnancy, and finally, the birth weights were noted. Data were recorded in an MS Excel spreadsheet program and analysis was performed with regard to CRL in the first trimester and birth weights using SPSS v23 (IBM Corp.).

Results

Crown-rump lengths and birth weights of 104 cases were evaluated. The mean age of the study population was 26.6 years and the mean period of gestation (weeks) was 8.28 ± 1.01. The incidence of low birth weight (LBW) in the study was 22.1%. The distribution of LBW was significantly different between the three CRL categories (χ2 = 15.868, p = <0.001), being considerably higher in the CRL <5^th centile category. No embryos with CRL >95^th centile had low birth weight.

Conclusions

Our study suggested a congruence between the crown-rump length of an embryo noted in the first trimester and its weight at birth, with low birth weight being a fairly common occurrence in the deficient CRL category. This study highlights the role of a carefully performed first-trimester ultrasound examination in possibly predicting an adverse pregnancy outcome such as low birth weight and the probable inherent tendency of growth restriction in fetuses that are destined to develop the same.

Role of pregnancy-associated plasma protein A (PAPP-A) and human-derived chorionic gonadotrophic hormone (free β-hCG) serum levels as a marker in predicting of Small for gestational age (SGA): A cohort study

Background:

Small-for-gestational-age (SGA) is one of the most important conditions, which is associated with the risk of perinatal mortality and morbidity. The levels of pregnancy-associated plasma protein A (PAPP-A) and β-human-derived chorionic gonadotrophic (β-hCG) in the first trimester can predict this adverse outcome, considering the controversial nature of studies in this area, this cohort study was conducted to investigate the role of PAPP-A and freeβ-hCG levels for predicting SGA.

Materials and Methods:

In this cohort study, from 16 randomly selected health centers in Isfahan, Iran, 4605 volunteer pregnant women who had performed first-trimester fetal anomalies screening tests were chosen based on the census, from July 2016 to June 2018. The multiples of the median (MoM) PAPP-A <0.4 and MoM β-hCG >3 were considered as abnormal; the samples were followed up after childbirth. The biomarkers' serum levels, relative risk, and odds ratio (OR) of SGA were compared in both SGA and appropriate for gestational age (AGA) groups.

Results:

In the SGA group, the mean of MOM PAPP-A was significantly lower (0.96 vs. 1.1 with P = 0.001) and MoM βhCG was significantly higher (1.24 vs. 1.15 with P = 0.01) than the AGA group. Odds for SGA in subjects with MoM PAPP-A <0.4 were 3.213; P = 0.001 and for subjects with MoM βhCG >3 reported as 0.683; P = 0.111.

Conclusion:

The results of the study showed that the low levels of PAPP-A would cause 3.213 times increase in the chance of developing SGA and no association between high level of βhCG >3 with SGA. Therefore, low level of the PAPP-A is a warning indicator for SGA.

Can first trimester pregnancy-associated plasma protein-A predict the surfactant needs of preterm neonates?

BACKGROUND

Low values of pregnancy associated plasma protein A (PAPP-A), have been shown to be associated with some poor gestational outcomes, especially those related to placental deficiency such as pre-eclampsia and fetal growth restriction as well as preterm labor. The aim of this study was to compare first trimester PAPP-A MoM values with the surfactant needs of newborns of pregnant women who had a preterm delivery.

METHODS

This study included 216 pregnant women who had a preterm delivery, who were found to be in the low-risk group based on their aneuploidy screening. The women were separated into two groups based on the surfactant receipts of their newborns. A record was made of the obstetric history, birth characteristics of the preterm infants, and whether or not there was a need for surfactant.

RESULTS

A comparison of the PAPP-A values of the two groups revealed that the group that received surfactant had statistically significantly lower PAPP-A values (t(-3.97) = 0.203, p <  0.001). When the cut-off value of PAPP-A was taken as 1 MoM and the gestational age was analyzed together with the birth weight, PAPP-A alone was found to be a significant independent variable for the prediction of respiratory distress syndrome (RDS) (p = 0.031; OR:8.2 (1.2-55.6)).

CONCLUSIONS

The result of this study demonstrated that PAPP-A MoM values may be significant in predicting the need for surfactant in RDS, which is a frequently seen condition in the neonatal period.

The evaluating of pregnancy-associated plasma protein-A with the likelihood of small for gestational age

OBJECTIVE

Recently, strong evidences were obtained on the association between low pregnancy-associated plasma protein-A (PAPP-A) levels in the first trimester and poor outcomes of pregnancy.

METHODS

This cross-sectional study was conducted on all pregnant women who were referred to the Obstetrics and Gynecology Clinic at Imam Hossein Hospital in Tehran, Iran in 2014. Women were asked to attend clinical examinations and screening at 11-14 weeks of gestation.

RESULTS

Based on the definition, 14.5% of neonates found to be small for gestational age (SGA). There was a strong association between PAPP-A levels and birth weight. The mean PAPP-A level in the mothers of neonates who were SGA was significantly lower than those without this poor outcome. Based on the receiver operating characteristic curve analysis, serum PAPP-A level was a main determinant in the prediction of SGA neonates.

CONCLUSION

The serum PAPP-A level at 11-13 weeks of gestation can effectively predict the increased risk for fetal growth retardation. In patients in this study, the best cutoff value for PAPP-A was 0.75 MOM, which signifies that lower levels of this marker can predict fetal growth restriction with high sensitivity and specificity.

Prenatal exposure to fine particulate matter, maternal hemoglobin concentration, and fetal growth during early pregnancy: associations and mediation effects analysis

BACKGROUND

Fetal essential organ development is completed during early pregnancy which is important for fetal and postnatal health. However, the effect of exposure to PM_2.5 on fetal growth during early pregnancy is less studied and the related mechanisms are largely unknown.

METHODS

We conducted a birth cohort study of 1945 pregnant women with measurement of the fetal crown to rump length (CRL) by ultrasound between the gestational age of 11 and 14 weeks. We estimated residential exposures of PM_2.5 from the date of LMP to the date of ultrasound examination using a spatial-temporal land use regression model. Maternal hemoglobin concentration was examined by maternal blood samples during the same gestational period or ±1 week of the ultrasound examination. The associations of exposure to PM_2.5 with maternal hemoglobin concentration, and exposure to PM_2.5 with fetal CRL during early pregnancy were estimated by multiple linear regression models. The mediation effect of maternal hemoglobin concentration on the association between exposure to PM_2.5 and fetal CRL was explored by a casual mediation analysis.

RESULTS

One IQR increment of prenatal exposure to PM_2.5 was associated with a 0.929 g/L (95% CI: 0.068, 1.789) increase in maternal hemoglobin concentration, and associated with a -0.082 cm (95% CI: 0.139, -0.025) decrease in fetal CRL. One g/L increment of maternal hemoglobin concentration was associated a -0.011 cm (95% CI: 0.014, -0.008) decrease in fetal CRL. The mediation analysis indicated that 12.1% of the total effect of prenatal exposure to PM_2.5 on reducing fetal CRL was mediated by increased maternal hemoglobin concentration.

CONCLUSION

Exposure to PM_2.5 was associated with reduced fetal growth during early pregnancy and elevated maternal hemoglobin concentration mediated this association.

A proteomic clock of human pregnancy

BACKGROUND

Early detection of maladaptive processes underlying pregnancy-related pathologies is desirable because it will enable targeted interventions ahead of clinical manifestations. The quantitative analysis of plasma proteins features prominently among molecular approaches used to detect deviations from normal pregnancy. However, derivation of proteomic signatures sufficiently predictive of pregnancy-related outcomes has been challenging. An important obstacle hindering such efforts were limitations in assay technology, which prevented the broad examination of the plasma proteome.

OBJECTIVE

The recent availability of a highly multiplexed platform affording the simultaneous measurement of 1310 plasma proteins opens the door for a more explorative approach. The major aim of this study was to examine whether analysis of plasma collected during gestation of term pregnancy would allow identifying a set of proteins that tightly track gestational age. Establishing precisely timed plasma proteomic changes during term pregnancy is a critical step in identifying deviations from regular patterns caused by fetal and maternal maladaptations. A second aim was to gain insight into functional attributes of identified proteins and link such attributes to relevant immunological changes.

STUDY DESIGN

Pregnant women participated in this longitudinal study. In 2 subsequent sets of 21 (training cohort) and 10 (validation cohort) women, specific blood specimens were collected during the first (7-14 weeks), second (15-20 weeks), and third (24-32 weeks) trimesters and 6 weeks postpartum for analysis with a highly multiplexed aptamer-based platform. An elastic net algorithm was applied to infer a proteomic model predicting gestational age. A bootstrapping procedure and piecewise regression analysis was used to extract the minimum number of proteins required for predicting gestational age without compromising predictive power. Gene ontology analysis was applied to infer enrichment of molecular functions among proteins included in the proteomic model. Changes in abundance of proteins with such functions were linked to immune features predictive of gestational age at the time of sampling in pregnancies delivering at term.

RESULTS

An independently validated model consisting of 74 proteins strongly predicted gestational age (P = 3.8 × 10^-14, R = 0.97). The model could be reduced to 8 proteins without losing its predictive power (P = 1.7 × 10^-3, R = 0.91). The 3 top ranked proteins were glypican 3, chorionic somatomammotropin hormone, and granulins. Proteins activating the Janus kinase and signal transducer and activator of transcription pathway were enriched in the proteomic model, chorionic somatomammotropin hormone being the top-ranked protein. Abundance of chorionic somatomammotropin hormone strongly correlated with signal transducer and activator of transcription-5 signaling activity in CD4 T cells, the endogenous cell-signaling event most predictive of gestational age.

CONCLUSION

Results indicate that precisely timed changes in the plasma proteome during term pregnancy mirror a proteomic clock. Importantly, the combined use of several plasma proteins was required for accurate prediction. The exciting promise of such a clock is that deviations from its regular chronological profile may assist in the early diagnoses of pregnancy-related pathologies, and point to underlying pathophysiology. Functional analysis of the proteomic model generated the novel hypothesis that chrionic somatomammotropin hormone may critically regulate T-cell function during pregnancy.

Is there any relationship between low PAPP-A levels and measures of umbilical vein and placental thickness during first trimester of pregnancy?

OBJECTIVE

Low pregnancy-associated plasma protein A (PAPP-A) level is associated with adverse perinatal outcomes. The purpose of this study was to evaluate relationship between umbilical cord diameter (UCD), umbilical vein and artery diameters (UVD, UAD), placental thickness, and PAPP-A level at gestational age of between 11 and 14 weeks.

METHODS

UCD, UVD, UAD, and placental thickness of 246 women were assessed during ultrasound examination at between 11 and 14 weeks of gestation, as well as measurement of nuchal translucency (NT) and crown-rump length (CRL). Patients were divided into 2 groups according to PAPP-A percentile. Group 1 comprised 23 patients who had low PAPP-A (<0.44 multiple of medians [MoM], <10th percentile) and Group 2 was made up of 223 patients with PAPP-A of >0.44 MoM, >10th percentile. Calipers used for measurement were placed inner edge to inner edge of echogenic boundaries of the vessel. Largest sections of all vessels (UV and both arteries) were evaluated. Thickest part of the placenta was used for placental thickness measurement.

RESULTS

Narrow UCD (<4.5±0.6 mm) was associated with low PAPP-A level (p=0.02). There was no significant difference in UVD, UAD, or placental thickness between groups. There was no significant difference in gestational age, CRL, or NT between groups. Fetal birth weight was significantly lower in Group 1 (p=0.03).

CONCLUSION

Closer attention to women with low-risk, healthy pregnancies and low PAPP-A level in first trimester screening results is recommended. They should be routinely screened for background medical risk factors and umbilical cord morphology in first trimester scan.

Predictive value of pregnancy-associated plasma protein-A (PAPP-A) and free beta-hCG on fetal growth restriction: results of a prospective study

PURPOSE

Low levels of plasmatic pregnancy-associated plasma protein-A (PAPP-A) and high levels of free-beta human chorionic gonadotropin (beta-hCG) could influence the outcome of pregnancy. The objective of this study is to assess the correlation between PAPP-A and free beta-hCG and birth weight.

MATERIALS AND METHODS

Prospective follow-up study performed on 3332 patients in the first trimester of pregnancy who were subjected to a screening test focused on evaluation of fetal aneuploidy (SCA-TEST). The values of PAPP-A and free beta-hCG were both analyzed as raw values and subsequently converted to a multiple of the median (MoM). Statistical analysis was performed using SPSS version 17.0.1 (SPSS Inc., Chicago, USA).

RESULTS

The incidence of "small for gestational age" in patients with PAPP-A MoM <1st and <5th ‰ was statistically significant (12 and 9.8 %; p < 0.0001). Also statistically significant data have been highlighted about free beta MoM > 95th ‰ (7 %; p = 0.03). The values of PAPP-A MoM > 99th ‰ are significantly correlated with an increased risk of "large for gestational age" (16.7 %; p < 0.0001).

CONCLUSION

Our study demonstrates that specific values of PAPP-A and free beta-hCG could identify the risk of low or high birth weight since the first trimester of pregnancy.

Validation of serum biomarkers derived from proteomic analysis for the early screening of preeclampsia

AIM

To examine the potential value of previously identified biomarkers using proteomics in early screening for preeclampsia (PE).

METHODS

24 blood samples from women who subsequently developed PE and 48 from uncomplicated pregnancies were obtained at 11-13 weeks and analysed after delivery. Cystatin-C, sVCAM-1, and Pappalysin-1 were quantified by ELISA. Maternal characteristics and medical history were recorded.

RESULTS

Median values of Cystatin-C, sVCAM-1, and Pappalysin-1 in the PE group as compared to controls were 909.1 gEq/mL versus 480.0 gEq/mL, P = .000, 832.0 gEq/mL versus 738.8 gEq/mL, P = .024, and 234.4 gEq/mL versus 74.9 gEq/mL, P = .064, respectively. Areas under the receiver-operating characteristic curves (AUC, standard error (SE)) for predicting PE were Cystatin-C: 0.90 (SE 0.04), VCAM-1: 0.66 (SE 0.074), and Pappalysin-1: 0.63 (SE 0.083). To discriminate between cases at risk for PE and normal controls, cut-off values of 546.8 gEq/mL for Cystatin-C, 1059.5 gEq/mL for sVCAM-1, and 220.8 gEq/mL for Pappalysin-1 were chosen, providing sensitivity of 91%, 41%, and 54% and specificity of 85%, 100%, and 95%, respectively.

CONCLUSIONS

sVCAM-1 and Pappalysin-1 do not improve early screening for PE. Cystatin-C, however, seems to be associated with subsequent PE development, but larger studies are necessary to validate these findings.

First-trimester 3D power Doppler of the uteroplacental circulation space and fetal growth restriction

OBJECTIVE

The objective of the study was to compare the 3-dimensional power Doppler (3DPD) of the uteroplacental circulation space in the first trimester between women who subsequently deliver growth-restricted vs normally grown neonates.

STUDY DESIGN

This was a prospective observational study of singleton pregnancies at 11-14 weeks' gestation. The 3DPD indices, vascularization index, flow index, and vascularization flow index were determined on a uteroplacental circulation space sphere biopsy with the virtual organ computer-aided analysis program. Growth restriction was defined as a birthweight less than the 10th percentile for gestational age and was evaluated using both population-based and customized birth curves.

RESULTS

Five hundred seventy-seven women were enrolled. Five hundred twenty-six were eligible for analysis using population centiles, and 497 were available for evaluation using customized centiles. There was no difference in the first-trimester 3DPD indices between patients with growth-restricted and normally grown neonates using either curve.

CONCLUSION

Three-dimensional power Doppler indices of the uteroplacental circulation space in the first trimester are similar between neonates who develop growth restriction and those who will grow normally.

Maternal Serum Screening Markers and Adverse Outcome: A New Perspective

There have been a number of studies evaluating the association of aneuploidy serum markers with adverse pregnancy outcome. More recently, the development of potential treatments for these adverse outcomes as well as the introduction of cell-free fetal DNA (cffDNA) screening for aneuploidy necessitates a re-evaluation of the benefit of serum markers in the identification of adverse outcomes. Analysis of the literature indicates that the serum markers tend to perform better in identifying pregnancies at risk for the more severe but less frequent form of individual pregnancy complications rather than the more frequent but milder forms of the condition. As a result, studies which evaluate the association of biomarkers with a broad definition of a given condition may underestimate the ability of such markers to identify pregnancies that are destined to develop the more severe form of the condition. Consideration of general population screening using cffDNA solely must be weighed against the fact that traditional screening using serum markers enables detection of severe pregnancy complications, not detectable with cffDNA, of which many may be amenable to treatment options.

First trimester screening can predict adverse pregnancy outcomes

There has been an increasing drive over the last two decades to push the detection of women at risk of adverse pregnancy outcomes into the first trimester. This has led to a plethora of techniques, risk assessments and biomarkers, both fascinating and bewildering in its breadth. Despite the vast amount of knowledge available, it is often difficult to determine what is practicable and valuable for clinical practice. This is especially true as earlier diagnosis does not necessarily equate to improved outcomes for mother and child. We suggest that, at least for preeclampsia, fetal growth restriction, spontaneous preterm birth and gestational diabetes, there are effective first trimester tests available to identify the women at risk of subsequently developing complications. Unfortunately, there are no currently reliable first trimester tests available for identifying women at risk of stillbirth. It is likely that this field will continue to develop over time, and we hope that new and better strategies will continue to emerge to target these clinically important pathologies.

First trimester pregnancy volumes and subsequent small for gestational age fetuses

OBJECTIVE

To examine whether in the first trimester, placental, gestational sac and fetal volumes are different in pregnancies that result in small for gestational age (SGA) compared to average for gestational age (AGA) neonates.

METHODS

Case-control study comparing first trimester 3D volumes of the placenta, the fetus and the gestational sac between SGA and AGA pregnancies. 3D volumes were acquired for quality assurance and documentation. Pregnancy volumes were calculated by the virtual organ computer-aided analysis technique. Linear regression analysis was used to compute a normal range for the placental, gestational sac and fetal volume based on the crown rump length (CRL) in AGA pregnancies. Multiple regression analysis was used to examine significant influencing covariates. A Student's t test was used to compare the difference between the SGA and AGA group.

RESULTS

The study population consisted of 19 first trimester pregnancies with subsequent SGA neonates and 105 control pregnancies. In the AGA group, all pregnancy volumes were significantly dependent on the CRL. After controlling the CRL effect, the placental, gestational sac and fetal volumes were not significantly different between the SGA and AGA group.

CONCLUSION

First trimester 3D pregnancy volume measurements are not different in SGA or AGA pregnancies.

Evaluation of the impact of maternal smoking on ultrasound and endocrinological markers of first trimester placentation

OBJECTIVES

To study the effect of maternal smoking on 2D ultrasound measurements and maternal serum (MS) levels of endocrinologic markers of placentation.

STUDY DESIGN

Prospective population-based cohort study of 32 smokers and 96 non-smoking controls with a normal pregnancy outcome.

MAIN OUTCOME MEASURES

Placental thickness and 2D-volume and MS levels of pregnancy-associated plasma protein A (PAPP-A) and free-beta human chorionic gonadotrophin (fβhCG) at 11-13(+6)weeks of gestation and mid-trimester MS α-fetoprotein (AFP), unconjugated estriol (uE3) and inhibin A levels.

RESULTS

The MS levels of fβhCG and PAPP-A were significantly (P < 0.01 and P < 0.001, respectively) lower in the serum and the level of inhibin A significantly (P < 0.001) higher in the smokers than in controls. There was no significant difference for the MSAFP, MSuE3 placental thickness, basal plate surface and volume between the groups.

CONCLUSION

The placental morphological alterations secondary to maternal smoking are mainly at the level of the villous trophoblast and are not associated with changes in the placental size or utero-placental interface during the first trimester of pregnancy.

Association between first-trimester maternal serum pregnancy-associated plasma protein-A and obstetric complications

OBJECTIVE

This study aimed to investigate the relationship between maternal serum pregnancy-associated plasma protein-A (PAPP-A) in the first trimester of pregnancy and the development of preeclampsia (PE), early PE, small-for-gestational age (SGA) fetus and preterm delivery (PD).

METHOD

This is a retrospective study of 12,355 pregnant women that delivered between 2008 and 2011. We define the first, third and fifth percentiles of maternal serum PAPP-A multiples of the median (MoM). The primary outcome measures were the occurrence of PE, early PE (PE requiring delivery before 34 weeks), SGA fetus (birth weight < 5th centile) and PD. The Mann-Whitney U-test and chi-squared test were used to analyze continuous and dichotomous variables, respectively.

RESULTS

Maternal serum PAPP-A was significantly lower in women with PE, early PE, SGA fetus and PD (0.91, 0.74, 0.80 and 0.84 MoM, respectively) than in the study population (0.99 MoM) (p < 0.05). The lower the MoM percentile of PAPP-A, the higher are the odds ratio (OR) to develop PE, early PE, SGA fetus and PD.

CONCLUSIONS

Maternal serum PAPP-A levels are lower in women who develop preeclampsia, those with SGA fetus and those who deliver preterm. However, on its own, maternal serum PAPP-A performs poorly (OR for PE between 1.76 and 2.41 with the lower percentile of PAPP-A) as a screening test for these conditions.

Changes in quality of life into adulthood after very preterm birth and/or very low birth weight in the Netherlands

Background

It is important to know the impact of Very Preterm (VP) birth or Very Low Birth Weight (VLBW). The purpose of this study is to evaluate changes in Health-Related Quality of Life (HRQoL) of adults born VP or with a VLBW, between age 19 and age 28.

Methods

The 1983 nationwide Dutch Project On Preterm and Small for gestational age infants (POPS) cohort of 1338 VP (gestational age <32 weeks) or VLBW (<1500 g) infants, was contacted to complete online questionnaires at age 28. In total, 33.8% of eligible participants completed the Health Utilities Index (HUI3), the London Handicap Scale (LHS) and the WHOQoL-BREF. Multiple imputation was applied to correct for missing data and non-response.

Results

The mean HUI3 and LHS scores did not change significantly from age 19 to age 28. However, after multiple imputation, a significant, though not clinically relevant, increase of 0.02 on the overall HUI3 score was found. The mean HRQoL score measured with the HUI3 increased from 0.83 at age 19 to 0.85 at age 28. The lowest score on the WHOQoL was the psychological domain (74.4).

Conclusions

Overall, no important changes in HRQoL between age 19 and age 28 were found in the POPS cohort. Psychological and emotional problems stand out, from which recommendation for interventions could be derived.

Clinical experience of noninvasive prenatal testing with cell-free DNA for fetal trisomies 21, 18, and 13, in a general screening population

OBJECTIVE

Evaluate noninvasive prenatal testing (NIPT) with cell-free DNA as a screening method for trisomies 21, 18, and 13 in an obstetrical clinical practice setting.

METHODS

Observational study of pregnant women who underwent prenatal screening for fetal trisomy from 30 July 2012 to 1 December 2012. NIPT was offered to all patients in addition to first trimester combined screening (FTS).

RESULTS

The cohort included 289 women with mean age of 32.3 years (range: 17.8-42.0) who underwent testing at 13.0 gestational age weeks (range: 10.1-20.7). NIPT results were provided for 98.6% of patients at a mean reporting time of 9.3 calendar days. With NIPT, all patients had a risk less than 1:10 000 for trisomy 21, 18, or 13. With FTS, 4.5% of patients had screening results indicating an increased risk for trisomy 21. One patient who had an elevated trisomy 21 risk with FTS elected to have an amniocentesis, which revealed a euploid fetus.

CONCLUSIONS

NIPT has the potential to be a highly effective screening method as a standard test for risk assessment of fetal trisomies 21, 18, and 13 in general pregnant populations.