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Chen Y, Wang C, Wang Y, Peng X, Li R, Pan F. Association of fetal fraction and cell-free fetal DNA with adverse pregnancy outcomes: A systematic review. Int J Gynaecol Obstet 2024. [PMID: 38766692 DOI: 10.1002/ijgo.15612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/28/2024] [Accepted: 04/30/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Adverse pregnancy outcomes, which can be caused by multiple factors, present a significant threat to the health of mothers and their babies. Cell-free fetal DNA (cffDNA) from placental trophoblast cells might be able to reflect placental and fetal status. Previous studies have yielded controversial results regarding the association of FF or cffDNA with various adverse pregnancy outcomes. A previous study has attempted to systematically assess the association between low fetal fraction (FF) and adverse pregnancy outcomes, but it failed to perform quantitative analyses due to the few studies included. In the present study, we attempted to quantitatively assess the association of FF (or cffDNA) with adverse pregnancy outcomes and further analyze the causes of heterogeneity. OBJECTIVES To investigate the association of high/low FF or cffDNA with adverse pregnancy outcomes. SEARCH STRATEGY We searched the databases of PubMed, Embase, Cochrane, and Web of Science from January 1, 1990, to June 15, 2022 in this meta-analysis. SELECTION CRITERIA Studies on the relationships of adverse pregnancy outcomes in women with FF or cell free DNA were included. Non-English literature was excluded. DATA COLLECTION AND ANALYSIS Data about pregnancy outcomes and cell free DNA were extracted and meta-analyzed. Subgroup analysis was performed by different outcomes. MAIN RESULTS There were 11 studies included involving 8280 participants. No significant heterogeneity was observed among the studies (I2 = 27%, 25%), and a fixed-effect model was used for weighted quantitative analysis. The results revealed that the FF or cffDNA during pregnancy was significantly associated with adverse pregnancy outcomes in pregnant women (OR = 1.57, 95% CI [1.24, 1.99], P = 0.233). The overall incidence of the maternal adverse outcomes was 8% (95% CI: 5-13). Subgroup analysis of different outcomes showed an evident association between low FF or cffDNA and hypertensive disorders of pregnancy (HDP) (OR = 1.76, 95% CI [1.36, 2.27], P = 0.581). There was no evidence that the occurrence of spontaneous preterm birth (sPTB) and placental abnormality was associated with FF or cffDNA. No association was observed between low FF or cffDNA during pregnancy and adverse outcomes in fetuses (OR = 1.39, 95% CI [0.99, 1.94], P = 0.242). The overall incidence of adverse outcomes in fetuses was 8% (95% CI: 6-11). There were controversies over the association between high FF or cffDNA and HDP, and sPTB and small for gestational age infant, among different studies. CONCLUSIONS Pregnant women with low FF or cffDNA during the first or second trimester of pregnancy have an overall increased risk of adverse pregnancy outcomes, especially HDP. However, the association between FF and various pregnancy outcomes needs to be further explored by more prospective studies.
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Affiliation(s)
- Yixin Chen
- Department of Blood Transfusion, Qianjiang Central Hospital, Qianjiang Hospital Affiliated to Chongqing University, Chongqing, P.R. China
| | - Chun Wang
- Department of Blood Transfusion, Qianjiang Central Hospital, Qianjiang Hospital Affiliated to Chongqing University, Chongqing, P.R. China
| | - Yonghong Wang
- Department of Clinical Laboratory, Qianjiang Central Hospital, Qianjiang Hospital Affiliated to Chongqing University, Chongqing, P.R. China
| | - Xin Peng
- Department of Clinical Laboratory, Qianjiang Central Hospital, Qianjiang Hospital Affiliated to Chongqing University, Chongqing, P.R. China
| | - Rujing Li
- Department of Clinical Laboratory, Qianjiang Central Hospital, Qianjiang Hospital Affiliated to Chongqing University, Chongqing, P.R. China
| | - Feng Pan
- Department of Clinical Laboratory, Qianjiang Central Hospital, Qianjiang Hospital Affiliated to Chongqing University, Chongqing, P.R. China
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Park JE, Kang KM, Kim H, Jang HY, Go M, Yang SH, Jeong D, Jeong H, Kim JC, Lim SY, Cha DH, Shim SH. Cell-Free Fetal DNA Screening Analysis in Korean Pregnant Women: Six Years of Experience and a Retrospective Study of 9327 Patients Analyzed from 2017 to 2022. J Pers Med 2023; 13:1468. [PMID: 37888079 PMCID: PMC10608624 DOI: 10.3390/jpm13101468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Cell-free DNA (cfDNA) screening for normal fetal aneuploidy has been widely adopted worldwide due to its convenience, non-invasiveness, and high positive predictive rate. We retrospectively evaluated 9327 Korean women with single pregnancies who underwent a non-invasive prenatal test (NIPT) to investigate how various factors such as maternal weight, age, and the method of conception affect the fetal fraction (FF). The average FF was 9.15 ± 3.31%, which decreased significantly as the maternal body mass index (BMI) increased (p < 0.001). The highly obese group showed a 'no-call' rate of 8.01%, which is higher than that of the normal weight group (0.33%). The FF was 8.74 ± 3.20% when mothers were in their 40s, and lower than that when in their 30s (9.23 ± 3.34, p < 0.001) and in the natural pregnancy group (9.31% ± 3.33). The FF of male fetuses was observed to be approximately 2.76% higher on average than that of female fetuses. As the gestational age increased, there was no significant increase in the fraction of fetuses up to 21 weeks compared to that at 10-12 weeks, and a significant increase was observed in the case of 21 weeks or more. The FFs in the NIPT high-risk result group compared to that in the low-risk group were not significantly different (p = 0.62). In conclusion, BMI was the factor most associated with the fetal fraction. Although the NIPT is a highly prevalent method in prenatal analysis, factors affecting the fetal fraction should be thoroughly analyzed to obtain more accurate results.
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Affiliation(s)
- Ji Eun Park
- Center for Genome Diagnostics, CHA Biotech Inc., Seoul 06125, Republic of Korea; (J.E.P.); (K.M.K.); (H.K.); (H.Y.J.); (M.G.); (S.H.Y.); (J.C.K.)
| | - Kyung Min Kang
- Center for Genome Diagnostics, CHA Biotech Inc., Seoul 06125, Republic of Korea; (J.E.P.); (K.M.K.); (H.K.); (H.Y.J.); (M.G.); (S.H.Y.); (J.C.K.)
| | - Hyunjin Kim
- Center for Genome Diagnostics, CHA Biotech Inc., Seoul 06125, Republic of Korea; (J.E.P.); (K.M.K.); (H.K.); (H.Y.J.); (M.G.); (S.H.Y.); (J.C.K.)
| | - Hee Yeon Jang
- Center for Genome Diagnostics, CHA Biotech Inc., Seoul 06125, Republic of Korea; (J.E.P.); (K.M.K.); (H.K.); (H.Y.J.); (M.G.); (S.H.Y.); (J.C.K.)
| | - Minyeon Go
- Center for Genome Diagnostics, CHA Biotech Inc., Seoul 06125, Republic of Korea; (J.E.P.); (K.M.K.); (H.K.); (H.Y.J.); (M.G.); (S.H.Y.); (J.C.K.)
| | - So Hyun Yang
- Center for Genome Diagnostics, CHA Biotech Inc., Seoul 06125, Republic of Korea; (J.E.P.); (K.M.K.); (H.K.); (H.Y.J.); (M.G.); (S.H.Y.); (J.C.K.)
| | - Daeun Jeong
- Department of Biomedical Science, College of Life Science, CHA University, Seongnam 13488, Republic of Korea; (D.J.); (H.J.); (S.Y.L.)
| | - Hyeonmin Jeong
- Department of Biomedical Science, College of Life Science, CHA University, Seongnam 13488, Republic of Korea; (D.J.); (H.J.); (S.Y.L.)
| | - Jong Chul Kim
- Center for Genome Diagnostics, CHA Biotech Inc., Seoul 06125, Republic of Korea; (J.E.P.); (K.M.K.); (H.K.); (H.Y.J.); (M.G.); (S.H.Y.); (J.C.K.)
| | - Seo Young Lim
- Department of Biomedical Science, College of Life Science, CHA University, Seongnam 13488, Republic of Korea; (D.J.); (H.J.); (S.Y.L.)
| | - Dong Hyun Cha
- Center for Genome Diagnostics, CHA Biotech Inc., Seoul 06125, Republic of Korea; (J.E.P.); (K.M.K.); (H.K.); (H.Y.J.); (M.G.); (S.H.Y.); (J.C.K.)
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06125, Republic of Korea
| | - Sung Han Shim
- Center for Genome Diagnostics, CHA Biotech Inc., Seoul 06125, Republic of Korea; (J.E.P.); (K.M.K.); (H.K.); (H.Y.J.); (M.G.); (S.H.Y.); (J.C.K.)
- Department of Biomedical Science, College of Life Science, CHA University, Seongnam 13488, Republic of Korea; (D.J.); (H.J.); (S.Y.L.)
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Lannoo L, Van Camp J, Brison N, Parijs I, Vancoillie L, Van Den Bogaert K, Vermeesch JR, Devriendt K, Van Calsteren K. What helps define outcomes in persistent uninterpretable non-invasive prenatal testing: Maternal factors, fetal fraction or quality scores? Prenat Diagn 2023; 43:1333-1343. [PMID: 37592442 DOI: 10.1002/pd.6423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVES To assess maternal characteristics and comorbidities in patients with persistent uninterpretable non-invasive prenatal testing (NIPT) and to evaluate the association with adverse pregnancy outcome in a general risk population. METHODS A retrospective cohort study (July 2017-December 2020) was conducted of patients with persistent uninterpretable NIPT samples. Maternal characteristics and pregnancy outcomes were compared with the general Belgian obstetric population. RESULTS Of the 148 patients with persistent uninterpretable NIPT, 37 cases were due to a low fetal fraction (LFF) and 111 due to a low quality score (LQS). Both groups (LFF, LQS) showed more obesity (60.6%, 42.4%), multiple pregnancies (18.9%, 4.5%) and more obstetrical complications. In the LQS group, a high rate of maternal auto-immune disorders (30.6%) was seen and hypertensive complications (17.6%), preterm birth (17.6%) and neonatal intensive care unit (NICU) admission (22%) were significantly increased. In the LFF group hypertensive complications (21.6%), gestational diabetes (20.6%), preterm birth (27%), SGA (25.6%), major congenital malformations (11.4%), c-section rate (51.4%) and NICU admission (34.9%) were significantly increased. Chromosomal abnormalities were not increased in both groups. CONCLUSIONS Patients with persistent uninterpretable NIPT have significantly more maternal obesity, comorbidities and adverse pregnancy outcome than the general population and should receive high-risk pregnancy care. Distinguishing between LFF and LQS optimizes counseling because maternal characteristics and pregnancy outcome differ between these groups.
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Affiliation(s)
- Lore Lannoo
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Joke Van Camp
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Nathalie Brison
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Ilse Parijs
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Leen Vancoillie
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Koen Devriendt
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
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Scarff KL, Flowers N, Love CJ, Archibald AD, Hunt CE, Giouzeppos O, Elliott J, Delatycki MB, Pertile MD. Performance of a cell-free DNA prenatal screening test, choice of prenatal procedure, and chromosome conditions identified during pregnancy after low-risk cell-free DNA screening. Prenat Diagn 2023; 43:213-225. [PMID: 36617980 DOI: 10.1002/pd.6307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To evaluate the performance of cell-free DNA (cfDNA) screening for common fetal aneuploidies, choice of prenatal procedure, and chromosome conditions identified during pregnancy after low-risk cfDNA screening. METHOD A single-center prenatal cfDNA screening test was employed to detect trisomies 21, 18, and 13 (T21, T18, T13) and sex chromosome aneuploidies (SCAs). Test performance, choice of prenatal procedure, and cytogenetic results in pregnancies with low-risk cfDNA screening were reviewed. RESULTS CfDNA screening of 38,289 consecutive samples identified 720 (1.9%) pregnancies at increased risk for aneuploidy. Positive predictive values (PPVs) for high-risk singleton pregnancies were 98.5% (T21), 92.5% (T18) and 55.2% (T13). PPVs for SCAs ranged from 30.6% to 95.2%. Most women elected chorionic villus sampling for prenatal diagnosis of T21, T18 and T13; amniocentesis and/or postnatal testing were commonly chosen for SCAs. Cytogenetic tests from 616 screen-negative pregnancies identified 64 cases (12.7%) with chromosome conditions not detected by cfDNA screening, including triploidy (n = 30) and pathogenic and likely pathogenic copy number variants (n = 34). A further 15 (0.04%) false-negative common aneuploidy results were identified. CONCLUSIONS CfDNA screening was highly accurate for detecting fetal aneuploidy in this general-risk obstetric population. Fetal ultrasound and prenatal diagnostic testing were important in identifying chromosome conditions in pregnancies screened as low-risk.
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Affiliation(s)
- Katrina L Scarff
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Nicola Flowers
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Clare J Love
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Alison D Archibald
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Clare E Hunt
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Olivia Giouzeppos
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Justine Elliott
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Martin B Delatycki
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Bruce Lefroy Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mark D Pertile
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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Palomaki GE, Eklund EE, Kloza EM, Lambert-Messerlian GM. Assessment of a Simplified Cell-Free DNA Method for Prenatal Down Syndrome Screening. Clin Chem 2022; 68:1449-1458. [DOI: 10.1093/clinchem/hvac131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Prenatal screening for common trisomies via cell-free (cfDNA) is usually implemented by technologies utilizing massively parallel sequencing, stringent environmental controls, complex bioinformatics, and molecular expertise. An alternative and less complex methodology utilizes rolling circle amplification (RCA). Further evaluation of its performance and related requirements are warranted.
Methods
At 16 sites, women at 10 to 20 weeks gestation provided informed consent, relevant information, and 2 to 3 blood samples. Samples shipped for testing were processed and stored. Women were enrolled at primary cfDNA screening, or following such screening at referral for diagnostic testing. RCA testing occurred post-enrollment, over 11 months. Diagnostic results and delivery notes determined clinical truth. Detection rates were based on confirmed trisomic pregnancies; false-positive rates were based on unaffected pregnancies from the general population.
Results
Detection rate for the common trisomies was 95.9% (117/122, 95% CI, 90.5%–98.5%); overall false-positive rate was 1.00% (22/2,205, 0.65%–1.51%). Test failure rate after repeat testing was 0.04%. When assay standard deviations were below pre-specified levels, the overall false-positive rate was much lower at 0.30% (P < 0.001). Fetal sex calls were correct for 99.7%. One technician analyzed 560 samples over 2 weeks, a rate of 14 000/year.
Conclusions
Our assessment of this simplified cfDNA-based system for prenatal screening for common trisomies performed in a prenatal screening laboratory is encouraging. Improved detection, low failure rates and rapid reporting can be achieved by collecting 2 samples. Future priorities should include achieving higher run precision using a single collection tube.
Clinicaltrials.gov Registration Number: NCT03087357.
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Affiliation(s)
- Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital , Providence, RI , USA
- Department of Pathology and Laboratory Medicine, Alpert Medical School at Brown University , Providence, RI , USA
| | - Elizabeth E Eklund
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital , Providence, RI , USA
| | - Edward M Kloza
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital , Providence, RI , USA
| | - Geralyn M Lambert-Messerlian
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital , Providence, RI , USA
- Department of Pathology and Laboratory Medicine, Alpert Medical School at Brown University , Providence, RI , USA
- Department of Obstetrics and Gynecology, Women & Infants Hospital , Providence, RI , USA
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