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Suresh V, Gupta S, Khulbe Y, Shamim MA, Jain V, Jayan M, Waleed MS, Joe N, Sanker V, Gandhi AP, Alam A, Singh Malhotra H, Garg RK, Gulati S, Roy P, Bardhan M. Identification of Putative Biomarkers in Cerebral Palsy: A Meta-Analysis and Meta-Regression. Pediatr Neurol 2024; 161:43-54. [PMID: 39265434 DOI: 10.1016/j.pediatrneurol.2024.07.016] [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] [Received: 01/31/2024] [Revised: 06/16/2024] [Accepted: 07/26/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Cerebral palsy (CP) is a neurological disorder that impairs motor abilities. Identifying maternal biomarker derangements can facilitate further evaluation for early diagnosis, potentially leading to improved clinical outcomes. This study investigates the association between maternal biomarker derangements and CP development during the antenatal period. METHODS A systematic search was conducted in MEDLINE, EMBASE, and Cochrane databases, following MOOSE guidelines. Data on participants exceeding biomarker thresholds (95th and 5th percentiles) were extracted for combined odds ratio estimation. Geometric mean differences, reported as multiples of the median (MoMs), were used to analyze changes in marker levels. Trimesterwise subgroup analysis and metaregression assessed the impact of variables on outcomes. RESULTS Five observational studies (1552 cases, 484,985 controls) revealed lower maternal pregnancy-associated plasma protein A levels were associated with CP (pooled odds ratio [OR] = 1.60, 95% confidence interval [CI] = 1.22 to 2.09; I = 0%), with a -0.04 MoM geometric mean difference. Lower maternal beta-human chorionic gonadotropin (HCG) levels in first and second trimesters indicated a pooled OR = 1.18 (95% CI = 0.85 to 1.63; I = 57%). Sensitivity analysis showed an OR = 1.40 (95% CI = 1.08 to 1.82; I = 0%), with a -0.07 MoM geometric mean difference. Metaregression identified primigravida status as negatively influencing beta-HCG levels. Elevated nuchal translucency values and CP presented a pooled OR = 1.06 (95% CI = 0.77 to 1.44; I = 0%). CONCLUSION Lower maternal pregnancy-associated plasma protein A levels during the first trimester and lower beta-HCG levels in the first and second trimesters are associated with CP development in children. Future research should validate the predictive utility of these biomarkers and explore novel ones through large-scale cohort studies.
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Affiliation(s)
- Vinay Suresh
- King George's Medical University, Lucknow, India
| | - Shiva Gupta
- King George's Medical University, Lucknow, India
| | | | - Muhammad Aaqib Shamim
- Department of Pharmacology, All India Institute of Medical Sciences - Jodhpur, Jodhpur, India
| | - Vaibhav Jain
- Davao Medical School Foundation, Davao City, Philippines
| | - Malavika Jayan
- Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | | | - Neha Joe
- St. John's Medical College, Bengaluru, Karnataka, India
| | - Vivek Sanker
- Department of Neurosurgery, Trivandrum Medical College, Thiruvananthapuram, Kerala, India
| | - Aravind P Gandhi
- Assistant Professor, Department of Community Medicine, ESIC Medical College & Hospital, Hyderabad, India
| | - Areesha Alam
- Department of Pediatrics, King George's Medical University, Lucknow, India
| | - Hardeep Singh Malhotra
- Department of Neurology, King George's Medical University, Lucknow, India; Research Cell and Development, King George's Medical University, Lucknow, India
| | - Ravindra K Garg
- Department of Neurology, King George's Medical University, Lucknow, India; Head of Department, Department of Neurology, King George's Medical University, Lucknow, India
| | - Sheffali Gulati
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Roy
- Directorate of Factories, Department of Labour, Kolkata, Government of West Bengal, India
| | - Mainak Bardhan
- Neuro Medical-Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.
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Pasquini L, Ponziani I, Spataro E, Masini G, Biancareddu E, Cordisco A, Petraglia F. Elevated nuchal translucency, is it time to discuss the cut off? Int J Gynaecol Obstet 2023; 163:540-546. [PMID: 37128959 DOI: 10.1002/ijgo.14834] [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: 03/04/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE We aimed to evaluate pregnancy and postnatal outcomes of fetuses with NT between 95th and 99th percentile at first trimester and whether they could benefit from further investigations rather that routine scans. METHODS Multicenter retrospective observational study which involved all cases with NT between 95th and 99th percentile from January 2015 to December 2020. Unfavorable outcome was considered as: miscarriage or intrauterine fetal death (IUFD), chromosomal abnormality/genetic syndrome, major malformation or neurodevelopmental delay. Study population outcomes were compared with general population. RESULTS The rate of unfavorable outcome was 25.44% (167 out of 667). We reported: 6 (0.90%) second trimester miscarriage or IUFD, 90 (13.49%) chromosomal abnormalities/genetic syndromes, 57 (8.55%) major malformations, 13 (1.95%) cases of neurodevelopmental delay. The incidence of chromosomal abnormalities/genetic syndromes and major malformations were significantly higher (OR 6.99 (IC 95% 4.33-11.28), P < 0.001 and OR 17.77 (IC 95%7.22-43.75), P < 0.001 respectively) compared to the general population. The incidence of neurodevelopmental delay was not increased (OR of 0.64 CI 95% 0.33-1.24 P = 0.185). CONCLUSIONS Fetuses with NT between 95th and 99th percentile have an increased risk of pregnancy and postnatal adverse outcomes. According to our data it is reasonable to consider a lower cut of NT (NT > 95th percentile) for offering further investigations such as detailed ultrasound scan, fetal echocardiography and counseling where the option of performing fetal karyotype and CGH array should be discussed.
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Affiliation(s)
- Lucia Pasquini
- Fetal Medicine Unit, Department for Woman and Child Health, Careggi University Hospital, Florence, Italy
| | - Ilaria Ponziani
- Fetal Medicine Unit, Department for Woman and Child Health, Careggi University Hospital, Florence, Italy
| | - Elisa Spataro
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Giulia Masini
- Fetal Medicine Unit, Department for Woman and Child Health, Careggi University Hospital, Florence, Italy
| | - Eleonora Biancareddu
- Fetal Medicine Unit, Department for Woman and Child Health, Careggi University Hospital, Florence, Italy
| | - Adalgisa Cordisco
- Division of Prenatal Diagnosis, Piero Palagi Hospital, Florence, Italy
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
- Obstetrics and Gynecology, Department of Maternal and Child Health, University of Florence, Careggi University Hospital, Florence, Italy
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Zhou H, Yang X, Yi C, Zhong H, Yuan S, Pan M, Li D, Liao C. Prenatal diagnosis and early childhood outcome of fetuses with extremely large nuchal translucency. Mol Cytogenet 2023; 16:22. [PMID: 37660152 PMCID: PMC10475177 DOI: 10.1186/s13039-023-00650-4] [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: 02/15/2023] [Accepted: 07/20/2023] [Indexed: 09/04/2023] Open
Abstract
OBJECTIVE To evaluate the prenatal and perinatal outcome of fetuses with extremely large nuchal translucency (eNT) thickness (≥ 6.5 mm). METHODS 193 (0.61%) singleton fetuses with eNT were retrospectively included. Anomaly scan, echocardiography, and chromosomal and genetic test were included in our antenatal investigation. Postnatal follow-up was offered to all newborns. RESULTS Major congenital anomalies included congenital heart defect (32.6%, 63/193), hydrops fetalis (13.5%, 26/193), omphalocele (9.3%, 18/193), and skeletal dysplasia (7.8%, 15/193) et al. Abnormal karyotype was identified in 81/115 (70.4%) cases including Turner syndrome (n = 47), Trisomy 18 (n = 17), Trisomy 21 (n = 9), and Trisomy 13 (n = 3). Chromosomal microarray analysis provided informative results with 3.6% (1/28) incremental diagnostic yield over conventional karyotyping. The diagnostic yield of exome sequencing is 10.0% (2/20). There was no significant increase [Odds Ratio (OR) = 1.974; 95% confidence interval 0.863-4.516; P = 0.104] in the incidence of chromosomal defects despite the presence of other structural anomalies. Only 13 fetuses were successfully followed up and survived at term, no one was found with developmental delay or mental retardation. CONCLUSIONS Extremely large NT has a high risk of chromosomal abnormality. CMA and ES improve chromosomal genomic and genetic diagnosis of fetal increased NT. When cytogenetic analysis and morphology assessment are both normal, the outcome is good.
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Affiliation(s)
- Hang Zhou
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xin Yang
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Medical Genetics and Prenatal Diagnosis, Longgang District Maternity and Child Healthcare Hospital of Shenzhen City (Longgang Maternity and Child Institute of Shantou University Medical College), Shenzhen, Guangdong, China
| | - CuiXing Yi
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Huizhu Zhong
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Simin Yuan
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Min Pan
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Dongzhi Li
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Can Liao
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China.
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De Vriendt M, Rooryck C, Coatleven F, Sarrau M, Vincienne M, Prier P, Naudion S, Sentilhes L, Bouchghoul H. [Management of isolated increased nuchal translucency: survey among the Pluridisciplinary Centers for Prenatal Diagnosis]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:367-371. [PMID: 36940866 DOI: 10.1016/j.gofs.2023.03.007] [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: 11/30/2022] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/22/2023]
Abstract
OBJECTIVES The management for isolated increased nuchal translucency (NT) in the first trimester with a normal karyotype and normal Chromosomal Microarray Analysis (CMA) is not consensual. The aim was to perform a survey among the Pluridisciplinary Centers for Prenatal Diagnosis (CPDPN) in France regarding their management of increased NT in the first trimester. METHODS We conducted a multicenter descriptive survey between September 2021 and October 2021 among the 46 CPDPNs of France. RESULTS The response rate was 56.5% (n = 26/46). The NT thickness threshold for which invasive diagnosis testing is performed is 3.0mm in 23.1% of centers (n = 6/26) and 3.5mm in 76.9% of centers (n = 20/26). A CMA was performed alone in 26.9% of centers (n = 7/26) while 7.7% of centers (n = 2/26) did not perform a CMA. The gestational age for the first reference ultrasound scan was 16 to 18 WG in 88.5% of centers (n = 23/26), while it was not performed before 22 WG in 11.5% of centers (n = 3/26). Fetal echocardiography is proposed systematically in 73.1% of centers (n = 19/26). CONCLUSION There is heterogeneity in the management of increased NT in the first trimester among the CPDPNs in France. In case of increased NT on first trimester ultrasound scan, the NT thickness threshold for which invasive diagnosis testing is performed varies from 3.0 mm or 3.5mm depending on the center. Moreover, CMA and early reference morphological ultrasound scan between 16 and 18 WG were not systematically performed, despite the current data suggesting their interest.
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Affiliation(s)
- Manon De Vriendt
- Service de gynécologie obstétrique, CHU de Bordeaux, Bordeaux, France
| | - Caroline Rooryck
- Service de génétique médicale, CHU de Bordeaux, Bordeaux, France
| | | | - Marie Sarrau
- Service de gynécologie obstétrique, CHU de Bordeaux, Bordeaux, France
| | - Marie Vincienne
- Service de gynécologie obstétrique, CHU de Bordeaux, Bordeaux, France
| | - Perrine Prier
- Service de gynécologie obstétrique, CHU de Bordeaux, Bordeaux, France
| | - Sophie Naudion
- Service de génétique médicale, CHU de Bordeaux, Bordeaux, France
| | - Loïc Sentilhes
- Service de gynécologie obstétrique, CHU de Bordeaux, Bordeaux, France
| | - Hanane Bouchghoul
- Service de gynécologie obstétrique, CHU de Bordeaux, Bordeaux, France.
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Buffin R, Fichez A, Decullier E, Roux A, Bin S, Combourieu D, Pastor‐Diez B, Huissoud C, Picaud J. Neurodevelopmental outcome at 2 years of corrected age in fetuses with increased nuchal translucency thickness and normal karyotype compared with matched controls. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:790-797. [PMID: 32149439 PMCID: PMC8251540 DOI: 10.1002/uog.22009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Increased nuchal translucency (NT) thickness is an antenatal marker of aneuploidy or malformation that can lead to termination of pregnancy. This study assessed the long-term neurodevelopmental prognosis of infants who had isolated increased NT in utero. METHODS This was a prospective cohort study of infants with a NT thickness > 95th percentile in the first trimester, but with a normal karyotype and no major anomalies, and controls with normal NT matched for birth weight, Apgar score, place of birth, parity and gestational age at birth. At 2 years of corrected age, all infants underwent the psychometric Brunet-Lézine test to evaluate their developmental quotient (DQ), overall (global) and specifically for the areas of posture, language, coordination and sociability. RESULTS A total of 203 chromosomally normal infants were included in the increased-NT group and 208 in the control group. The mean global DQ was significantly lower in the increased-NT group than in the control group (108.6 ± 9.7 vs 112.8 ± 8.3; P < 0.0001), but it was within the normal range expected for that age in both groups. Similarly, the mean DQs for coordination, sociability and language, but not for posture, were significantly lower in infants with increased NT than in controls. Only one case with increased NT had a DQ < 70 (defined as severe neurodevelopmental impairment), compared with none in the control group. The difference between the two groups remained significant for a NT threshold ≥ 99th percentile and when the data were adjusted for NT thickness, the infant's sex and the mother's educational level. In the increased-NT group, NT thickness was < 3.5 mm in over half (56%) of the infants, between 3.5 mm and 5 mm in 33% and > 5 mm in 11%, with a mean global DQ of 108.4, 110.1 and 109.7, respectively. CONCLUSIONS Infants who had isolated increased fetal NT in the first trimester had a significantly lower, but normal, DQ at a corrected age of 2 years, when compared with controls. The findings were independent of the infant's sex, fetal NT thickness and the mother's educational level. © 2020 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R. Buffin
- Hospices Civils de Lyon, Hôpital de la Croix‐RousseService de NéonatologieLyonFrance
- Hospices Civils de Lyon, Hôpital de la Croix‐RousseCentre Pluridisciplinaire de Diagnostic PrénatalLyonFrance
| | - A. Fichez
- Hospices Civils de Lyon, Hôpital de la Croix‐RousseCentre Pluridisciplinaire de Diagnostic PrénatalLyonFrance
| | - E. Decullier
- Hospices Civils de Lyon, Pole IMER, Unité de Recherche CliniqueLyonFrance
| | - A. Roux
- Hospices Civils de Lyon, Pole IMER, Unité de Recherche CliniqueLyonFrance
| | - S. Bin
- Hospices Civils de Lyon, Pole IMER, Unité de Recherche CliniqueLyonFrance
| | - D. Combourieu
- Hospices Civils de Lyon, Hôpital Mère EnfantCentre Pluridisciplinaire de Diagnostic PrénatalBronFrance
| | - B. Pastor‐Diez
- Hospices Civils de Lyon, Hôpital de la Croix‐RousseService de NéonatologieLyonFrance
| | - C. Huissoud
- Hospices Civils de Lyon, Hôpital de la Croix‐RousseCentre Pluridisciplinaire de Diagnostic PrénatalLyonFrance
| | - J.‐C. Picaud
- Hospices Civils de Lyon, Hôpital de la Croix‐RousseService de NéonatologieLyonFrance
- Hospices Civils de Lyon, Hôpital de la Croix‐RousseCentre Pluridisciplinaire de Diagnostic PrénatalLyonFrance
- Université Lyon 1Faculté de Médecine Lyon Sud Charles Mérieux, Pierre BéniteLyonFrance
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Miranda J, Paz Y Miño F, Borobio V, Badenas C, Rodriguez-Revenga L, Pauta M, Borrell A. Should cell-free DNA testing be used in pregnancy with increased fetal nuchal translucency? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:645-651. [PMID: 31301176 DOI: 10.1002/uog.20397] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 06/11/2019] [Accepted: 06/14/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess the frequency of atypical chromosomal and submicroscopic anomalies, as well as fetal structural abnormalities, observed on first-trimester ultrasound scan in fetuses with nuchal translucency (NT) thickness > 99th centile, in order to evaluate the suitability of using standard cell-free DNA (cfDNA) testing as the sole screening test in these pregnancies. METHODS This was a retrospective cohort study of 226 fetuses with NT > 99th centile at 11-14 weeks' gestation, between January 2013 and December 2017, in a clinical setting in which greater than 95% of pregnant women receive first-trimester combined screening. All patients underwent genetic testing by means of quantitative fluorescence polymerase chain reaction and chromosomal microarray analysis, mainly in chorionic villus samples. We assessed the theoretical yield of two cfDNA testing models, targeted cfDNA (chromosomes 21, 18 and 13) and extended cfDNA (chromosomes 21, 18, 13 and sex chromosomes), and compared it with that of cytogenetic testing and ultrasound assessment in the first and second or third trimesters. RESULTS In the 226 fetuses analyzed, cytogenetic testing revealed 84 (37%) anomalies, including 68 typical aneuploidies (involving chromosomes 13, 18 or 21), six sex chromosome aneuploidies (four cases of monosomy X and two of trisomy X), three clinically relevant atypical chromosomal anomalies (one trisomy 22, one trisomy 21 mosaicism and one unbalanced translocation), five submicroscopic pathogenic variants and two cases with Noonan syndrome. Targeted and extended cfDNA testing would miss at least 12% (10/84) and 19% (16/84), respectively, of genetic anomalies, accounting for 4.4% and 7.1% of the fetuses with an increased NT, respectively. Finally, of the 142 fetuses with no identified genetic anomaly, a major fetal malformation was observed in 15 (10.6%) fetuses at the early anomaly scan, and in 19 (13.4%) in the second or third trimester. CONCLUSIONS cfDNA does not appear to be the appropriate genetic test in fetuses with NT > 99th centile, given that it would miss 12-19% of genetic anomalies in this group. Additionally, first-trimester ultrasound will identify a major structural abnormality in 11% of the fetuses with NT > 99th centile and no genetic anomaly. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J Miranda
- Fetal i+D Fetal Medicine Research, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
- Center for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - F Paz Y Miño
- Fetal i+D Fetal Medicine Research, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
- Center for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - V Borobio
- Fetal i+D Fetal Medicine Research, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
- Center for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - C Badenas
- Biomedical Diagnostic Center, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
- CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
| | - L Rodriguez-Revenga
- Biomedical Diagnostic Center, Hospital Clinic de Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
- CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
| | - M Pauta
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Barcelona, Catalonia, Spain
| | - A Borrell
- Fetal i+D Fetal Medicine Research, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Deu, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
- Center for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
- CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
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Xue S, Yan H, Chen J, Li N, Wang J, Liu Y, Zhang H, Li S, Zhang W, Chen D, Chen M. Genetic Examination for Fetuses with Increased Fetal Nuchal Translucency by Genomic Technology. Cytogenet Genome Res 2020; 160:57-62. [PMID: 32036363 DOI: 10.1159/000506095] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2020] [Indexed: 01/23/2023] Open
Abstract
This study aims to investigate the value of chromosomal microarray analysis (CMA) and whole exome sequencing (WES) in fetuses with increased nuchal translucency (defined as NT above the 95th centile for the crown-rump length). A total of 374 singleton pregnancies with gestational ages ranging from 11 to 13 + 6 weeks were investigated. Ultrasound displayed increased NT and no detectable structural malformations in these fetuses. Pregnancies were divided into 4 groups according to the NT values: 95th centile-3.4 mm (114 cases); 3.5-4.4 mm (150 cases); 4.5-5.4 mm (55 cases); and ≥5.5 mm (55 cases). The possible chromosomal anomalies were all analyzed by CMA first. Furthermore, 24 cases with increased NT but negative CMA results were investigated by WES, and the outcomes were followed up. Among all the 374 cases, causative genetic defects were detected in 100/374 (26.7%) of the cases along with 9 variants of unknown significance (VOUS) by CMA. CMA testing yielded 30 pathogenic variants (30/55), accounting for a detection rate of 54.5%, and 1 VOUS in the group of NT ≥5.5 mm, indicating the highest detection rate in the 4 groups. The 24 cases of the CMA negative sub-cohort with WES analysis further yielded 2 VOUS and 3 likely pathogenic variants, including 2 dominant de novo mutations in SOS1 and ECE1 and 1 recessive inherited compound heterozygous mutation in PIGN, which are associated with cardiac defects. All 3 cases opted for termination of pregnancy (TOP). In addition, 2 cases with increased NT were negative by both CMA and WES analysis, and fetal demise occurred. In conclusion, for the investigation of fetuses with increased NT exome sequencing is suggested to be considered in cases with negative CMA findings. However, appropriate genetic counseling should be given to optimizing its utilization in prenatal diagnosis.
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Socolov D, Socolov R, Gorduza VE, Butureanu T, Stanculescu R, Carauleanu A, Pavaleanu I. Increased nuchal translucency in fetuses with a normal karyotype-diagnosis and management: An observational study. Medicine (Baltimore) 2017; 96:e7521. [PMID: 28723764 PMCID: PMC5521904 DOI: 10.1097/md.0000000000007521] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The use of nuchal translucency (NT) in 1992 by Nicolaides et al was a major breakthrough in screening for chromosomal aneuploidies at the end of the first trimester. However, pathological conditions other than chromosomal aneuploidies are also associated with increased NT, which can also be detected in normal fetuses. This study sought to evaluate the causes of this ultrasound sign in a group of patients from Iasi, Romania.During the decade-long study period, there were 71 certified cases involving increased NT; the patients in these cases underwent diagnostic amniocentesis and karyotyping.In most of the examined cases (55 cases, 78%), there was no aneuploidy. The remaining cases involved trisomy 21 (T21) (18%), trisomy 18 (T18) (2%), or triploidy (2%). In most cases, the indication for amniocentesis was increased NT alone (81%), whereas the remaining cases also involved advanced maternal age (5.5%), abnormal serologic markers (10%), or other ultrasound signs (3.5%) (2 cases-cardiac anomalies and fetal hydrops). A favorable pregnancy outcome at term was achieved in 40 cases (56% from total, 72% from euploid pregnancies); kidney anomalies or nonlethal cardiac conditions were observed in 12 cases (17%), 6 of which involved complications associated with premature onset of labor, and miscarriages occurred in 6 cases. Three cases were lost at follow-up.Although it is common practice to assume that increased NT is an indication for amniocentesis, both literature results and our study findings indicate that the majority of cases with increased NT involve no aneuploidy and result in a favorable outcome if no other anomaly is present. Better evidence-based management of such cases could be promoted by conducting larger, multicenter studies, and following cases for longer periods.
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Affiliation(s)
- Demetra Socolov
- Department of Mother and Child Medicine, University of Medicine and Pharmacy Gr. T. Popa Iasi
| | - Razvan Socolov
- Department of Mother and Child Medicine, University of Medicine and Pharmacy Gr. T. Popa Iasi
- Hospital of Obstetrics and Gynecology Elena Doamna-Iasi
| | | | - Tudor Butureanu
- Department of Mother and Child Medicine, University of Medicine and Pharmacy Gr. T. Popa Iasi
| | | | - Alexandru Carauleanu
- Department of Mother and Child Medicine, University of Medicine and Pharmacy Gr. T. Popa Iasi
| | - Ioana Pavaleanu
- Department of Mother and Child Medicine, University of Medicine and Pharmacy Gr. T. Popa Iasi
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Roozbeh N, Azizi M, Darvish L. Pregnancy Outcome of Abnormal Nuchal Translucency: A Systematic Review. J Clin Diagn Res 2017; 11:QC12-QC16. [PMID: 28511453 DOI: 10.7860/jcdr/2017/23755.9384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/01/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Nuchal Translucency (NT) is the sonographic form of subcutaneous gathering of liquid behind the foetal neck in the first trimester of pregnancy. There is association of increased NT with chromosomal and non-chromosomal abnormalities. AIM The purpose of this systemic review was to review the pregnancy outcome of abnormal nuchal translucency. MATERIALS AND METHODS The present systematic review was conducted by searching English language articles from sources such as International Medical Sciences, Medline, Web of science, Scopus, Google Scholar, PubMed, Index Copernicus, DOAJ, EBSCO-CINAHL. Persian articles were searched from Iranmedex and SID sources. Related key words were "outcome", "pregnancy", "abnormal", and "Nuchal Translucency" (NT). All, randomized, descriptive, analytic-descriptive, case control study conducted during 1997-2015 were included. RESULTS Including duplicate articles, 95 related articles were found. After reviewing article titles, 30 unrelated article and abstracts were removed, and 65 articles were evaluated of which 30 articles were duplicate. Finally 22 articles were selected for final analysis. Exclusion criteria were, case studies and reports and quasi experimental designs. This evaluation has optioned negative relationship between nuchal translucency and pregnancy result. Rate of cardiac, chromosomal and other defects are correlated with increased NT≥2.5mm. Cardiac disease which were associated to the increased NT are heart murmur, systolic organic murmur, Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), tricuspid valve insufficiency and pulmonary valve insufficiency, Inferior Vena Cava (IVC) and Patent Ductus Arteriosus (PDA). The most common problems that related with increased NT were allergic symptoms. CONCLUSION According to this systematic review, increased NT is associated with various foetal defects. To verify the presence of malformations, birth defect consultations with a perinatologist and additional tests are required.
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Affiliation(s)
- Nasibeh Roozbeh
- Faculty, Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar, Abbas, Iran
| | - Maryam Azizi
- Assistant Professor, Fertility and Infertility Research Center, Hormozgan University of Medical SciencesBandar Abbas, Iran
| | - Leili Darvish
- Faculty, Department of Radiology, Faculty of Para-Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Äyräs O, Eronen M, Tikkanen M, Rahkola-Soisalo P, Paavonen J, Stefanovic V. Long-term outcome in apparently healthy children with increased nuchal translucency in the first trimester screening. Acta Obstet Gynecol Scand 2016; 95:541-6. [PMID: 26918672 DOI: 10.1111/aogs.12878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/15/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Increased nuchal translucency is known to be associated with chromosomal and structural defects and genetic syndromes. Little is known about the overall long-term outcome of euploid children after increased nuchal translucency. The aims of this study were to assess the additional structural defects diagnosed after discharge from the delivery hospital and the long-term overall outcome of euploid children after increased nuchal translucency and normal second trimester anomaly scan. MATERIAL AND METHODS All children from singleton euploid pregnancies during 2002-2007 with increased nuchal translucency in the first trimester screening, normal second trimester anomaly scan, and discharged as apparently healthy were included. Data on the structural defects and genetic disorders diagnosed until 2012 were retrieved from hospital databases and national registers. Previously published data of structural defects diagnosed after birth but before discharge and of severe neurodevelopmental impairment and genetic syndromes was added. RESULTS The cohort included 733 children. During the follow-up time (mean 6.5 years), major structural defects were observed in 10 (1.4%), genetic disorders in two (0.3%), and minor defects in 23 (3.1%) children. In addition, there were 42 previously published major structural defects and major neurodevelopmental impairment or genetic disorders. Adding these results together, major health problems were detected in 54 (7%) euploid children with increased fetal nuchal translucency and normal findings in second trimester anomaly scan. CONCLUSION Although only few additional major structural defects are diagnosed during the follow-up after increased fetal nuchal translucency, 7% of fetuses assumed to be healthy after second trimester anomaly scan have a major health impairment.
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Affiliation(s)
- Outi Äyräs
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki Finland, Helsinki, Finland
| | - Marianne Eronen
- Health Department, Social Insurance Institution of Finland, Helsinki, Finland
| | - Minna Tikkanen
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki Finland, Helsinki, Finland
| | - Päivi Rahkola-Soisalo
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki Finland, Helsinki, Finland
| | - Jorma Paavonen
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki Finland, Helsinki, Finland
| | - Vedran Stefanovic
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki Finland, Helsinki, Finland
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Le Lous M, Bouhanna P, Colmant C, Rozenberg P, Quibel T. The performance of an intermediate 16th-week ultrasound scan for the follow-up of euploid fetuses with increased nuchal translucency. Prenat Diagn 2015; 36:148-53. [DOI: 10.1002/pd.4756] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 11/18/2015] [Accepted: 11/27/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Maela Le Lous
- Department of Obstetrics and Gynecology; Poissy-Saint Germain Hospital, Versailles-Saint Quentin University; Versailles France
| | - Philippe Bouhanna
- Department of Obstetrics and Gynecology; Poissy-Saint Germain Hospital, Versailles-Saint Quentin University; Versailles France
| | - Claire Colmant
- Department of Obstetrics and Gynecology, AP-HP; Kremlin-Bicêtre Hospital, University of Paris-Sud; Orsay France
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology; Poissy-Saint Germain Hospital, Versailles-Saint Quentin University; Versailles France
| | - Thibaud Quibel
- Department of Obstetrics and Gynecology; Poissy-Saint Germain Hospital, Versailles-Saint Quentin University; Versailles France
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Liao KW, Tsai MS, Chang CH, Chien LC, Mao IF, Tsai YA, Chen ML. Do the Levels of Maternal Plasma Trace Elements Affect Fetal Nuchal Translucency Thickness? PLoS One 2015; 10:e0138145. [PMID: 26367380 PMCID: PMC4569564 DOI: 10.1371/journal.pone.0138145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 08/25/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Fetal nuchal translucency (NT) thickness is an important marker for prenatal screening; however, studies focusing on the correlation between maternal trace element levels and NT thickness are limited. The aim of this study was to evaluate maternal trace element levels during the first trimester and to investigate the association between maternal trace element levels and fetal NT thickness. METHODS In total, 113 samples were obtained from singleton pregnant women. Maternal plasma samples were collected in the first trimester of gestation. Plasma trace element levels were measured using Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Nuchal translucency thickness was measured using ultrasonography at 10-14 weeks of gestation. RESULTS We found that maternal plasma potassium (K) levels had a significant negative correlation with both NT (r = -0.230, p < 0.05) and NT Multiples of the Median (NT MoM) (r = -0.206, p < 0.05). After adjustment for potential confounders, log-transformed maternal plasma potassium levels in the first trimester were significantly associated with fetal NT (NT MoM: β = -0.68, p < 0.05; NT: β = -1.20, p < 0.01). Although not statistically significant, the As, Hg and Pb levels in maternal plasma were positively correlated with NT, and the Mg, Cu, Zn, Na and Ca levels were negatively correlated with NT. CONCLUSION Maternal plasma K levels during the first trimester appeared to be associated with NT thickness. The essential elements tended to decrease NT thickness, and non-essential elements tended to increase it.
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Affiliation(s)
- Kai-Wei Liao
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Ming-Song Tsai
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chia-Huang Chang
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Ling-Chu Chien
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - I-Fang Mao
- Department of Occupational Safety and Health, Chung Shan Medical University, Taichung, Taiwan
| | - Yen-An Tsai
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Mei-Lien Chen
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming University, Taipei, Taiwan
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Pitkanen S, Laitinen P, Yla-Outinen A, Heikkila M, Honkasalo T, Ryynanen M, Marttala J. Extremely large nuchal translucency measurement predicts adverse pregnancy outcome. J OBSTET GYNAECOL 2014; 35:22-4. [PMID: 25020113 DOI: 10.3109/01443615.2014.935713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A prospective study was conducted to determine the outcome of pregnancies with 1st trimester nuchal translucency measurement of ≥ 6.5 mm. The risk of fetal abnormalities increases with enlarging nuchal translucency, being around 45% with a measurement of ≥ 6.5 mm. A total of 27,144 women with singleton pregnancies participated in the combined Down syndrome screening within the public healthcare system in Northern Finland. The study period was 1 May 2002 to 31 May 2009. The nuchal translucency measurement was ≥ 6.5 mm in 16 cases (0.06%). Pregnancy outcome was normal in one case (6.3%). The risk of abnormality was higher in our study than reported in the literature. According to our study, immediate diagnostic tests should be offered after an nuchal translucency measurement of ≥ 6.5 mm. We should also consider analysis of fetal micro-deletions associated with certain syndromes.
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Affiliation(s)
- S Pitkanen
- Department of Obstetrics and Gynecology, Oulu University Hospital , Oulu , Finland
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Bakker M, Pajkrt E, Bilardo CM. Increased nuchal translucency with normal karyotype and anomaly scan: What next? Best Pract Res Clin Obstet Gynaecol 2014; 28:355-66. [DOI: 10.1016/j.bpobgyn.2013.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 09/23/2013] [Accepted: 10/14/2013] [Indexed: 11/28/2022]
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What is new in ultrasonography? Best articles from the past year. Obstet Gynecol 2013; 121:1357-1359. [PMID: 23812473 DOI: 10.1097/aog.0b013e318294512f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Significance of septa in first trimester increased nuchal translucency thickness. J Med Ultrason (2001) 2013; 41:51-6. [DOI: 10.1007/s10396-013-0464-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 04/26/2013] [Indexed: 10/26/2022]
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Lajeunesse C, Stadler A, Trombert B, Varlet MN, Patural H, Prieur F, Chêne G. [First-trimester cystic hygroma: prenatal diagnosis and fetal outcome]. ACTA ACUST UNITED AC 2013; 43:455-62. [PMID: 23747217 DOI: 10.1016/j.jgyn.2013.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/13/2013] [Accepted: 04/26/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To describe the ultrasonographic (US) and fetal karyotyping data of fetuses with cystic hygroma diagnosed in the first trimester. PATIENTS & METHODS Maternal and fetal data of 69 consecutive fetal cystic hygroma were analysed between 2002 and 2009. RESULTS The mean size of the cystic hygroma was 6.3 mm ± 2.4 mm. US abnormalities were present in 54% of cases (37/69) (essentially hydrops fetalis in 45%), with an unfavourable prognosis (P=0.006). Chromosomal abnormalities were present in 53% of cases (36/68) (including 44% of Down syndrome). The rate of unfavourable outcome of pregnancy was 71% of cases (49/69) and was associated with the oldest mothers (P=0.011). In the chromosomally normal pregnancies, there were 59% (19/32) fetus with no apparently abnormalities. Among these 19 children, 13 have been followed up until an average age of 5 years and a half, the infant development was strictly normal. DISCUSSION AND CONCLUSION The current results suggest to look for the poor prognosis data: nuchal thickness superior to 6 to 6,5 mm, presence of a hydrops fetalis and/or US abnormalities, fetal karyotyping and/or US evolution of cystic hygroma.
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Affiliation(s)
- C Lajeunesse
- Département de gynécologie-obstétrique & médecine de la reproduction, université de Saint-Étienne, Jean-Monnet, CHU de Saint-Étienne, avenue Albert-Raimond, 42023 Saint-Étienne, France
| | - A Stadler
- Département de gynécologie-obstétrique & médecine de la reproduction, université de Saint-Étienne, Jean-Monnet, CHU de Saint-Étienne, avenue Albert-Raimond, 42023 Saint-Étienne, France
| | - B Trombert
- Département de santé publique, université de Saint-Étienne, Jean-Monnet, CHU de Saint-Étienne, 42023 Saint-Étienne, France
| | - M N Varlet
- Département de gynécologie-obstétrique & médecine de la reproduction, université de Saint-Étienne, Jean-Monnet, CHU de Saint-Étienne, avenue Albert-Raimond, 42023 Saint-Étienne, France
| | - H Patural
- Département de pédiatrie, université de Saint-Étienne, Jean-Monnet, CHU de Saint-Étienne, 42023 Saint-Étienne, France
| | - F Prieur
- Département de génétique, université de Saint-Étienne, Jean-Monnet, CHU de Saint-Étienne, 42023 Saint-Étienne, France
| | - G Chêne
- Département de gynécologie-obstétrique & médecine de la reproduction, université de Saint-Étienne, Jean-Monnet, CHU de Saint-Étienne, avenue Albert-Raimond, 42023 Saint-Étienne, France.
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