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Ye C, Duan H, Liu M, Liu J, Xiang J, Yin Y, Zhou Q, Yang D, Yan R, Li R. The value of combined detailed first-trimester ultrasound-biochemical analysis for screening fetal aneuploidy in the era of non-invasive prenatal testing. Arch Gynecol Obstet 2024; 310:843-853. [PMID: 37938359 PMCID: PMC11258060 DOI: 10.1007/s00404-023-07267-3] [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: 07/28/2023] [Accepted: 10/10/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE This study aimed to investigate the performance, cost-effectiveness and additional findings of combined detailed ultrasound and biochemical screening for risks of major fetal trisomies in the first-trimester. METHODS This is a retrospective analysis study, we estimated the risk of trisomies 21, 18 and 13 based on maternal age, fetal nuchal translucency thickness, nasal bone, ductus venosus pulsatility index velocity, tricuspid regurgitation, fetal heart rate, free beta-human chorionic gonadotropin, and pregnancy-associated plasma protein A in singleton pregnant women, and performed non-invasive prenatal testing for women with risks of trisomy 21 between 1:500 and 1:300. Invasive diagnostic testing was performed for women with positive or failed non-invasive prenatal testing result and in the high-risk group of this screening method. The direct costs were compared between this strategy and the non-invasive prenatal testing which alone used as first-line screening for all pregnant women. RESULTS Among 25,155 singleton pregnant women who underwent screening, 24,361 were available for analysis, of these, 194 cases underwent non-invasive prenatal testing. Among the 24,361 women, 39, 19, and 7 had trisomies 21, 18 and 13, respectively. The use of this strategy could potentially detect approximately 94.87% of trisomy 21 cases, 100% of trisomy 18 cases, and 100% of trisomy 13 cases, with false-positive rates of 2.49%, 0.41%, and 0.49%, respectively. The overall detection rate and overall false-positive rates were 96.92% and 2.52%, respectively. The detection rate was 100% in the advanced age group and 94.12% in the general age group. Additionally, structural abnormalities were detected in 137 fetuses, and 44 fetuses had other chromosomal abnormalities. The total cost of this strategy was $3,730,843.30, and the cost per person tested was $153.15. The total cost of using non-invasive prenatal testing as the first-line strategy would be $6,813,387.04 and the cost per person tested was $279.68. CONCLUSIONS Our strategy is an efficient and cost-effective approach for detecting major trisomies and identifying more fetuses with a potential abnormality. Therefore, this strategy is a valuable screening method and highly feasible in the clinical setting.
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Affiliation(s)
- Caixia Ye
- The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Hongyan Duan
- The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Mengyuan Liu
- The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Jianqiang Liu
- The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Jingwen Xiang
- The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Yizhen Yin
- The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Qiong Zhou
- The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Dan Yang
- The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Ruiling Yan
- The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
| | - Ruiman Li
- The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
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Wang Y, Sun Y, Meng L, He Q, Zhao J, Zhou R, Wang Z, Tan J, Ma D, Fan L, Chen Y, Wang Y, Jiang Z, Qiao Z, Wu X, Shao B, Xue Y, Song L, Wang T, Hu P, Xu Z. A new strategy for prenatal genetic screening of copy number variations in the DMD gene: A large cohort study based on NIPT analysis. Clin Transl Med 2024; 14:e1706. [PMID: 38797938 PMCID: PMC11128712 DOI: 10.1002/ctm2.1706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Affiliation(s)
- Yan Wang
- Department of Prenatal DiagnosisWomen's Hospital of Nanjing Medical UniversityNanjing Women and Children's Healthcare HospitalNanjingChina
| | | | - Lulu Meng
- Department of Prenatal DiagnosisWomen's Hospital of Nanjing Medical UniversityNanjing Women and Children's Healthcare HospitalNanjingChina
| | - Quanze He
- Center for Reproduction and GeneticsThe Affiliated Suzhou Hospital of Nanjing Medical UniversitySuzhou Municipal Hospital, Gusu School, Nanjing Medical UniversitySuzhouChina
| | | | - Ran Zhou
- Department of Prenatal DiagnosisWomen's Hospital of Nanjing Medical UniversityNanjing Women and Children's Healthcare HospitalNanjingChina
| | | | - Jianxin Tan
- Department of Prenatal DiagnosisWomen's Hospital of Nanjing Medical UniversityNanjing Women and Children's Healthcare HospitalNanjingChina
| | - Dingyuan Ma
- Department of Prenatal DiagnosisWomen's Hospital of Nanjing Medical UniversityNanjing Women and Children's Healthcare HospitalNanjingChina
| | | | | | - Yuguo Wang
- Department of Prenatal DiagnosisWomen's Hospital of Nanjing Medical UniversityNanjing Women and Children's Healthcare HospitalNanjingChina
| | - Zhu Jiang
- Department of Prenatal DiagnosisWomen's Hospital of Nanjing Medical UniversityNanjing Women and Children's Healthcare HospitalNanjingChina
| | | | - Xiaojuan Wu
- Center for Reproduction and GeneticsThe Affiliated Suzhou Hospital of Nanjing Medical UniversitySuzhou Municipal Hospital, Gusu School, Nanjing Medical UniversitySuzhouChina
| | - Binbin Shao
- Department of Prenatal DiagnosisWomen's Hospital of Nanjing Medical UniversityNanjing Women and Children's Healthcare HospitalNanjingChina
| | - Ying Xue
- Center for Reproduction and GeneticsThe Affiliated Suzhou Hospital of Nanjing Medical UniversitySuzhou Municipal Hospital, Gusu School, Nanjing Medical UniversitySuzhouChina
| | | | - Ting Wang
- Center for Reproduction and GeneticsThe Affiliated Suzhou Hospital of Nanjing Medical UniversitySuzhou Municipal Hospital, Gusu School, Nanjing Medical UniversitySuzhouChina
| | - Ping Hu
- Department of Prenatal DiagnosisWomen's Hospital of Nanjing Medical UniversityNanjing Women and Children's Healthcare HospitalNanjingChina
| | - Zhengfeng Xu
- Department of Prenatal DiagnosisWomen's Hospital of Nanjing Medical UniversityNanjing Women and Children's Healthcare HospitalNanjingChina
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3
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Boo HY, Han YJ. Cell-free DNA screening in twin pregnancies. Obstet Gynecol Sci 2024; 67:160-168. [PMID: 38268143 PMCID: PMC10948209 DOI: 10.5468/ogs.23135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/18/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024] Open
Abstract
Cell-free DNA (cfDNA) screening for fetal aneuploidies is clinically available and exhibits better performance than conventional serum screening tests. However, data on the clinical performance of cfDNA screening in twin pregnancies are limited. In this review, we summarized the clinical performance and evaluated the feasibility of cfDNA screening in twin pregnancies based on recent studies and recommendations. The performance of cfDNA screening for trisomy 21 in twin pregnancies is similar to that in singleton pregnancies. Specifically, cfDNA screening has a higher detection rate and lower false-positive rate compared with conventional serum screening. Consequently, recent international guidelines from several academic communities have recommended that cfDNA screening for aneuploidy in twin pregnancies could be considered. Moreover, twin pregnancies can present with specific conditions, such as different zygosities and vanishing twins; therefore, individualized counseling and management are required. Further clinical studies with more twin pregnancies are required for a more accurate analysis.
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Affiliation(s)
- Hye Yeon Boo
- Department of Obstetrics and Gynecology, CHA Ilsan Medical Center, Goyang,
Korea
| | - You Jung Han
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, Seoul,
Korea
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He S, Zhang Q, Chen M, Chen X, Liang B, Lin N, Huang H, Xu L. Analysis of retest reliability for pregnant women undergoing cfDNA testing with a no-call result. Mol Biol Rep 2023; 50:7649-7657. [PMID: 37535243 PMCID: PMC10460704 DOI: 10.1007/s11033-023-08591-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 06/13/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Determining the reasons for unreportable or no-call cell-free DNA (cfDNA) test results has been an ongoing issue, and a consensus on subsequent management is still lacking. This study aimed to explore potential factors related to no-call cfDNA test results and to discuss whether retest results are reliable. METHODS AND RESULTS This was a retrospective study of women with singleton pregnancies undergoing cfDNA testing in 2021. Of the 9871 pregnant patients undergoing cfDNA testing, 111 had a no-call result, and their results were compared to those of 170 control patients. The no-call rate was 1.12% (111/9871), and the primary cause for no-call results was data fluctuation (88.29%, 98/111). Medical conditions were significantly more frequent in the no-call group than in the reportable results group (P < 0.001). After retesting, 107 (107/111, 96.40%) patients had a result, and the false-positive rate (FPR) of retesting was 10.09% (10.09%, 11/109). In addition, placental lesions were more frequent in the no-call group than in the reportable results group (P = 0.037), and 4 patients, all in the no-call group, experienced pregnancy loss. CONCLUSIONS Pregnant women with medical conditions are more likely to have a no-call result. A retest is suggested for patients with a no-call result, but retests have a high FPR. In addition, pregnant women with a no-call result are at increased risk of adverse pregnancy outcomes. In conclusion, more attention should be given to pregnant women for whom a no-call cfDNA result is obtained.
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Affiliation(s)
- Shuqiong He
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Medical University, Fuzhou, China
| | - Qian Zhang
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Medical University, Fuzhou, China
| | - Meihuan Chen
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Medical University, Fuzhou, China
| | - Xuemei Chen
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Medical University, Fuzhou, China
| | - Bin Liang
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Medical University, Fuzhou, China
| | - Na Lin
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Medical University, Fuzhou, China.
| | - Hailong Huang
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Medical University, Fuzhou, China.
| | - Liangpu Xu
- Medical Genetic Diagnosis and Therapy Center, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Medical University, Fuzhou, China.
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Shear MA, Swanson K, Garg R, Jelin AC, Boscardin J, Norton ME, Sparks TN. A systematic review and meta-analysis of cell-free DNA testing for detection of fetal sex chromosome aneuploidy. Prenat Diagn 2023; 43:133-143. [PMID: 36588186 PMCID: PMC10268789 DOI: 10.1002/pd.6298] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/05/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The aim was to determine the accuracy of cell-free DNA testing (cfDNA) for detecting sex chromosome aneuploidies (SCA) in singleton pregnancies. METHODS A systematic review and meta-analysis was performed to assess cfDNA accuracy for prenatal detection of 45,X, 47,XXY, 47,XXX and 47,XYY. Inclusion was restricted to studies published between January 2010 and December 2021 reporting both cfDNA and confirmatory diagnostic test results. RESULTS For 45,X, the sensitivity was 98.8% (95%CI 94.6%-100%), specificity 99.4% (95%CI 98.7%-99.9%) and positive predictive value (PPV) 14.5% (95%CI 7.0%-43.8%). For 47,XXY, the sensitivity was 100% (95%CI 99.6%-100%), specificity 100% (95%CI 99.9%-100%) and PPV 97.7% (95%CI 78.6%-100%). For 47,XXX, the sensitivity was 100% (95%CI 96.9%-100%), specificity 99.9% (95%CI 99.7%-100%) and PPV 61.6% (95%CI 37.6%-95.4%). For 47,XYY, the sensitivity was 100% (95%CI 91.3%-100%), specificity 100% (95% CI 100%-100%) and PPV 100% (95%CI 76.5%-100%). All four SCAs had estimated negative predictive values (NPV) exceeding 99.99%, though false negatives were reported. CONCLUSIONS This analysis suggests that cfDNA is a reliable screening test for SCA, though both false negatives and false positives were reported. These estimates of test performance are derived from pregnancies at high pretest risk for aneuploidy, limiting the generalisability to average risk pregnancies.
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Affiliation(s)
- Matthew A. Shear
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, California, USA
- Department of Pediatrics, Division of Medical Genetics, University of California, San Francisco, California, USA
| | - Kate Swanson
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, California, USA
- Department of Pediatrics, Division of Medical Genetics, University of California, San Francisco, California, USA
| | - Ria Garg
- Department of Pediatrics, Division of Medical Genetics, University of California, San Francisco, California, USA
| | - Angie C. Jelin
- Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - John Boscardin
- Department of Medicine, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Mary E. Norton
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, California, USA
- Department of Pediatrics, Division of Medical Genetics, University of California, San Francisco, California, USA
- Institute of Human Genetics, University of California, San Francisco, California, USA
- Center for Maternal Fetal Precision Medicine, University of California, San Francisco, California, USA
| | - Teresa N. Sparks
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, California, USA
- Institute of Human Genetics, University of California, San Francisco, California, USA
- Center for Maternal Fetal Precision Medicine, University of California, San Francisco, California, USA
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6
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Shree R, Kolarova TR, MacKinnon HJ, Lockwood CM, Chandrasekaran S. Association of fetal fraction with hypertensive disorders of pregnancy incidence and disease severity. Am J Obstet Gynecol MFM 2022; 4:100671. [PMID: 35644526 PMCID: PMC9452472 DOI: 10.1016/j.ajogmf.2022.100671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/06/2022] [Accepted: 05/24/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hypertensive disorders of pregnancy contribute to maternal and offspring morbidity and mortality. Studies suggest that a lower early pregnancy fetal fraction is associated with an increased risk of hypertensive disorders of pregnancy. However, maternal obesity significantly affects fetal fraction and is a risk factor for hypertensive disorders of pregnancy. OBJECTIVE We determined the association between fetal fraction (using a standardized single-institution platform, including male and female fetuses) and hypertensive disorders of pregnancy, stratified by obesity status. Second, we evaluated differences in total cell-free DNA concentration and correlation of fetal fraction with clinical markers of hypertensive disorders of pregnancy severity. STUDY DESIGN This was a retrospective, single-institution study of a previously validated cell-free DNA-based noninvasive prenatal screening assay of 1058 samples. Maternal body mass index at the time of noninvasive prenatal screening was assessed, and hypertensive disorders of pregnancy were confirmed by a detailed medical record review. Differences in fetal fraction and total cell-free DNA concentration between the groups were assessed with univariate analyses. Multivariable regression was used to evaluate the association between fetal fraction and hypertensive disorders of pregnancy, adjusted for body mass index, maternal age, gestational age at noninvasive prenatal screening, and fetal sex. The association between fetal fraction and hypertensive disorders of pregnancy among individuals with obesity (body mass index, ≥30 kg/m2) and individuals without obesity (body mass index, <30 kg/m2) was investigated while controlling for the aforementioned covariates. Lastly, multivariable linear regression was used to evaluate the association between fetal fraction and clinical markers of hypertensive disorders of pregnancy severity. RESULTS We identified individuals with (n=117) and without (n=941) hypertensive disorders of pregnancy with noninvasive prenatal screening drawn before 20 weeks of gestation and with fetal fraction and body mass index data available. Those with hypertensive disorders of pregnancy had a lower fetal fraction (10.2%±4.2% vs 11.6%±4.7%; P<.01), without differences in total cell-free DNA concentration (P=.14). When groups were stratified by obesity status, this relationship was only valid for individuals without obesity (P=.02). Only when logistic regression analysis was restricted to individuals without obesity did the likelihood of hypertensive disorders of pregnancy rise with decreasing fetal fraction (odds ratio, 0.93; 95% confidence interval, 0.88-0.99; P=.02). In addition, fetal fraction was inversely associated with maximum systolic blood pressure at the time of hypertensive disorders of pregnancy only in the population without obesity (β, -0.08; 95% confidence interval, -0.147 to -0.01; P=.02). CONCLUSION Although a lower fetal fraction is associated with the development of hypertensive disorders of pregnancy, the use of this parameter for the prediction may be problematic in individuals with obesity, as obesity has such a profound effect on fetal fraction. However, we uniquely noted that among individuals without obesity, fetal fraction is lower for those that develop hypertensive disorders of pregnancy and lower fetal fraction increases the odds of hypertensive disorders of pregnancy development. Lastly, low fetal fraction in the population without obesity that developed hypertensive disorders of pregnancy was associated with higher systolic blood pressure at the time of hypertensive disorders of pregnancy, an important clinical marker of hypertensive disorders of pregnancy severity. As analytical approaches of cell-free DNA interrogation advance, the prediction of placental-mediated disorders with first-trimester sampling is likely to improve, although this may remain challenging in gravidas with obesity, a cohort at high risk of developing hypertensive disorders of pregnancy.
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Affiliation(s)
- Raj Shree
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA (Drs Shree, Kolarova, Mackinnon, and Chandrasekaran).
| | - Teodora R Kolarova
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA (Drs Shree, Kolarova, Mackinnon, and Chandrasekaran)
| | - Hayley J MacKinnon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA (Drs Shree, Kolarova, Mackinnon, and Chandrasekaran)
| | - Christina M Lockwood
- Department of Laboratory Medicine, University of Washington, Seattle, WA (Dr Lockwood)
| | - Suchitra Chandrasekaran
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA (Drs Shree, Kolarova, Mackinnon, and Chandrasekaran); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Emory University, Atlanta, GA (Dr Chandrasekaran)
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7
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Akiel MA, Mohamud MS, Masuadi EM, Alamri HS. Knowledge and attitude of pregnant women in the Kingdom of Saudi Arabia toward Noninvasive prenatal testing: A single center study. Mol Genet Genomic Med 2022; 10:e1960. [PMID: 35481946 PMCID: PMC9266591 DOI: 10.1002/mgg3.1960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 12/17/2021] [Accepted: 04/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background Noninvasive prenatal testing (NIPT) is a screening tool for chromosomal aneuploidies. Prior knowledge of NIPT is an inherent factor in the decision‐making process. We assessed the knowledge and attitude of pregnant women related to prenatal testing with a particular focus on NIPT. Methods A prospective cross‐sectional study, using a culturally validated questionnaire, was conducted with 342 pregnant women of whom 74.9% consented for prenatal screening. Mean age and gestational weeks ± standard deviation was 31 ± 5 and 26 ± 11, respectively. Results A positive/very positive attitude was observed to ultrasound, followed by FCT, NIPT, and lastly to CVS. More than half of the participants (56.1%) had no previous knowledge of NIPT. A reaching significance association was detected between education and knowledge of NIPT. Significant association was detected between risk for aneuploidy and knowledge of NIPT. The majority (74%) indicated their willingness to perform the test. The effect and value of society on the pregnant women to make a decision regarding NIPT was negligible. Conclusion The pregnant women in the current study displayed a lack of knowledge and awareness regarding prenatal screening, particularly the NIPT. We recommend that pregnant women receive adequate counseling regarding prenatal screening to increase their awareness and knowledge of prenatal testing, including NIPT.
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Affiliation(s)
- Maaged A. Akiel
- Department of Clinical Laboratory Sciences, College of Applied Medical SciencesKing Saud bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhKingdom of Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhKingdom of Saudi Arabia
- Department of Human and Molecular GeneticsVirginia Commonwealth UniversityVirginiaUSA
| | - Mohamud S. Mohamud
- King Abdullah International Medical Research Center (KAIMRC)RiyadhKingdom of Saudi Arabia
- Research Unit, College of MedicineKing Saud bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhKingdom of Saudi Arabia
| | - Emad M. Masuadi
- King Abdullah International Medical Research Center (KAIMRC)RiyadhKingdom of Saudi Arabia
- Research Unit, College of MedicineKing Saud bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhKingdom of Saudi Arabia
| | - Hassan S. Alamri
- Department of Clinical Laboratory Sciences, College of Applied Medical SciencesKing Saud bin Abdulaziz University for Health Sciences (KSAU‐HS)RiyadhKingdom of Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC)RiyadhKingdom of Saudi Arabia
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8
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Shree R, Kolarova TR, MacKinnon HJ, Hedge JM, Vinopal E, Ma KK, Lockwood CM, Chandrasekaran S. Low fetal fraction in obese women at first trimester cell-free DNA based prenatal screening is not accompanied by differences in total cell-free DNA. Prenat Diagn 2021; 41:1277-1286. [PMID: 34297415 DOI: 10.1002/pd.6023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/26/2021] [Accepted: 07/10/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Reasons for first trimester noninvasive prenatal screening (NIPS) test failure in obese women remain elusive. As dilution from maternal sources may be explanatory, we determined the relationship between obesity, fetal fraction (FF), and total cell-free DNA (cfDNA) using our NIPS platform. METHODS We assessed differences in first trimester (≤14 weeks) FF, indeterminate rate, and total cfDNA between obese (n = 518) and normal-weight women (n = 237) after exclusion of confounders (anticoagulation, autoimmunity, aneuploidy) and controlling for covariates. RESULTS Fetal fraction was lower, and the indeterminate rate higher, in obese compared to controls (9.2% ± 4.4 vs. 12.5% ± 4.5, p < 0.001 and 8.4 vs. 1.7%, p < 0.001, respectively), but total cfDNA was not different (92.0 vs. 82.1 pg/µl, p = 0.10). For each week, the FF remained lower in obese women (all p < 0.01) but did not increase across the first trimester for either group. Obesity increased the likelihood of indeterminate result (OR 6.1, 95% CI 2.5, 14.8; p < 0.001) and maternal body mass index correlated with FF (β -0.27, 95% CI -0.3, -0.22; p < 0.001), but not with total cfDNA (β 0.49, 95% CI -0.55, 1.53; p = 0.3). CONCLUSIONS First trimester obese women have persistently low FF and higher indeterminate rates, without differences in total cfDNA, suggesting placental-specific mechanisms versus dilution from maternal sources as a potential etiology.
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Affiliation(s)
- Raj Shree
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Washington, Seattle, Washington, USA
| | - Teodora R Kolarova
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Washington, Seattle, Washington, USA
| | - Hayley J MacKinnon
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Washington, Seattle, Washington, USA
| | - Jaclynne M Hedge
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Elena Vinopal
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Kimberly K Ma
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Washington, Seattle, Washington, USA
| | - Christina M Lockwood
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Suchitra Chandrasekaran
- Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Washington, Seattle, Washington, USA
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9
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Ashfield T, McCready E, Shago M, Wang H, Sinclair-Bourque E, Cappa E, Piche Marolt A, Chun K. Practice patterns of prenatal and perinatal testing in Canadian cytogenetics laboratories. Prenat Diagn 2021; 41:843-854. [PMID: 33882154 DOI: 10.1002/pd.5951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 02/04/2021] [Accepted: 03/22/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To survey patterns of practice in Canadian cytogenetics laboratories and evaluate whether newer technologies have influenced testing algorithms for the detection of common aneuploidies and other genomic imbalances in the prenatal and perinatal settings. METHODS Cytogenetics laboratories across Canada were invited to participate in two patterns-of-practice surveys: one in 2016 and one in 2019. They were asked to identify the prenatal and perinatal specimen types tested at their facility and which testing methods were used for initial testing and for follow-up. RESULTS All clinical laboratories performing prenatal testing offer rapid aneuploidy detection (RAD). Most laboratories also offer microarray analysis. A positive result is either followed up by karyotyping or no further testing is performed. For prenatal samples, a negative result may be followed up by microarray or karyotyping and is dependent on the reason for referral. For perinatal samples, availability of microarray to follow up a negative result is increasing. CONCLUSIONS Since 2016, the availability of RAD as a first-line test in Canadian cytogenetics laboratories remains consistent, while microarray has become the preferred follow-up testing method over traditional karyotyping following a normal RAD result. Despite a universal healthcare system, disparities in prenatal and perinatal cytogenetic testing algorithms are apparent.
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Affiliation(s)
- Tamara Ashfield
- Institute for Quality Management in Healthcare, Toronto, Canada
| | - Elizabeth McCready
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada.,Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Canada
| | - Mary Shago
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Hong Wang
- Genetics Program, North York General Hospital, Toronto, Canada
| | | | - Eva Cappa
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital - Joseph & Wolf Lebovic Health Complex, Toronto, Canada
| | | | - Kathy Chun
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
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10
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Chang J, Qi Q, Zhou X, Jiang Y, Hao N, Liu J. Factors associated with test failure in pregnant women undergoing cell-free DNA-based testing for fetal trisomy. J Med Screen 2021; 28:411-418. [PMID: 33884933 DOI: 10.1177/09691413211009940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the factors associated with cell-free DNA test failure, and the optimal subsequent management of these pregnancies. METHODS This was a retrospective study of 27,363 singleton pregnancies undergoing cell-free DNA testing. Women with cell-free DNA test failure were divided into a high-risk group and a low-risk group according to their indications. The subsequent management and pregnancy outcomes of these women were followed up. RESULTS The rate of cell-free DNA test failure at the first sampling was 1.49%, and 78.4% of failures were due to a low fetal fraction. Of the 66 women who refused any subsequent management, an adverse pregnancy outcome was seen in 5 cases, all belonging to the high-risk group. Of the 13 low-risk women who chose second-trimester maternal serum screening, all obtained a low-risk maternal serum screening result and an unaffected pregnancy outcome. A redraw was chosen by 171 women, which yielded a result in 75.4% and their pregnancy outcomes were unaffected; 42 women had an uninformative result again and received an amniocentesis. As 158 women had an amniocentesis after the first sampling, this procedure was offered in 200 cases altogether. Abnormal genetic testing results were shown in six (3%, 6/200) cases, all in the high-risk group. CONCLUSIONS High-risk pregnant women with cell-free DNA test failure are at increased risk of adverse pregnancy outcomes. A second sampling for cell-free DNA test or maternal serum screening might be suggested to low-risk women. Invasive prenatal diagnosis should be offered to the high-risk patients, especially those with a second cell-free DNA test failure.
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Affiliation(s)
- Jiazhen Chang
- 34732Peking Union Medical College Hospital, Beijing, China
| | - Qingwei Qi
- 34732Peking Union Medical College Hospital, Beijing, China
| | - Xiya Zhou
- 34732Peking Union Medical College Hospital, Beijing, China
| | - Yulin Jiang
- 34732Peking Union Medical College Hospital, Beijing, China
| | - Na Hao
- 34732Peking Union Medical College Hospital, Beijing, China
| | - Juntao Liu
- 34732Peking Union Medical College Hospital, Beijing, China
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11
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Carbone L, Cariati F, Sarno L, Conforti A, Bagnulo F, Strina I, Pastore L, Maruotti GM, Alviggi C. Non-Invasive Prenatal Testing: Current Perspectives and Future Challenges. Genes (Basel) 2020; 12:genes12010015. [PMID: 33374411 PMCID: PMC7824607 DOI: 10.3390/genes12010015] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022] Open
Abstract
Fetal aneuploidies are among the most common causes of miscarriages, perinatal mortality and neurodevelopmental impairment. During the last 70 years, many efforts have been made in order to improve prenatal diagnosis and prenatal screening of these conditions. Recently, the use of cell-free fetal DNA (cff-DNA) testing has been increasingly used in different countries, representing an opportunity for non-invasive prenatal screening of pregnant women. The aim of this narrative review is to describe the state of the art and the main strengths and limitations of this test for prenatal screening of fetal aneuploidies.
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Affiliation(s)
- Luigi Carbone
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università di Napoli Federico II, 80131 Naples, Italy; (L.C.); (L.S.); (A.C.); (I.S.); (G.M.M.); (C.A.)
| | - Federica Cariati
- CEINGE-Biotecnologie Avanzate s.c.a.r.l., 80145 Naples, Italy;
- Fertility Unit, Maternal-Child Department, AOU Policlinico Federico II, 80131 Naples, Italy;
- Correspondence: ; Tel.: +39-3331219825
| | - Laura Sarno
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università di Napoli Federico II, 80131 Naples, Italy; (L.C.); (L.S.); (A.C.); (I.S.); (G.M.M.); (C.A.)
| | - Alessandro Conforti
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università di Napoli Federico II, 80131 Naples, Italy; (L.C.); (L.S.); (A.C.); (I.S.); (G.M.M.); (C.A.)
| | - Francesca Bagnulo
- Fertility Unit, Maternal-Child Department, AOU Policlinico Federico II, 80131 Naples, Italy;
| | - Ida Strina
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università di Napoli Federico II, 80131 Naples, Italy; (L.C.); (L.S.); (A.C.); (I.S.); (G.M.M.); (C.A.)
- Fertility Unit, Maternal-Child Department, AOU Policlinico Federico II, 80131 Naples, Italy;
| | - Lucio Pastore
- CEINGE-Biotecnologie Avanzate s.c.a.r.l., 80145 Naples, Italy;
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, 80131 Naples, Italy
| | - Giuseppe Maria Maruotti
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università di Napoli Federico II, 80131 Naples, Italy; (L.C.); (L.S.); (A.C.); (I.S.); (G.M.M.); (C.A.)
| | - Carlo Alviggi
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università di Napoli Federico II, 80131 Naples, Italy; (L.C.); (L.S.); (A.C.); (I.S.); (G.M.M.); (C.A.)
- Fertility Unit, Maternal-Child Department, AOU Policlinico Federico II, 80131 Naples, Italy;
- Istituto per l’Endocrinologia e l’Oncologia Sperimentale, Consiglio Nazionale Delle Ricerche, 80131 Naples, Italy
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12
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Ayaz R, Göktas E, Turkyilmaz G, Asoglu MR. PRENATAL IDENTIFICATION OF ABERRANT RIGHT SUBCLAVIAN ARTERY IN ISOLATION: THE NEED FOR FURTHER GENETIC WORK-UP? Acta Clin Croat 2020; 59:582-589. [PMID: 34285428 PMCID: PMC8253070 DOI: 10.20471/acc.2020.59.04.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 09/29/2020] [Indexed: 11/24/2022] Open
Abstract
The objective of this study was to evaluate the association between aberrant right subclavian artery (ARSA) and chromosomal abnormalities. The study included 5211 women having attended our unit for fetal anatomic screening and fetal echocardiography from August 2016 until February 2019. After diagnosing ARSA, prenatal invasive testing was discussed with the patients. ARSA affected fetus was determined in 57 cases; of these, there were 38 cases of isolated ARSA and 19 cases of non-isolated ARSA but associated with soft markers and fetal anomalies. Nineteen patients underwent amniocentesis; Down syndrome was determined in two women, both of them from the non-isolated ARSA group, with fetal hydrops, atrioventricular septal defect and esophageal atresia. Fifteen of 38 patients who declined prenatal diagnostic testing, accepted karyotype analysis after delivery and none of these 15 cases had chromosomal abnormalities. Identification of ARSA should be followed by detailed ultrasound examination to ensure that there are no accompanying soft markers and/or structural defects. Isolated ARSA may not be an indication for karyotype analysis or 22q11.2 microdeletions. Non-ARSA implies a strong predictor of aneuploidy, and when additional findings are detected, invasive testing should be offered to the parents. The association between isolated ARSA and genetic disease should be evaluated in large powered prospective studies.
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Affiliation(s)
| | - Emine Göktas
- 1Division of Perinatology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey; 2Division of Genetic Disease, Van Regional Training and Research Hospital, Van, Turkey; 3Division of Obstetrics & Gynecology, Van Regional Trainingand Research Hospital, Van, Turkey; 4Bahceci Infertility and IVF Center, Fulya, Istanbul, Turkey
| | - Gurcan Turkyilmaz
- 1Division of Perinatology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey; 2Division of Genetic Disease, Van Regional Training and Research Hospital, Van, Turkey; 3Division of Obstetrics & Gynecology, Van Regional Trainingand Research Hospital, Van, Turkey; 4Bahceci Infertility and IVF Center, Fulya, Istanbul, Turkey
| | - Mehmet Resit Asoglu
- 1Division of Perinatology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey; 2Division of Genetic Disease, Van Regional Training and Research Hospital, Van, Turkey; 3Division of Obstetrics & Gynecology, Van Regional Trainingand Research Hospital, Van, Turkey; 4Bahceci Infertility and IVF Center, Fulya, Istanbul, Turkey
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13
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Abstract
Introduction Non-invasive prenatal testing (NIPT) using cell-free foetal DNA has been widely accepted in recent years for detecting common foetal chromosome aneuploidies, such as trisomies 13, 18 and 21, and sex chromosome aneuploidies. In this study, the practical clinical performance of our foetal DNA testing was evaluated for analysing all chromosome aberrations among 7113 pregnancies in Italy. Methods This study was a retrospective analysis of collected NIPT data from the Ion S5 next-generation sequencing platform obtained from Altamedica Medical Centre in Rome, Italy. Results In this study, NIPT showed 100% sensitivity and 99.9% specificity for trisomies 13, 18 and 21. Out of the 7113 samples analysed, 74 cases (1%) were positive by NIPT testing; foetal karyotyping and follow-up results validated 2 trisomy 13 cases, 5 trisomy 18 cases, 58 trisomy 21 cases and 10 sex chromosome aneuploidy cases. There were no false-negative results. Conclusion In our hands, NIPT had high sensitivity and specificity for common chromosomal aneuploidies such as trisomies 13, 18 and 21.
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14
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Putra M, Idler J, Patek K, Contos G, Walker C, Olson D, Hicks MA, Chaperon J, Korzeniewski SJ, Patwardhan SC, Sokol RJ. The association of HBB-related significant hemoglobinopathies and low fetal fraction on noninvasive prenatal screening for fetal aneuploidy. J Matern Fetal Neonatal Med 2019; 34:3657-3661. [PMID: 31736384 DOI: 10.1080/14767058.2019.1689558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: HBB-related significant hemoglobinopathies have been anecdotally associated with low fetal fraction on noninvasive prenatal screening (NIPS). We sought to compare the difference in fetal fraction using NIPS in women with HBB-related significant hemoglobinopathies (HSH) and women with normal hemoglobin.Study design: This is a retrospective case-control study. Cases were women with a diagnosis of HSH using NIPS from a commercial laboratory. The comparison group was women with hemoglobin AA from a tertiary care center database. We tested for differences in median fetal fraction using quantile regression analysis, adjusting for maternal body weight and gestational age.Results: This study includes 35 women with clinically significant HSH and a comparison group of 636 women with hemoglobin AA. Adjusting for gestational age and body weight, the median fetal fraction was 4.1 point lower in the HSH than in the comparison group (β - 4.1; 95% -5.7 to -2.5, p < .05). The rate of no-calls due to low fetal fraction was significantly higher in the clinically significant HSH group than in the comparison group [HSH: n = 9/35, 25.7% versus comparison: n = 32/636, 5.0% (p < .001)].Conclusion: Women with HSH were more likely to have a lower fetal fraction and ultimately a five-fold higher no-call rate. What's already known about this topic?Low fetal fraction is one of the most common causes of no-call result in noninvasive prenatal screeningHigh maternal weight, early gestational age and fetal aneuploidies are associated with low fetal fraction What does this study add?HBB-related significant hemoglobinopathies are associated with low fetal fractionReduction in fetal fraction due to HBB-related significant hemoglobinopathies may also result in higher no-call rate.
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Affiliation(s)
- Manesha Putra
- Department of Reproductive Biology, Division of Maternal-Fetal Medicine, MetroHealth Medical Center, Cleveland, OH, USA.,University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Jay Idler
- Detroit Medical Center, Detroit, MI, USA.,Wayne State University School of Medicine, Detroit, MI, USA
| | - Kara Patek
- Detroit Medical Center, Detroit, MI, USA.,Wayne State University School of Medicine, Detroit, MI, USA
| | - George Contos
- Detroit Medical Center, Detroit, MI, USA.,Wayne State University School of Medicine, Detroit, MI, USA
| | - Christopher Walker
- Detroit Medical Center, Detroit, MI, USA.,Wayne State University School of Medicine, Detroit, MI, USA
| | - Danielle Olson
- Department of Reproductive Biology, Division of Maternal-Fetal Medicine, MetroHealth Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| | | | | | | | | | - Robert J Sokol
- Wayne State University School of Medicine, Detroit, MI, USA
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15
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Nicht invasive Pränataldiagnostik mittels molekulargenetischer Tests (NIPT) zur Erkennung der Trisomien 13, 18 und 21. MED GENET-BERLIN 2019. [DOI: 10.1007/s11825-019-00251-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Zusammenfassung
Hintergrund
Molekulargenetische Tests (NIPT) auf Trisomie sind längst Teil der nicht invasiven Pränataldiagnostik (NIPD). In Deutschland wird derzeit geprüft, ob und für wen diese Tests von den gesetzlichen Krankenkassen künftig bezahlt werden sollen.
Fragestellung
(I) Diagnostische Eigenschaften der NIPT zur Entdeckung der Trisomien 13, 18 und 21 und (II) hypothetische Berechnung der möglichen Anwendung der NIPT in verschiedenen Gruppen.
Methoden
(I) Systematische Recherche nach Primärliteratur und systematischen Übersichten in MEDLINE und vier weiteren Datenbanken. Einschlusskriterien: Studien mit schwangeren Frauen, Indextest: NIPT mittels molekulargenetischer Analyse von cffDNA im mütterlichen Blut zur Bestimmung des Trisomie-Risikos; Referenztest: zytogenetische Diagnostik oder postnatale klinische Untersuchung. (II) Orientierende Recherche. Hypothetische Berechnungen für (1) alle schwangeren Frauen nach aktuellem Vorgehen ohne NIPT am Beispiel von Ersttrimesterscreening (ETS), (2) Anwendung bei schwangeren Frauen mit erhöhtem Risiko, z. B. nach vorgeschaltetem auffälligem ETS und (3) NIPT in einer Population mit und ohne erhöhtes Risiko für eine Trisomie.
Ergebnisse
Bei 22 eingeschlossenen Studien lagen die Sensitivität und die Spezifität zur Erkennung der Trisomie 21 bei 99,13 % (95 %-KI: [97,39 %; 99,72 %]) und 99,95 % (95 %-KI: [99,88 %; 99,98 %]). Der mögliche Einfluss von Testversagern blieb bei den Berechnungen unberücksichtigt, womit die Sensitivität oder die Spezifität der NIPT möglicherweise überschätzt wurde. Für die Erkennung der Trisomien 13 und 18 konnte jeweils die Sensitivität nicht robust geschätzt werden.
Diskussion
Bei Frauen mit erhöhtem Risiko können NIPT die Zahl der invasiven Tests und damit der testbedingten Fehlgeburten vermutlich verringern.
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16
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Smith SK, Cai A, Wong M, Sousa MS, Peate M, Welsh A, Meiser B, Kaur R, Halliday J, Lewis S, Trevena L, Yanes T, Barlow-Stewart K, Barclay M. Improving women's knowledge about prenatal screening in the era of non-invasive prenatal testing for Down syndrome - development and acceptability of a low literacy decision aid. BMC Pregnancy Childbirth 2018; 18:499. [PMID: 30558569 PMCID: PMC6296052 DOI: 10.1186/s12884-018-2135-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 12/04/2018] [Indexed: 02/02/2023] Open
Abstract
Background Access to information about prenatal screening is important particularly in light of new techniques such as non-invasive prenatal testing (NIPT). This study aimed to develop and examine the acceptability of a low literacy decision aid (DA) about Down syndrome screening among pregnant women with varying education levels and GPs. Methods We developed a DA booklet providing information about first-trimester combined testing, maternal serum screening, and NIPT. GPs and women participated in a telephone interview to examine the acceptability of the DA and measure screening knowledge before and after reading the DA. The knowledge measure was designed to assess whether women had understood the gist of the information presented in the decision aid. It comprised conceptual questions (e.g. screening tells you the chance of having a baby with Down syndrome) and numeric questions (e.g. the accuracy of different screening tests). Results Twenty-nine women and 18 GPs participated. Regardless of education level, most women found the booklet ‘very’ clearly presented (n = 22, 76%), and ‘very’ informative (n = 23, 80%). Overall, women’s conceptual and numeric knowledge improved after exposure to the DA, from 4% having adequate knowledge to 69%. Women’s knowledge of NIPT also improved after receiving the decision aid, irrespective of education. Most GPs found it ‘very’ clearly presented (n = 13, 72%), and that it would ‘very much’ facilitate decision-making (n = 16, 89%). Conclusions The DA was found to be acceptable to women as well as GPs. A comprehensive evaluation of the efficacy of the decision aid compared to standard information is an important next step. Strategies are needed on how to implement the tool in practice. Electronic supplementary material The online version of this article (10.1186/s12884-018-2135-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sian Karen Smith
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia.
| | - Antonia Cai
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia
| | - Michelle Wong
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia
| | - Mariana S Sousa
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia.,Centre for Applied Nursing Research, School of Nursing and Midwifery, Western Sydney University, Ingham, Sydney, Australia.,South Western Sydney Local Health District, Institute for Applied Medical Research, Sydney, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, Australia
| | - Alec Welsh
- School of Women's and Children's Health, UNSW Sydney, Sydney, Australia.,Department of Maternal-Fetal Medicine, Royal Hospital for Women, Sydney, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia
| | - Rajneesh Kaur
- Psychosocial Research Group, Lowy Research Centre, C25, Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Corner High and Botany St, Kensington, Sydney New South Wales, 2033, Australia
| | - Jane Halliday
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Lyndal Trevena
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Tatiane Yanes
- School of Psychiatry, Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | | | - Margot Barclay
- Women's Services, Liverpool Hospital, Sydney, Australia.,Western Sydney University, Parramatta, Sydney, Australia
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17
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McBrien A, Hornberger LK. Early fetal echocardiography. Birth Defects Res 2018; 111:370-379. [PMID: 30430770 DOI: 10.1002/bdr2.1414] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 09/27/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To explore the technical aspects and clinical utility of early fetal echocardiography and screening of the fetal heart in early pregnancy. Also, to document differences in cardiac structure and function which can be demonstrated in the late first/early second trimesters. METHODS In addition to summarizing our own experiences of late first/early second trimester fetal echocardiography, we reviewed the literature to explore clinical indications for, technical aspects, safety, accuracy, strengths and weaknesses of early fetal echocardiography. RESULTS In the current era, an increasing number of fetuses are identified as being at risk of congenital heart disease from as early as the late first trimester. In experienced hands, early fetal echocardiography can pick up a high proportion of congenital heart disease with good reliability for the majority of lesions. Early fetal echocardiography is relatively poor at assessing pulmonary veins, the atrioventricular valves and lesions that typically occur later or progress during the course of pregnancy. There is increasing interest in widespread implementation of an early obstetric anomaly screen which includes an assessment of the fetal heart for all pregnancies. There are a variety of hemodynamic differences in the late first/early second trimester compared with later in pregnancy. CONCLUSION Early fetal echocardiography is has become an established tool for detection of congenital heart disease. It affords opportunities to learn about the true spectrum and progression of congenital heart disease in-utero. Operators should be mindful of safety issues, technical aspects and hemodynamic findings which differ when performing echocardiograms at this stage of pregnancy.
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Affiliation(s)
- Angela McBrien
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute, Cardiovascular Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa K Hornberger
- Fetal & Neonatal Cardiology Program, Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute, Cardiovascular Research Institute, University of Alberta, Edmonton, Alberta, Canada.,The Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
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18
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Lambert-Messerlian G, Palomaki GE. Fewer women aged 35 and older choose serum screening for Down's syndrome: Impact and implications. J Med Screen 2018; 26:59-66. [PMID: 30253677 DOI: 10.1177/0969141318797961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To quantify changes in the proportion of women aged 35 and older choosing serum screening for Down's syndrome over time and the effect on false positive and detection rates. METHODS From Rhode Island hospital-based laboratory prenatal screening records (2013-2017) we extracted the test performed (Integrated, Combined, Quadruple), maternal age, and Down's syndrome risk; documented observed changes in maternal age distributions and false positive rates, and modelled the impact of varying proportions of older women choosing screening on each test's performance using the 2015 United States birth cohort as baseline. RESULTS Over five years, observed false positive rates for Integrated testing declined from 1.9 to 1.3% (-32%). The proportion of older women tested declined from 14.9 to 8.5%, from which modelling predicts a 16% decline in the false positive rate. This is lower than our observed change but consistent with a reduction driven by declining participation by older women. Modelling predicted a detection rate reduction from 89 to 87%. Larger detection rate impacts were predicted for Combined and Quadruple testing. CONCLUSIONS This study documents, for the first time, the declining proportion of older women choosing Down's syndrome serum screening and subsequent impact on screening performance. The American College of Obstetrics and Gynecology recommends offering cell-free DNA screening for these 'high risk' pregnancies and uptake may increase further. Screening programmes could consider increasing use of Integrated testing over other serum screening tests or lowering risk cut-offs so false positive rates approach those of 2012 to regain lost detection.
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Affiliation(s)
- Geralyn Lambert-Messerlian
- 1 Department of Pathology and Laboratory Medicine, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, USA.,2 Obstetrics and Gynecology, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, USA
| | - Glenn E Palomaki
- 1 Department of Pathology and Laboratory Medicine, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, USA
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19
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Phadke SR, Puri RD, Ranganath P. Prenatal screening for genetic disorders: Suggested guidelines for the Indian Scenario. Indian J Med Res 2018; 146:689-699. [PMID: 29664026 PMCID: PMC5926339 DOI: 10.4103/ijmr.ijmr_1788_15] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Prenatal testing is the best strategy for reducing the burden of genetic disorders and congenital disabilities that cause significant postnatal functional impairment. Universal prenatal screening is advisable for common genetic disorders and congenital anomalies such as Down syndrome, beta-thalassaemia and neural tube defects. Several prenatal-screening tests are now available for Down syndrome, but knowledge about the appropriate timing of the test and the need for pre- and post-test counselling may not be updated among the primary care physicians. There is also a considerable degree of confusion regarding the prenatal screening test to be chosen in each case, due to the availability of a number of new and advanced screening techniques. At present, there is no nation-wide consensus regarding the nature and timing of these prenatal-screening protocols. Due to the absence of any definite guidelines and the additional lacunae in the awareness regarding the appropriate prenatal screening in the country, the optimum benefits of these screening protocols are not reaching the population. This review focuses on the various prenatal screening and diagnostic tests that are available for common genetic conditions and congenital disabilities and attempts to outline the most cost-effective and gestational age-appropriate strategies for prenatal screening for the Indian healthcare set-up. The recommendations suggested would serve as a source guide for formulating prenatal-screening guidelines for reducing the incidence of common genetic disorders and congenital disabilities in India.
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Affiliation(s)
- Shubha R Phadke
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ratna D Puri
- Institute of Medical Genetics & Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Prajnya Ranganath
- Department of Medical Genetics, Nizam's Institute of Medical Sciences, Hyderabad, India
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20
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Yang J, Qi Y, Hou Y, Guo F, Peng H, Wang D, Haoxin OY, Wang Y, Huang H, Yin A. Performance of non-invasive prenatal testing for trisomies 21 and 18 in twin pregnancies. Mol Cytogenet 2018; 11:47. [PMID: 30166996 PMCID: PMC6103871 DOI: 10.1186/s13039-018-0392-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/23/2018] [Indexed: 01/18/2023] Open
Abstract
Background Cell-free fetal DNA in maternal plasma represents a source of fetal genetic material that can be sampled noninvasively. There are ample studies confirming the accuracy of NIPT in singleton pregnancies, but there is still relatively little studies demonstrate the feasibility and clinical application of a NIPT for fetal aneuploidy screening in twin pregnancies. Results In this study, we have finished 432 twin pregnancies screening by NIPT. There were 4 double chorionic dichorionic diamniotic (DCDA) cases of true positive NIPT results, including 1of T18 and 3 of T21, and 1 monochorionic diamniotic (MCDA) cases of true positive NIPT results, including 1of T21. The combined false-positive frequency for trisomies 21, 18 was 0%. Furthermore, there were 2 cases of false positive NIPT results, including 1 of T7 and 1 of sex chromosome aneuploidy. There was no false negative case, which gave a combined sensitivity and specificity of 100 and 99.53% respectively. Conclusion Our study demonstrated NIPT performed well in the detection of trisomy 21 in twin pregnancy. It is feasible and clinical applicable of NIPT for fetal aneuploidy screening in twin pregnancies. But, it needs a large number of clinical samples to demonstrate the applicability of other chromosomal abnormalities besides trisomies 21 and 18 in both singleton pregnancies and twin pregnancies.
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Affiliation(s)
- Jiexia Yang
- 1Prenatal Diagnosis Centre, Guangdong Women and Children Hospital, Guangzhou, 511400 Guangdong China.,2Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, 511400 Guangdong China
| | - Yiming Qi
- 1Prenatal Diagnosis Centre, Guangdong Women and Children Hospital, Guangzhou, 511400 Guangdong China.,2Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, 511400 Guangdong China
| | - Yaping Hou
- 1Prenatal Diagnosis Centre, Guangdong Women and Children Hospital, Guangzhou, 511400 Guangdong China.,2Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, 511400 Guangdong China
| | - Fangfang Guo
- 1Prenatal Diagnosis Centre, Guangdong Women and Children Hospital, Guangzhou, 511400 Guangdong China.,2Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, 511400 Guangdong China
| | - Haishan Peng
- 1Prenatal Diagnosis Centre, Guangdong Women and Children Hospital, Guangzhou, 511400 Guangdong China.,2Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, 511400 Guangdong China
| | - Dongmei Wang
- 1Prenatal Diagnosis Centre, Guangdong Women and Children Hospital, Guangzhou, 511400 Guangdong China.,2Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, 511400 Guangdong China
| | - O Y Haoxin
- 1Prenatal Diagnosis Centre, Guangdong Women and Children Hospital, Guangzhou, 511400 Guangdong China.,2Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, 511400 Guangdong China
| | - Yixia Wang
- 1Prenatal Diagnosis Centre, Guangdong Women and Children Hospital, Guangzhou, 511400 Guangdong China.,2Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, 511400 Guangdong China
| | - Huajie Huang
- 1Prenatal Diagnosis Centre, Guangdong Women and Children Hospital, Guangzhou, 511400 Guangdong China.,2Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, 511400 Guangdong China
| | - Aihua Yin
- 1Prenatal Diagnosis Centre, Guangdong Women and Children Hospital, Guangzhou, 511400 Guangdong China.,2Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, 511400 Guangdong China
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Palomaki GE, Kloza EM. Prenatal cell-free DNA screening test failures: a systematic review of failure rates, risks of Down syndrome, and impact of repeat testing. Genet Med 2018; 20:1312-1323. [PMID: 30514979 DOI: 10.1038/gim.2018.22] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/19/2018] [Indexed: 01/12/2023] Open
Abstract
PURPOSE We systematically reviewed the published literature on test failure rates for the sequencing of cell-free DNA (cfDNA) in maternal plasma to identify Down syndrome. METHODS We searched peer-reviewed English publications with diagnostic results on all pregnancies that provided test failure rates. Data on the odds of failure in Down syndrome and euploid pregnancies and the impact of repeat testing were extracted. Random-effects modeling was then used to identify moderators that could explain variability. RESULTS Thirty articles satisfied the inclusion criteria for overall failure rates. Study location (Western and Asian with initial testing, and Western with repeat testing) were significant moderators with failure rates of 3.3, 0.6, and 1.2%, respectively (P = 0.001). The odds ratio for Down syndrome in successful versus failed tests was 0.98 (95% confidence interval: 0.62-1.55, I2 = 0%). Repeat testing from 14 large clinical cohort studies found that 83% (range: 52-100%) of failures were repeated, with 79% (range: 46-97%) being successful. CONCLUSION Lower failure rates in Asian studies may be related to not routinely measuring the fetal fraction and to fewer obese women. Repeat cfDNA testing is effective in providing reliable results after initial failures. Protocols for primary cfDNA screening should focus on Down syndrome, with less common and more structurally abnormal trisomy 18 and 13 pregnancies treated as adjuncts.
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Affiliation(s)
- Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, Rhode Island, USA. .,Department of Pathology and Laboratory Medicine, Alpert Medical School at Brown University, Providence, Rhode Island, USA.
| | - Edward M Kloza
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, Rhode Island, USA
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Vinante V, Keller B, Huhn EA, Huang D, Lapaire O, Manegold-Brauer G. Impact of nationwide health insurance coverage for non-invasive prenatal testing. Int J Gynaecol Obstet 2018; 141:189-193. [PMID: 29215710 DOI: 10.1002/ijgo.12422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 10/05/2017] [Accepted: 12/06/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To describe the changes in women's choices for prenatal testing after the introduction of nationwide health insurance coverage for non-invasive prenatal testing (NIPT) in Switzerland. METHODS The present retrospective study reviewed data from all women with singleton pregnancies who presented at the prenatal unit of Basel University Hospital, Switzerland, for first-trimester screening between July 15, 2014, and December 31, 2015. Women were divided into three categories according to their risk for aneuploidy, and the uptake of NIPT in the period before and after the introduction of the nationwide coverage for NIPT was compared. RESULTS Overall, 887 women were included in the study: 573 screens were carried out before (group 1) and 314 after (group 2) the introduction of insurance coverage for NIPT. In group 1, 53 (9.2%) had NIPT as compared with 72 (22.9%) in group 2. Among women with intermediate risk for aneuploidies and basic insurance coverage, NIPT increased by 56% (12/88 [14%] vs 32/46 [70%]; P<0.001). CONCLUSION There was a notable increase in the uptake of NIPT; uptake was most significant among women with basic health insurance and intermediate risk for aneuploidy.
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Affiliation(s)
- Valentina Vinante
- Division of Prenatal and Gynecologic Ultrasound, Department of Obstetrics and Gynecology, Basel University Hospital, Basel, Switzerland
| | - Bettina Keller
- Division of Prenatal and Gynecologic Ultrasound, Department of Obstetrics and Gynecology, Basel University Hospital, Basel, Switzerland
| | - Evelyn A Huhn
- Division of Prenatal and Gynecologic Ultrasound, Department of Obstetrics and Gynecology, Basel University Hospital, Basel, Switzerland
| | - Dorothy Huang
- Division of Prenatal and Gynecologic Ultrasound, Department of Obstetrics and Gynecology, Basel University Hospital, Basel, Switzerland
| | - Olav Lapaire
- Division of Prenatal and Gynecologic Ultrasound, Department of Obstetrics and Gynecology, Basel University Hospital, Basel, Switzerland
| | - Gwendolin Manegold-Brauer
- Division of Prenatal and Gynecologic Ultrasound, Department of Obstetrics and Gynecology, Basel University Hospital, Basel, Switzerland
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23
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Gil MM, Accurti V, Santacruz B, Plana MN, Nicolaides KH. Analysis of cell-free DNA in maternal blood in screening for aneuploidies: updated meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:302-314. [PMID: 28397325 DOI: 10.1002/uog.17484] [Citation(s) in RCA: 407] [Impact Index Per Article: 58.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To review clinical validation or implementation studies of maternal blood cell-free (cf) DNA analysis and define the performance of screening for fetal trisomies 21, 18 and 13 and sex chromosome aneuploidies (SCA). METHODS Searches of PubMed, EMBASE and The Cochrane Library were performed to identify all peer-reviewed articles on cfDNA testing in screening for aneuploidies between January 2011, when the first such study was published, and 31 December 2016. The inclusion criteria were peer-reviewed study reporting on clinical validation or implementation of maternal cfDNA testing in screening for aneuploidies, in which data on pregnancy outcome were provided for more than 85% of the study population. We excluded case-control studies, proof-of-principle articles and studies in which the laboratory scientists carrying out the tests were aware of fetal karyotype or pregnancy outcome. Pooled detection rates (DRs) and false-positive rates (FPRs) were calculated using bivariate random-effects regression models. RESULTS In total, 35 relevant studies were identified and these were used for the meta-analysis on the performance of cfDNA testing in screening for aneuploidies. These studies reported cfDNA results in relation to fetal karyotype from invasive testing or clinical outcome. In the combined total of 1963 cases of trisomy 21 and 223 932 non-trisomy 21 singleton pregnancies, the weighted pooled DR and FPR were 99.7% (95% CI, 99.1-99.9%) and 0.04% (95% CI, 0.02-0.07%), respectively. In a total of 563 cases of trisomy 18 and 222 013 non-trisomy 18 singleton pregnancies, the weighted pooled DR and FPR were 97.9% (95% CI, 94.9-99.1%) and 0.04% (95% CI, 0.03-0.07%), respectively. In a total of 119 cases of trisomy 13 and 212 883 non-trisomy 13 singleton pregnancies, the weighted pooled DR and FPR were 99.0% (95% CI, 65.8-100%) and 0.04% (95% CI, 0.02-0.07%), respectively. In a total of 36 cases of monosomy X and 7676 unaffected singleton pregnancies, the weighted pooled DR and FPR were 95.8% (95% CI, 70.3-99.5%) and 0.14% (95% CI, 0.05-0.38%), respectively. In a combined total of 17 cases of SCA other than monosomy X and 5400 unaffected singleton pregnancies, the weighted pooled DR and FPR were 100% (95% CI, 83.6-100%) and 0.004% (95% CI, 0.0-0.08%), respectively. For twin pregnancies, in a total of 24 cases of trisomy 21 and 1111 non-trisomy 21 cases, the DR was 100% (95% CI, 95.2-100%) and FPR was 0.0% (95% CI, 0.0-0.003%), respectively. CONCLUSIONS Screening by analysis of cfDNA in maternal blood in singleton pregnancies could detect > 99% of fetuses with trisomy 21, 98% of trisomy 18 and 99% of trisomy 13 at a combined FPR of 0.13%. The number of reported cases of SCA is too small for accurate assessment of performance of screening. In twin pregnancies, performance of screening for trisomy 21 is encouraging but the number of cases reported is small. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M M Gil
- Fetal Medicine Research Institute, King's College Hospital, London, UK
- Obstetrics and Gynecology Department, Torrejon University Hospital, Torrejon de Ardoz, Madrid, Spain
- Obstetrics and Gynecology Department, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - V Accurti
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - B Santacruz
- Obstetrics and Gynecology Department, Torrejon University Hospital, Torrejon de Ardoz, Madrid, Spain
| | - M N Plana
- Clinical Biostatistics Unit, Ramón y Cajal Hospital (IRYCIS), CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
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Jin J, Yang J, Chen Y, Huang J. Systematic review and meta-analysis of non-invasive prenatal DNA testing for trisomy 21: implications for implementation in China. Prenat Diagn 2017; 37:864-873. [PMID: 28686807 DOI: 10.1002/pd.5111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 05/20/2017] [Accepted: 07/03/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To systematically review clinical validation studies of massive parallel sequencing (MPS) technology in prenatal screening for trisomy 21 and to explore the potential implementation strategies in China compared with those in developing countries. METHODS Searches of the Cochrane Library, Medline, EMBASE, Web of Science, Biosis Previews, and three major Chinese databases were performed to identify all the peer-reviewed articles published between 1 January 2011 and 15 October 2016. We also reviewed and discussed the potential challenges and risks in the future promotion of MPS technology in China compared with those in developing countries. RESULTS The weighted pooled sensitivity and specificity of MPS technology for the prenatal detection of trisomy 21 were 99.7% (95% CI 98.3-99.9%) and 100.0% (95% CI 99.9-100.0%), respectively, based on a meta-analysis of 44 included studies. An additional meta-analysis was conducted based on the 25 included studies that were performed in medical/genetic sequencing institutions in mainland China, showing a weighted pooled sensitivity and specificity of MPS technology as 99.5% (95% CI 98.7-99.8%) and 100% (95% CI 99.9-100%), respectively. CONCLUSION MPS technology offers effective screening performance for trisomy 21 but should be cautiously promoted due to its clinical limitations and challenges that stem from the ethics and business aspects. © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jiajie Jin
- School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Shanghai, China
| | - Junwen Yang
- School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Shanghai, China
| | - Yingyao Chen
- School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Shanghai, China
| | - Jiayan Huang
- School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Shanghai, China
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25
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Zhu Y, Lu S, Bian X, Wang H, Zhu B, Wang H, Xu Z, Xu L, Yan W, Zeng Y, Chen Z, Tang S, Shen G, Miao Z. A multicenter study of fetal chromosomal abnormalities in Chinese women of advanced maternal age. Taiwan J Obstet Gynecol 2017; 55:379-84. [PMID: 27343319 DOI: 10.1016/j.tjog.2016.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE This study aimed to determine the rates of different fetal chromosomal abnormalities among women of advanced maternal age in China and to discuss the possible misdiagnosis risks of newer molecular techniques, for selection of appropriate prenatal screening and diagnostic technologies. MATERIALS AND METHODS Second trimester amniocentesis and fetal karyotype results of 46,258 women were retrospectively reviewed. All women were ≥ 35 years old with singleton pregnancies. The rates of clinically significant chromosomal abnormalities (CSCAs), incidence of chromosomal abnormalities, and correlations with age were determined. RESULTS From 2001 to 2010, the proportion of women of advanced maternal age undergoing prenatal diagnosis increased from 20% to 46%. The mean age was 37.4 years (range, 35-46 years). A total of 708 cases of CSCAs, with a rate of 1.53% were found. Trisomy 21 was the most common single chromosome abnormality and accounted for 55.9% of all CSCAs with an incidence of 0.86%. Trisomy 13, trisomy 18, and trisomy 21, the most common chromosome autosomal aneuploidies, accounted for 73.6% of all CSCAs, with a rate of 1.13%. As a group, the most common chromosomal aneuploidies (13/18/21/X/Y) accounted for 93.9% of all abnormalities, with a rate of 1.44%. The incidence of trisomy 21, trisomy 13/18/21 as a group, and 13/18/21/X/Y as a group was significantly greater in women aged 39 years and older (p < 0.001), but was not different between women aged 35 years, 36 years, 37 years, and 38 years. CONCLUSION These findings may assist in genetic counseling of advanced maternal age pregnant women, and provide a basis for the selection of prenatal screening and diagnostic technologies.
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Affiliation(s)
- Yuning Zhu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Prenatal Diagnosis Center of Zhejiang Province, Hangzhou, China
| | - Shiming Lu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Prenatal Diagnosis Center of Zhejiang Province, Hangzhou, China.
| | - Xuming Bian
- Department of Obstetrics and Gynecology, Academy of Medical Science, Chinese Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - He Wang
- West China Second University Hospital, Sichuan University, Prenatal Diagnosis Center of Sichuan Province, Chengdu, China
| | - Baosheng Zhu
- Genetic Diagnostic Center, the First People's Hospital of Yunnan Province, Kunming, China
| | - Hua Wang
- The Maternal and Child Health Hospital of Hunan Province, Prenatal Diagnosis Center of Hunan Province, Changsha, Hunan, China
| | - Zhengfeng Xu
- Center of Prenatal Diagnosis, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Liangpu Xu
- Center of Prenatal Diagnosis, Maternal and Child Health Hospital of Fujian Province, Fuzhou, China
| | - Weihua Yan
- Center of Prenatal Diagnosis, Taizhou Hospital, Taizhou, China
| | - Yan Zeng
- Center of Prenatal Diagnosis, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China
| | - Zhiyang Chen
- Center of Prenatal Diagnosis, Ningbo Maternity and Child Health Care Hospital, Ningbo, China
| | - Shaohua Tang
- Center of Prenatal Diagnosis, Wenzhou Central Hospital, Wenzhou, China
| | - Guosong Shen
- Center of Prenatal Diagnosis, Huzhou Maternity and Child Health Care Hospital, Huzhou, China
| | - Zhengyou Miao
- Center of Prenatal Diagnosis, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China
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Vialard F, Quarello E. [What strategies for prenatal screening and diagnosis in France?]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2017; 45:129-130. [PMID: 28259706 DOI: 10.1016/j.gofs.2017.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Indexed: 06/06/2023]
Affiliation(s)
- F Vialard
- Fédération de génétique, CHI de Poissy Saint-Germain-en-Laye, Poissy, France; GIG, EA 7404, unité de formation et de recherche des sciences de la santé Simone-Veil, université de Versailles-Saint-Quentin-en-Yvelines, université Paris Saclay, 78180 Montigny-le-Bretonneux, France
| | - E Quarello
- Institut de médecine de la reproduction, 6, rue Rocca, 13008 Marseille, France; Unité de dépistage et de diagnostic prénatal, hôpital Saint-Joseph, 26, boulevard de Louvain, 13285 Marseille, France.
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Monni G, Iuculano A. Re: ISUOG Practice Guidelines: invasive procedures for prenatal diagnosis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 49:414-415. [PMID: 28266159 DOI: 10.1002/uog.17375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/24/2016] [Indexed: 06/06/2023]
Affiliation(s)
- G Monni
- Ob/Gyn Department, Microcitemico Hospital 'A. Cao', Cagliari, Italy
| | - A Iuculano
- Ob/Gyn Department, Microcitemico Hospital 'A. Cao', Cagliari, Italy
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28
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Comments on Editorial: Has Noninvasive Prenatal Testing (NIPT) Come of Age? J Obstet Gynaecol India 2017; 67:74-75. [DOI: 10.1007/s13224-015-0758-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022] Open
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Colosi E, D'Ambrosio V, Periti E. First trimester contingent screening for trisomies 21,18,13: is this model cost efficient and feasible in public health system? J Matern Fetal Neonatal Med 2017; 30:2905-2910. [PMID: 27915499 DOI: 10.1080/14767058.2016.1268593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the effectiveness of three different first trimester screening models for trisomies 21, 18 and 13, in terms of detection rate, invasive test rate and final costs. MATERIAL AND METHODS We analyzed the distribution of risk for trisomies 21, 18 and 13 in a population of 20,831 singleton pregnancies based on maternal age, fetal heart rate, nuchal translucency, free beta human chorionic gonadotropin and pregnancy-associated plasma protein A (Combined test). On the basis of our data, we estimated the performance and cost of screening for trisomies using three different models at specific cutoffs: Combined test; Cell free DNA test and Contingent screening test. RESULTS Using Combined test, DR for major trisomies was estimated to be 94.92%, invasive test rate was 6.3%. cfDNA would result in a DR of 97.92%, with an invasive test rate of 3.64%. Contingent screening approach would result in an overall DR of 97.82, with a rate for invasive procedure of 1.36% and a final cost lower than other screening policies (2,338,433 euro vs 5,796,060 of cfDNA and 2,385,473 of Combined test). CONCLUSIONS Contingent screening test could be a cost-efficient and feasible first trimester screening test for aneuploidies in public health system.
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Affiliation(s)
- Enrico Colosi
- a Center for Reproductive Medicine and BirthCare Program, Hospital Misericordia, Azienda USL Toscana Sud Est , Grosseto , Italy
| | - Valentina D'Ambrosio
- b Department of Experimental Medicine , University of Rome "Sapienza", Umberto I Hospital , Rome , Italy
| | - Enrico Periti
- c Prenatal Diagnosis Unit , Palagi Hospital , Florence , Italy
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30
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Rosignoli L, Tonni G. Should cell-free fetal DNA be included in first trimester screening (FTS) for common trisomy? A possible scenario on 6697 women screened over 10 years. J Eval Clin Pract 2016; 22:899-906. [PMID: 27345561 DOI: 10.1111/jep.12557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The primary aim was to determine the performance of the first trimester screening (FTS) test in a general obstetrics population. Cost-benefit analysis of a hypothetic model based on implementation of the FTS test by cell-free fetal (cff) DNA was calculated. METHODS A total of 6697 women were screened using FTS test. A two-step strategy based upon nuchal translucency, serum screening and ultrasound assessment of nasal bone (NB) was applied. Three groups were identified (high-risk: >1:250; intermediate-risk: 1:251-1:999 and low-risk group: <1:1000). Women at intermediate-risk (1:251-1:999) underwent NB assessment and recalculation of individual risk. All women at high-risk were offered fetal karyotyping. RESULTS A total of 321 women (4.8%) resulted at high-risk while 480 women (7.1%) with intermediate-risk underwent assessment of the NB, which was absent in 15 fetuses. Overall, 54 aneuploidies were detected for a 96.4% sensitivity, a 96.1% specificity, a 99.9% negative predictive value and a false positive rate of 4.8%. Audit was conducted on a yearly basis and lost to follow up was 0.47% (32 cases). CONCLUSIONS Public health system would not be able to cover the cost of including cff DNA in women undergoing first trimester screening on universal basis. However, assuming a possible scenario based on implementation of FTS by cff DNA in women at high-risk would result in a 6-fold reduction in the number of invasive procedures while avoiding two false negative results (trisomy 21) that were diagnosed in women with intermediate-risk using current screening strategy by combined test.
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Affiliation(s)
- Lucia Rosignoli
- Center for Prevention of Fetal Malformations, Department of Obstetrics and Gynecology, Hospital Meyer, Florence, Italy
| | - Gabriele Tonni
- Prenatal Diagnostic Center, Department of Obstetrics and Gynecology, Guastalla Civil Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy
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31
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Maternal Urine Screening for Down Syndrome: Past Studies and Future Perspectives. JOURNAL OF FETAL MEDICINE 2016. [DOI: 10.1007/s40556-016-0107-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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33
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Oepkes D, Page-Christiaens GCL, Bax CJ, Bekker MN, Bilardo CM, Boon EMJ, Schuring-Blom GH, Coumans ABC, Faas BH, Galjaard RJH, Go AT, Henneman L, Macville MVE, Pajkrt E, Suijkerbuijk RF, Huijsdens-van Amsterdam K, Van Opstal D, Verweij EJJ, Weiss MM, Sistermans EA. Trial by Dutch laboratories for evaluation of non-invasive prenatal testing. Part I-clinical impact. Prenat Diagn 2016; 36:1083-1090. [PMID: 27750376 PMCID: PMC5214231 DOI: 10.1002/pd.4945] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/12/2016] [Accepted: 10/13/2016] [Indexed: 12/15/2022]
Abstract
Objective To evaluate the clinical impact of nationwide implementation of genome‐wide non‐invasive prenatal testing (NIPT) in pregnancies at increased risk for fetal trisomies 21, 18 and 13 (TRIDENT study). Method Women with elevated risk based on first trimester combined testing (FCT ≥ 1:200) or medical history, not advanced maternal age alone, were offered NIPT as contingent screening test, performed by Dutch University Medical laboratories. We analyzed uptake, test performance, redraw/failure rate, turn‐around time and pregnancy outcome. Results Between 1 April and 1 September 2014, 1413/23 232 (6%) women received a high‐risk FCT result. Of these, 1211 (85.7%) chose NIPT. One hundred seventy‐nine women had NIPT based on medical history. In total, 1386/1390 (99.7%) women received a result, 6 (0.4%) after redraw. Mean turn‐around time was 14 days. Follow‐up was available in 1376 (99.0%) pregnancies. NIPT correctly predicted 37/38 (97.4%) trisomies 21, 18 or 13 (29/30, 4/4 and 4/4 respectively); 5/1376 (0.4%) cases proved to be false positives: trisomies 21 (n = 2), 18 (n = 1) and 13 (n = 2). Estimated reduction in invasive testing was 62%. Conclusion Introduction of NIPT in the Dutch National healthcare‐funded Prenatal Screening Program resulted in high uptake and a vast reduction of invasive testing. Our study supports offering NIPT to pregnant women at increased risk for fetal trisomy. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd. What's already known about this topic?Non‐invasive prenatal testing (NIPT) for trisomies 21, 18 and 13 is mainly offered in a commercial setting. Offering NIPT to pregnant women at increased risk for fetal trisomy leads to a reduction in invasive testing.
What does this study adds?NIPT implemented as a contingent test under the umbrella of a national health authority‐supported fetal trisomy screening program facilitates optimal counseling with close to 100% follow‐up, results in 86% uptake and confirms a major reduction of invasive tests.
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Affiliation(s)
- Dick Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Caroline J Bax
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Catia M Bilardo
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elles M J Boon
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Audrey B C Coumans
- Department of Obstetrics and Gynaecology, Maastricht UMC+, Maastricht, The Netherlands
| | - Brigitte H Faas
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Attie T Go
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Merryn V E Macville
- Department of Clinical Genetics, Maastricht UMC+, Maastricht, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Ron F Suijkerbuijk
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Diane Van Opstal
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - E J Joanne Verweij
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Marjan M Weiss
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Erik A Sistermans
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
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Qi G, Yi J, Han B, Liu H, Guo W, Shi C, Yin L. Noninvasive prenatal testing in routine clinical practice for a high-risk population: Experience from a center. Medicine (Baltimore) 2016; 95:e5126. [PMID: 27741136 PMCID: PMC5072963 DOI: 10.1097/md.0000000000005126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This study aimed to summarize the effects of noninvasive prenatal testing (NIPT) on aneuploidy among high-risk participants in Tangshan Maternal and Children Health Hospital.NIPT or invasive prenatal diagnosis was recommended to patients with a high risk of fetal aneuploidy from February 2013 to February 2014. Patients who exhibited eligibility and applied for NIPT from January 2012 to January 2013 were included in a comparison group. The rates of patients who underwent invasive testing, declined to undergo further testing, and manifested trisomies 21, 18, and 13 were compared between two groups. Follow-up data were obtained from the participants who underwent NIPT from 2013 to 2014.A total of 7223 patients (3018 and 4205 individuals before and after NIPT) were eligible for analysis. After NIPT was introduced in 2013 to 2014, 727 patients (17.3%) underwent invasive testing, 2828 preferred NIPT (67.3%), and 650 declined to undergo further testing (15.5%). A total of 34 cases of trisomies 21, 18, and 13 (0.8%) were found. In 2012 to 2013, 565 patients (18.7%) underwent invasive testing and 2453 declined to undergo further testing (81.3%). A total of 7 cases of trisomies 21, 18, and 13 were documented (0.2%). Of these cases, 24 were found from NIPT and 10 cases were found from invasive testing. The number of participants who declined to undergo further testing significantly decreased after NIPT was introduced (81.3% vs. 15.5%, P < 0.001). The sensitivity and specificity of NIPT for trisomies 21, 18, and 13 were 100% and 99.9%, respectively. The detection rates of NIPT for trisomies 21, 18, and 13 also significantly increased (0.2% vs. 0.8%, P < 0.001). By contrast, the overall rates of invasive testing remained unchanged (18.7% vs. 17.3%, P = 0.12). The positive predictive values of NIPT for trisomies 21, 18, and 13 were 100%, 83.3%, and 50.0%, respectively. The false positive rates of NIPT were 0% and 0.04%.With NIPT implementation in clinical practice, the rate of declining a follow-up test among high-risk women was decreased and the detection rate of prenatal chromosomal aneuploidy for trisomies 21, 18, and 13 was increased without requiring numerous invasive procedures.
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Affiliation(s)
- Guijie Qi
- Department of Obstetrics and Gynecology, The Second Hospital of Tianjin Medical University, Tianjin
- Department of Genetics
| | - Jianping Yi
- Department of Obstetrics and Gynecology, Tangshan Maternal and Children Health Hospital, Tangshan City, Hebei, China
| | | | | | | | | | - Lirong Yin
- Department of Obstetrics and Gynecology, The Second Hospital of Tianjin Medical University, Tianjin
- Correspondence: Lirong Yin, Department of Obstetrics and Gynecology, The Second Hospital of Tianjin Medical University, No. 23, Pingjiang road, Tianjin, 300200 China (e-mail: )
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Ellison CK, Sun Y, Hogg G, Fox J, Tao H, McCarthy E, Sagoe B, Azab MA, Mazloom AR, Tynan J, Burcham T, Kim SK, van den Boom D, Ehrich M, Jensen TJ. Using Targeted Sequencing of Paralogous Sequences for Noninvasive Detection of Selected Fetal Aneuploidies. Clin Chem 2016; 62:1621-1629. [PMID: 27694391 DOI: 10.1373/clinchem.2016.260034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/08/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Current methods for noninvasive prenatal testing (NIPT) ascertain fetal aneuploidies using either direct counting measures of DNA fragments from specific genomic regions or relative measures of single nucleotide polymorphism frequencies. Alternatively, the ratios of paralogous sequence pairs were predicted to reflect fetal aneuploidy. We developed a NIPT assay that uses paralog sequences to enable noninvasive detection of fetal trisomy 21 (T21) and trisomy 18 (T18) using cell-free DNA (cfDNA) from maternal plasma. METHODS A total of 1060 primer pairs were designed to determine fetal aneuploidy status, fetal sex, and fetal fraction. Each library was prepared from cfDNA by coamplifying all 1060 target pairs together in a single reaction well. Products were measured using massively parallel sequencing and deviations from expected paralog ratios were determined based on the read depth from each paralog. RESULTS We evaluated this assay in a blinded set of 480 cfDNA samples with fetal aneuploidy status determined by the MaterniT21® PLUS assay. Samples were sequenced (mean = 2.3 million reads) with 432 samples returning a result. Using the MaterniT21 PLUS assay for paired plasma aliquots from the same individuals as a reference, all 385 euploid samples, all 31 T21 samples, and 14 of 16 T18 samples were detected with no false positive results observed. CONCLUSIONS This study introduces a novel NIPT aneuploidy detection approach using targeted sequencing of paralog motifs and establishes proof-of-concept for a potentially low-cost, highly scalable method for the identification of selected fetal aneuploidies with performance and nonreportable rate similar to other published methods.
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Wiechec M, Knafel A, Nocun A, Wiercinska E, Ludwin A, Ludwin I. What are the most common first-trimester ultrasound findings in cases of Turner syndrome? J Matern Fetal Neonatal Med 2016; 30:1632-1636. [DOI: 10.1080/14767058.2016.1220525] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Marcin Wiechec
- Department of Gynecology and Obstetrics, Jagiellonian University, Krakow, Poland,
- Ultrasound Group Practice “Dobreusg”, Krakow, Poland, and
| | - Anna Knafel
- Department of Gynecology and Obstetrics, Jagiellonian University, Krakow, Poland,
- Ultrasound Group Practice “Dobreusg”, Krakow, Poland, and
| | | | - Ewa Wiercinska
- Voivodeship Sanitary-Epidemiological Station, Krakow, Poland
| | - Artur Ludwin
- Department of Gynecology and Obstetrics, Jagiellonian University, Krakow, Poland,
| | - Inga Ludwin
- Department of Gynecology and Obstetrics, Jagiellonian University, Krakow, Poland,
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Lynch TA, Ruzzo K, Sack V, Rijhsinghani A. Fetal sex determination using NIPT and ultrasound as a method for diagnosing important fetal sex abnormalities. Prenat Diagn 2016; 36:888-90. [DOI: 10.1002/pd.4867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 06/23/2016] [Accepted: 06/24/2016] [Indexed: 01/11/2023]
Affiliation(s)
- Tara A. Lynch
- Department of Obstetrics and Gynecology; Albany Medical Center; Albany NY USA
| | - Kathleen Ruzzo
- Department of Obstetrics and Gynecology; Albany Medical Center; Albany NY USA
| | - Virginia Sack
- Department of Obstetrics and Gynecology; Albany Medical Center; Albany NY USA
| | - Asha Rijhsinghani
- Department of Obstetrics and Gynecology; Albany Medical Center; Albany NY USA
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Arumugam A, Raja K, Venugopalan M, Chandrasekaran B, Kovanur Sampath K, Muthusamy H, Shanmugam N. Down syndrome-A narrative review with a focus on anatomical features. Clin Anat 2016; 29:568-77. [PMID: 26599319 DOI: 10.1002/ca.22672] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/19/2015] [Indexed: 12/14/2022]
Abstract
Down syndrome (DS) is the most common aneuploidy of chromosome 21, characterized by the presence of an extra copy of that chromosome (trisomy 21). Children with DS present with an abnormal phenotype, which is attributed to a loss of genetic balance or an excess dose of chromosome 21 genes. In recent years, advances in prenatal screening and diagnostic tests have aided in the early diagnosis and appropriate management of fetuses with DS. A myriad of clinical symptoms resulting from cognitive, physical, and physiological impairments caused by aberrations in various systems of the body occur in DS. However, despite these impairments, which range from trivial to fatal manifestations, the survival rate of individuals with DS has increased dramatically from less than 50% during the mid-1990s to 95% in the early 2000s, with a median life expectancy of 60 years reported recently. The aim of this narrative review is to review and summarize the etiopathology, prenatal screening and diagnostic tests, prognosis, clinical manifestations in various body systems, and comorbidities associated with DS. Clin. Anat. 29:568-577, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Ashokan Arumugam
- Department of Physical Therapy, College of Applied Medical Sciences, Majmaah University, Kingdom of Saudi Arabia
| | - Kavitha Raja
- JSS College of Physiotherapy, Mysore, Karnataka, India
| | | | | | - Kesava Kovanur Sampath
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Hariraja Muthusamy
- Department of Physical Therapy, College of Applied Medical Sciences, Majmaah University, Kingdom of Saudi Arabia
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Maggi E, Patterson NE, Montagna C. Technological advances in precision medicine and drug development. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2016; 1:331-343. [PMID: 27622214 DOI: 10.1080/23808993.2016.1176527] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
New technologies are rapidly becoming available to expand the arsenal of tools accessible for precision medicine and to support the development of new therapeutics. Advances in liquid biopsies, which analyze cells, DNA, RNA, proteins, or vesicles isolated from the blood, have gained particular interest for their uses in acquiring information reflecting the biology of tumors and metastatic tissues. Through advancements in DNA sequencing that have merged unprecedented accuracy with affordable cost, personalized treatments based on genetic variations are becoming a real possibility. Extraordinary progress has been achieved in the development of biological therapies aimed to even further advance personalized treatments. We provide a summary of current and future applications of blood based liquid biopsies and how new technologies are utilized for the development of biological therapeutic treatments. We discuss current and future sequencing methods with an emphasis on how technological advances will support the progress in the field of precision medicine.
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Affiliation(s)
- Elaine Maggi
- Department of Genetics Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Nicole E Patterson
- Department of Genetics Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Cristina Montagna
- Department of Genetics Albert Einstein College of Medicine, Bronx, NY 10461, USA; Department of Pathology Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Oneda B, Steindl K, Masood R, Reshetnikova I, Krejci P, Baldinger R, Reissmann R, Taralczak M, Guetg A, Wisser J, Fauchère JC, Rauch A. Noninvasive prenatal testing: more caution in counseling is needed in high risk pregnancies with ultrasound abnormalities. Eur J Obstet Gynecol Reprod Biol 2016; 200:72-5. [DOI: 10.1016/j.ejogrb.2016.02.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/23/2016] [Accepted: 02/29/2016] [Indexed: 01/13/2023]
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Li SW, Barrett AN, Gole L, Tan WC, Biswas A, Tan HK, Choolani M. The assessment of combined first trimester screening in women of advanced maternal age in an Asian cohort. Singapore Med J 2016; 56:47-52. [PMID: 25640099 DOI: 10.11622/smedj.2015009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION First trimester screening (FTS) is a validated screening tool that has been shown to achieve detection rates of 84%-90% for trisomies 21, 18 and 13. However, its effectiveness for different maternal ages has not been assessed. The present study aimed to assess the performance of FTS in an Asian population, and to compare its effectiveness in older (≥ 35 years) and younger (< 35 years) women. The potential use of noninvasive prenatal test (NIPT) as a contingent screening test is also examined. METHODS Data on cases of FTS performed on singleton pregnancies over a six-year period was collated from two Singapore maternal centres, National University Hospital and Singapore General Hospital. Cases that had a 1:250 risk of trisomy were considered to be screen-positive. Pregnancy outcomes were obtained from birth records or karyotype test results. RESULTS From 10,289 FTS cases, we obtained a sensitivity of 87.8%, a specificity of 97.6%, a false positive rate of 2.4% and a false negative rate of 0.06% for the detection of aneuploidy. The overall detection rate for trisomy 21 was 86.5%-85.7% for older women and 87.5% for younger women. The mean number of invasive tests required per case of trisomy 21 was 9.3 in younger women, 8.6 in older women and 13.5 in women with intermediate risk (1:250-1,000). CONCLUSION While the performance of FTS was similar in younger and older women, more invasive procedures were required to diagnose trisomy 21 in women with intermediate risk. It may be advantageous to offer contingent NIPT to this group of women to reduce the risk of iatrogenic fetal loss.
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Affiliation(s)
| | | | | | | | | | | | - Mahesh Choolani
- Department of Obstetrics and Gynaecology, National University of Singapore, NUHS Tower Block, Level 12, 1E Kent Ridge Road, Singapore 119228.
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Hui L, Teoh M, Piessens S, Walker SP. Early clinical experience of cell-free DNA-based aneuploidy screening: A survey of obstetric sonologists in Australia and New Zealand. Aust N Z J Obstet Gynaecol 2016; 55:138-43. [PMID: 25921004 DOI: 10.1111/ajo.12306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/02/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cell-free DNA-based non-invasive prenatal testing for aneuploidy (NIPT) is now established as the most accurate screening test for trisomy 21. This test became clinically available on a patient-funded basis in Australia and New Zealand in 2013. AIM To investigate the clinical implementation of NIPT use by members of the Australian Association of Obstetrical and Gynaecological Ultrasonologists (AAOGU) during its first year of local availability. METHOD Email invitations with an embedded link to an anonymous online survey were sent to all 140 members of the AAOGU in December 2013. RESULTS We received 54 responses to the survey (39% response rate). Two thirds of respondents were subspecialists in obstetric and gynaecological ultrasound or maternal fetal medicine. The majority of respondents had already used NIPT in their practice (94%). There was no significant difference in the proportion of respondents offering NIPT to high-risk women in private versus public practice (95 versus 82%, P = 0.14). However, inequity of access due to cost was the most common ethical issue encountered. The vast majority continued to offer an 11-13 week ultrasound in addition to NIPT. Almost all respondents (96%) were also willing to offer NIPT to low-risk women in December 2013 after appropriate genetic counselling. CONCLUSIONS Non-invasive prenatal testing was introduced into clinical care by obstetric sonologists with confidence and in accordance with the current recommended guidelines. These results may help inform future prenatal screening policy and cost-effectiveness analyses.
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Affiliation(s)
- Lisa Hui
- Department of Perinatal Medicine, The Mercy Hospital for Women, Heidelberg, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Australia; Public Health Genetics, Murdoch Children's Research Institute, Parkville, Australia
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Van Opstal D, Srebniak MI, Polak J, de Vries F, Govaerts LCP, Joosten M, Go ATJI, Knapen MFCM, van den Berg C, Diderich KEM, Galjaard RJH. False Negative NIPT Results: Risk Figures for Chromosomes 13, 18 and 21 Based on Chorionic Villi Results in 5967 Cases and Literature Review. PLoS One 2016; 11:e0146794. [PMID: 26771677 PMCID: PMC4714811 DOI: 10.1371/journal.pone.0146794] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 12/22/2015] [Indexed: 11/21/2022] Open
Abstract
Non-invasive prenatal testing (NIPT) demonstrated a small chance for a false negative result. Since the “fetal” DNA in maternal blood originates from the cytotrophoblast of chorionic villi (CV), some false negative results will have a biological origin. Based on our experience with cytogenetic studies of CV, we tried to estimate this risk. 5967 CV samples of pregnancies at high risk for common aneuplodies were cytogenetically investigated in our centre between January 2000 and December 2011. All cases of fetal trisomy 13, 18 and 21 were retrospectively studied for the presence of a normal karyotype or mosaicism < 30% in short-term cultured (STC-) villi. 404 cases of trisomies 13, 18 and 21 were found amongst 5967 samples (6,8%). Of these 404 cases, 14 (3,7%) had a normal or low mosaic karyotype in STC-villi and therefore would potentially be missed with NIPT. It involved 2% (5/242) of all trisomy 21 cases and 7.3% (9/123) of all trisomy 18 cases. In 1:426 (14/5967) NIPT samples of patients at high risk for common aneuploidies, a trisomy 18 or 21 will potentially be missed due to the biological phenomenon of absence of the chromosome aberration in the cytotrophoblast.
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Affiliation(s)
- Diane Van Opstal
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
- * E-mail:
| | | | - Joke Polak
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Femke de Vries
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Marieke Joosten
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Attie T. J. I. Go
- Department of obstetrics and prenatal medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Maarten F. C. M. Knapen
- Department of obstetrics and prenatal medicine, Erasmus Medical Center, Rotterdam, the Netherlands
- Stichting Prenatale Screening Zuidwest Nederland, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Cardi van den Berg
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Karin E. M. Diderich
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
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Affiliation(s)
- Felix C.K. Wong
- Centre for Research into Circulating Fetal Nucleic Acids, Li Ka Shing Institute of Health Sciences, and
- Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China; ,
| | - Y.M. Dennis Lo
- Centre for Research into Circulating Fetal Nucleic Acids, Li Ka Shing Institute of Health Sciences, and
- Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China; ,
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Zhang R, Zhang H, Li Y, Han Y, Xie J, Li J. External Quality Assessment for Detection of Fetal Trisomy 21, 18, and 13 by Massively Parallel Sequencing in Clinical Laboratories. J Mol Diagn 2015; 18:244-52. [PMID: 26747585 DOI: 10.1016/j.jmoldx.2015.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/24/2015] [Accepted: 10/21/2015] [Indexed: 01/24/2023] Open
Abstract
An external quality assessment for detection of trisomy 21, 18, and 13 by massively parallel sequencing was implemented by the National Center for Clinical Laboratories of People's Republic of China in 2014. Simulated samples were prepared by mixing fragmented abnormal DNA with plasma from non-pregnant women. The external quality assessment panel, comprising 5 samples from pregnant healthy women, 2 samples with sex chromosome aneuploidies, and 13 samples with different concentrations of fetal fractions positive for trisomy 21, 18, and 13, was then distributed to participating laboratories. In total, 55.6% (47 of 84) of respondents correctly identified each of the samples in the panel. Seventeen false-negative and 87 gray zone results were reported, most [102 of 104 (98.1%)] of which were derived from for trisomy samples with effective fetal fractions <4%. No laboratories generated false-positive results. In addition, we observed varied diagnostic capabilities of different assays, with the assay on the basis of NextSeq CN500 performing better than others, whereas Z values generated by BGISEQ-100 fluctuated greatly. There were no significant correlations between the numbers of unique sequence reads and Z values from any trisomy sample generated by BGISEQ-100. Overall, most clinical laboratories detected samples containing effective fetal fractions >4%. Our study shows need for further laboratory training in the management of samples with low fetal fractions. For some assays, precision of Z values needs to be improved.
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Affiliation(s)
- Rui Zhang
- National Center for Clinical Laboratories, Beijing Hospital, Beijing, People's Republic of China
| | - Hongyun Zhang
- BGI Clinical Laboratories-Shenzhen, Shenzhen, People's Republic of China
| | - Yulong Li
- Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, National Center for Clinical Laboratories, Beijing Hospital, Beijing, People's Republic of China
| | - Yanxi Han
- National Center for Clinical Laboratories, Beijing Hospital, Beijing, People's Republic of China
| | - Jiehong Xie
- National Center for Clinical Laboratories, Beijing Hospital, Beijing, People's Republic of China
| | - Jinming Li
- National Center for Clinical Laboratories, Beijing Hospital, Beijing, People's Republic of China.
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Rolfes V, Schmitz D. Unfair discrimination in prenatal aneuploidy screening using cell-free DNA? Eur J Obstet Gynecol Reprod Biol 2015; 198:27-29. [PMID: 26773245 DOI: 10.1016/j.ejogrb.2015.12.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/21/2015] [Indexed: 11/28/2022]
Abstract
Non-invasive prenatal testing on the basis of cell-free DNA of placental origin (NIPT) changed the landscape of prenatal care and is seen as superior to all other up to now implemented prenatal screening procedures - at least in the high-risk population. NIPT has spread almost worldwide commercially, but only in a few countries the costs of NIPT are covered by insurance companies. Such financial barriers in prenatal testing can lead to significant restrictions to the average range of opportunities of pregnant women and couples, which on an intersubjective level can be defined as unfair discrimination and on an individual level weakens reproductive autonomy. Given that enabling reproductive autonomy is the main ethical justification for offering prenatal (genetic) testing, these barriers are not only an issue of justice in health care, but are potentially counteracting the primary purpose of these testing procedures.
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Affiliation(s)
- Vasilija Rolfes
- Institute for History, Theory and Ethics of Medicine, University Hospital RWTH Aachen, Wendlingweg 2, 52074 Aachen, Germany.
| | - Dagmar Schmitz
- Institute for History, Theory and Ethics of Medicine, University Hospital RWTH Aachen, Wendlingweg 2, 52074 Aachen, Germany.
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Higuchi EC, Sheldon JP, Zikmund-Fisher BJ, Yashar BM. Non-invasive prenatal screening for trisomy 21: Consumers' perspectives. Am J Med Genet A 2015; 170A:375-385. [PMID: 26553705 DOI: 10.1002/ajmg.a.37460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 10/22/2015] [Indexed: 11/05/2022]
Abstract
Non-invasive prenatal screening (NIPS) has the potential to dramatically increase the prenatal detection rate of Down syndrome because of improvements in safety and accuracy over existing tests. There is concern that NIPS could lead to more negative attitudes towards Down syndrome and less support for individuals with Down syndrome. To assess the impact of NIPS on support for prenatal testing, decision-making about testing, and beliefs or attitudes about Down syndrome, we performed an Internet-based experiment using adults (N = 1,789) recruited through Amazon Mechanical Turk. Participants were randomly assigned to read a mock news article about NIPS, a mock news article about amniocentesis, or no article. The content in the two articles varied only in their descriptions of the test characteristics. Participants then answered questions about their support for testing, hypothetical testing decision, and beliefs and attitudes about Down syndrome. Reading the mock NIPS news article predicted increased hypothetical test uptake. In addition, the NIPS article group also agreed more strongly that pregnant women, in general, should utilize prenatal testing. We also found that the more strongly participants supported prenatal testing for pregnant women, the less favorable their attitudes towards individuals with Down syndrome; providing some evidence that NIPS may indirectly result in more negative perceptions of individuals with this diagnosis.
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Affiliation(s)
- Emily C Higuchi
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin
| | - Jane P Sheldon
- Department of Behavioral Sciences, University of Michigan-Dearborn, Dearborn, Michigan
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Beverly M Yashar
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan
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Dondorp W, de Wert G, Bombard Y, Bianchi DW, Bergmann C, Borry P, Chitty LS, Fellmann F, Forzano F, Hall A, Henneman L, Howard HC, Lucassen A, Ormond K, Peterlin B, Radojkovic D, Rogowski W, Soller M, Tibben A, Tranebjærg L, van El CG, Cornel MC. Non-invasive prenatal testing for aneuploidy and beyond: challenges of responsible innovation in prenatal screening. Eur J Hum Genet 2015; 23:1438-50. [PMID: 25782669 PMCID: PMC4613463 DOI: 10.1038/ejhg.2015.57] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/15/2015] [Accepted: 02/19/2015] [Indexed: 12/25/2022] Open
Abstract
This paper contains a joint ESHG/ASHG position document with recommendations regarding responsible innovation in prenatal screening with non-invasive prenatal testing (NIPT). By virtue of its greater accuracy and safety with respect to prenatal screening for common autosomal aneuploidies, NIPT has the potential of helping the practice better achieve its aim of facilitating autonomous reproductive choices, provided that balanced pretest information and non-directive counseling are available as part of the screening offer. Depending on the health-care setting, different scenarios for NIPT-based screening for common autosomal aneuploidies are possible. The trade-offs involved in these scenarios should be assessed in light of the aim of screening, the balance of benefits and burdens for pregnant women and their partners and considerations of cost-effectiveness and justice. With improving screening technologies and decreasing costs of sequencing and analysis, it will become possible in the near future to significantly expand the scope of prenatal screening beyond common autosomal aneuploidies. Commercial providers have already begun expanding their tests to include sex-chromosomal abnormalities and microdeletions. However, multiple false positives may undermine the main achievement of NIPT in the context of prenatal screening: the significant reduction of the invasive testing rate. This document argues for a cautious expansion of the scope of prenatal screening to serious congenital and childhood disorders, only following sound validation studies and a comprehensive evaluation of all relevant aspects. A further core message of this document is that in countries where prenatal screening is offered as a public health programme, governments and public health authorities should adopt an active role to ensure the responsible innovation of prenatal screening on the basis of ethical principles. Crucial elements are the quality of the screening process as a whole (including non-laboratory aspects such as information and counseling), education of professionals, systematic evaluation of all aspects of prenatal screening, development of better evaluation tools in the light of the aim of the practice, accountability to all stakeholders including children born from screened pregnancies and persons living with the conditions targeted in prenatal screening and promotion of equity of access.
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Affiliation(s)
- Wybo Dondorp
- Department of Health, Ethics & Society, Research Schools CAPHRI and GROW, Maastricht University, Maastricht, The Netherlands
| | - Guido de Wert
- Department of Health, Ethics & Society, Research Schools CAPHRI and GROW, Maastricht University, Maastricht, The Netherlands
| | - Yvonne Bombard
- Li Ka Shing Knowledge Institute of St Michael's Hospital & Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Diana W Bianchi
- Department of Pediatrics, Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA, USA
| | - Carsten Bergmann
- Center for Human Genetics Bioscientia, Ingelheim, Germany
- Department of Medicine, University Freiburg Medical Center, Freiburg, Germany
| | - Pascal Borry
- Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, Leuven University, Belgium
| | - Lyn S Chitty
- Clinical and Molecular Genetics Unit, UCL Institute of Child Health, Great Ormond Street Hospital and UCLH NHS Foundations Trusts, London, UK
| | - Florence Fellmann
- Service of Medical Genetics, University Hospital of Lausanne, Lausanne, Switzerland
| | | | | | - Lidewij Henneman
- Section Community Genetics, Department of Clinical Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Heidi C Howard
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Anneke Lucassen
- Department of Clinical Ethics and Law (CELS), University of Southampton and Wessex Clinical Genetic Service, Southampton, UK
| | - Kelly Ormond
- Department of Genetics and Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
| | - Borut Peterlin
- Clinical Institute of Medical Genetics, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Dragica Radojkovic
- Laboratory for Molecular Biology, Institute of Molecular Genetics and Genetic Engineering (IMGGE), University of Belgrade, Belgrade, Serbia
| | - Wolf Rogowski
- Deutsches Forschungszentrum für Gesundheit und Umwelt, Helmholtz Zentrum, München, Germany
| | - Maria Soller
- Division Clinical Genetics, University and Regional Laboratories Region Skåne, Lund University Hospital, Lund, Sweden
| | - Aad Tibben
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisbeth Tranebjærg
- Department of Audiology, Bispebjerg Hospital/Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Genetics, The Kennedy Center, University of Copenhagen, Copenhagen, Denmark
- Institute of Cellular and Molecular Medicine, ICMM, University of Copenhagen, Copenhagen, Denmark
| | - Carla G van El
- Section Community Genetics, Department of Clinical Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Martina C Cornel
- Section Community Genetics, Department of Clinical Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Development and validation of a measure of informed choice for women undergoing non-invasive prenatal testing for aneuploidy. Eur J Hum Genet 2015; 24:809-16. [PMID: 26508572 PMCID: PMC4867447 DOI: 10.1038/ejhg.2015.207] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/07/2015] [Accepted: 08/14/2015] [Indexed: 12/14/2022] Open
Abstract
Non-invasive prenatal testing (NIPT) using cell-free DNA for aneuploidy is a highly accurate screening test; however, concerns exist around the potential for routinisation of testing. The multidimensional measure of informed choice (MMIC) is a quantitative instrument developed to assess informed choice for Down syndrome screening (DSS). We have validated a modified MMIC for NIPT and measured informed choice among women offered NIPT in a public health service. The measure was distributed to women recruited across eight maternity units in the United Kingdom who had accepted DSS. Construct validity was assessed by simultaneously conducting qualitative interviews. Five hundred and eighty-five questionnaires were completed and 45 interviews conducted after blood-draw (or equivalent for those that declined NIPT). The measure demonstrated good internal consistency and internal validity. Results indicate the vast majority of women (89%) made an informed choice; 95% were judged to have good knowledge, 88% had a positive attitude and 92% had deliberated. Of the 11% judged to have made an uninformed choice, 55% had not deliberated, 41% had insufficient knowledge, and 19% had a negative attitude. Ethnicity (OR=2.78, P=0.003) and accepting NIPT (OR=16.05, P=0.021) were found to be significant predictors of informed choice. The high rate of informed choice is likely to reflect the importance placed on the provision of pre-test counselling in this study. It will be vital to ensure that this is maintained once NIPT is offered in routine clinical practice.
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50
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Khalifeh A, Weiner S, Berghella V, Donnenfeld A. Trends in Invasive Prenatal Diagnosis: Effect of Sequential Screening and Noninvasive Prenatal Testing. Fetal Diagn Ther 2015; 39:292-6. [DOI: 10.1159/000441028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 09/07/2015] [Indexed: 11/19/2022]
Abstract
Objective: To examine trends in the incidence and method of invasive prenatal diagnosis due to the impact of sequential screening and noninvasive prenatal testing. Methods: This is a retrospective review of all pregnancies that have undergone invasive prenatal diagnostic testing between June 2002 and June 2014, divided in 3 periods: period 1 from June 2002 to October 2006, period 2 from November 2006 to December 2011, and period 3 from January 2012 to June 2014. The main outcome measures were trends in the incidence and method of each procedure. Results: There were 88,135 deliveries and 6,080 invasive procedures during the study period. In period 1, 2,755 (8.8%) procedures were carried out, in period 2 2,820 (7.3%), and in period 3 505 (2.5%; p < 0.01). In period 1, there were 1,990 (6.3%) cases of amniocentesis, 1,646 (4.3%) in period 2, and 254 (1.2%) in period 3 (p < 0.01). In addition, in 765 (2.5%) cases, chorionic villus sampling (CVS) was performed in period 1, compared to 1,174 (3.0%) cases in period 2 and 251 (1.3%) cases in period 3 (p < 0.01). Advanced maternal age as the sole indication for invasive procedures decreased significantly over time, while the indication of abnormal serum screening and abnormal ultrasound findings increased (p < 0.01). Conclusion: There was a significant decline in the incidence of invasive prenatal testing over the 12 years of the study. The decrease in amniocentesis was more marked than that in CVS.
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