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Lugthart G, Verweij EJT, Harteveld CL, Tan RNGB, Knapen MFCM, Slaghekke F, Haak MC, Mohseny AB, Smiers FJ. Suppression of Hb Bart's to improve tissue oxygenation and fetal development in homozygous alpha-thalassemia. Am J Hematol 2024. [PMID: 38655712 DOI: 10.1002/ajh.27344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
Intra-uterine reduction of Hb Bart's only reached with exchange transfusions.
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Affiliation(s)
- G Lugthart
- Leiden University Medical Center (LUMC) Willem-Alexander Children's Hospital, Pediatric Hematology and HSCT, Leiden, The Netherlands
| | - E J T Verweij
- Department of Obstetrics and Fetal Therapy, LUMC, Leiden, The Netherlands
| | - C L Harteveld
- Department of Clinical Genetics, LUMC, Leiden, The Netherlands
| | - R N G B Tan
- LUMC Willem-Alexander Children's Hospital, Neonatal Intensive Care Unit, Leiden, The Netherlands
| | - M F C M Knapen
- Department of Obstetrics and Prenatal Medicine, ErasmusMC, Rotterdam, The Netherlands
| | - F Slaghekke
- Department of Obstetrics and Fetal Therapy, LUMC, Leiden, The Netherlands
| | - M C Haak
- Department of Obstetrics and Fetal Therapy, LUMC, Leiden, The Netherlands
| | - A B Mohseny
- Leiden University Medical Center (LUMC) Willem-Alexander Children's Hospital, Pediatric Hematology and HSCT, Leiden, The Netherlands
| | - F J Smiers
- Leiden University Medical Center (LUMC) Willem-Alexander Children's Hospital, Pediatric Hematology and HSCT, Leiden, The Netherlands
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2
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Donze SH, Srebniak MI, Diderich KEM, van den Born M, Galjaard RJ, Govaerts LCP, van der Schoot V, Knapen MFCM, Joosten M, Van Opstal D. Limited additional value of karyotyping cultured amniotic fluid cell colonies in addition to microarray on uncultured cells for confirmation of abnormal non-invasive prenatal testing results. Prenat Diagn 2024; 44:401-408. [PMID: 38141050 DOI: 10.1002/pd.6499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/18/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Non-invasive prenatal testing (NIPT) allows the detection of placental chromosome aberrations. To verify whether the fetus also has the chromosome aberration, diagnostic follow-up testing is required. The aim of this retrospective study was to assess the added value of analyzing amniotic fluid (AF) cell cultures in addition to uncultured AF cells for the detection of fetal mosaicism. METHOD NIPT was performed as part of the Dutch TRIDENT study. Cytogenetic studies in uncultured AF were performed using single nucleotide polymorphism (SNP)-array. Cultured AF cell colonies (in situ method) were investigated with fluorescent in situ hybridization and/or karyotyping. Clinical outcome data were collected in cases with discordant results. RESULTS Between April 2014 and December 2021, 368 amniocenteses were performed after a chromosomal aberration was detected with NIPT. Excluding 134 cases of common aneuploidies (confirmed by quantitative fluorescence polymerase chain reaction), 29 cases with investigation of uncultured cells only and 1 case without informed consent, 204 cases were eligible for this study. In 196 (96%) cases, the results in uncultured and cultured cells were concordant normal, abnormal or mosaic. Five cases (2%) showed mosaicism in cultured AF cells, whereas uncultured AF cells were normal. Two (1%) of these, one mosaic trisomy 13 and one mosaic trisomy 16, were considered true fetal mosaics. CONCLUSION The added value of investigating AF cell cultures in addition to uncultured cells is limited to two of 204 (1%) cases in which true fetal mosaicsm would otherwise be missed. The clinical relevance of one (trisomy 13) remained unknown and the other case also showed ultrasound anomalies, which determined pregnancy management. This seems to justify limiting prenatal cytogenetic confirmatory testing to SNP arrays on uncultured AF cells, considerably shortening the reporting time.
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Affiliation(s)
- Stephany H Donze
- Department of Clinical Genetics, ErasmusMC, University Medical Center, Rotterdam, The Netherlands
| | - Malgorzata I Srebniak
- Department of Clinical Genetics, ErasmusMC, University Medical Center, Rotterdam, The Netherlands
| | - Karin E M Diderich
- Department of Clinical Genetics, ErasmusMC, University Medical Center, Rotterdam, The Netherlands
| | - Myrthe van den Born
- Department of Clinical Genetics, ErasmusMC, University Medical Center, Rotterdam, The Netherlands
| | - Robert-Jan Galjaard
- Department of Clinical Genetics, ErasmusMC, University Medical Center, Rotterdam, The Netherlands
| | - Lutgarde C P Govaerts
- Department of Clinical Genetics, ErasmusMC, University Medical Center, Rotterdam, The Netherlands
| | - Vyne van der Schoot
- Department of Clinical Genetics, ErasmusMC, University Medical Center, Rotterdam, The Netherlands
| | - Maarten F C M Knapen
- Department of Obstetrics and Prenatal Medicine, ErasmusMC, University Medical Center, Rotterdam, The Netherlands
| | - Marieke Joosten
- Department of Clinical Genetics, ErasmusMC, University Medical Center, Rotterdam, The Netherlands
| | - Diane Van Opstal
- Department of Clinical Genetics, ErasmusMC, University Medical Center, Rotterdam, The Netherlands
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3
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van Zutven LJCM, Mijalkovic J, van Veghel-Plandsoen M, Goense M, Polak M, Knapen MFCM, de Weerd S, Joosten M, Diderich KEM, Hoefsloot LH, Van Opstal D, Srebniak MI. What proportion of couples with a history of recurrent pregnancy loss and with a balanced rearrangement in one parent can potentially be identified through cell-free DNA genotyping? Mol Cytogenet 2023; 16:26. [PMID: 37775759 PMCID: PMC10543837 DOI: 10.1186/s13039-023-00657-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Balanced chromosome aberrations are reported in about 1:30 couples with recurrent pregnancy loss (RPL). Karyotyping of both parents is necessary to identify these aberrations. Genome-wide non-invasive prenatal testing (NIPT) in case of recurrent pregnancy loss could be a more efficient way to identify couples at increased risk for carrying a balanced chromosome rearrangement. The aim of this study was to evaluate whether the potential fetal imbalances caused by parental balanced aberrations detected in our center are large enough to be detectable by genome-wide non-invasive prenatal testing (NIPT). MATERIAL AND METHODS From January 1970 until May 2020 our laboratory received 30,863 unique requests for karyotyping due to RPL. We have identified 16,045 couples and evaluated all abnormal cytogenetic results to assess the minimal size of the involved chromosomal segments in potential unbalanced products of the rearrangements. RESULTS In the presented cohort we detected 277 aberrant balanced translocations/inversions in females and 185 in males amongst 16,045 couples with RPL, which can be translated to a risk of 1:35 (2.9%, 95% CI 2.6-3.2%). Our study showed that the vast majority (98.7%, 95% CI 97.1-99.5%) of these balanced aberrations will potentially cause a fetal imbalance > 10 Mb, which is detectable with genome-wide NIPT if it was performed during one of the miscarriages. CONCLUSIONS Our study suggests that genome-wide NIPT is able to reveal most unbalanced products of balanced chromosomal rearrangements carried by couples with RPL and therefore can potentially identify balanced chromosomal aberration carriers. Moreover, our data suggest that these couples can be offered NIPT in case they decline invasive testing in future pregnancies.
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Affiliation(s)
- Laura J C M van Zutven
- Department of Clinical Genetics, Erasmus Medical Centre, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Jona Mijalkovic
- Department of Clinical Genetics, Erasmus Medical Centre, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Monique van Veghel-Plandsoen
- Department of Clinical Genetics, Erasmus Medical Centre, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Margaret Goense
- Department of Clinical Genetics, Erasmus Medical Centre, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Marike Polak
- Department of Psychology, Education & Child Studies (DPECS), Erasmus University, Rotterdam, The Netherlands
| | - Maarten F C M Knapen
- Department of Obstetrics and Prenatal Medicine, Erasmus Medical Centre, Wytemaweg 80, Na-1517, 3015 GE, Rotterdam, The Netherlands
| | - Sabina de Weerd
- Department of Obstetrics and Gynaecology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands
| | - Marieke Joosten
- Department of Clinical Genetics, Erasmus Medical Centre, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Karin E M Diderich
- Department of Clinical Genetics, Erasmus Medical Centre, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Lies H Hoefsloot
- Department of Clinical Genetics, Erasmus Medical Centre, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Diane Van Opstal
- Department of Clinical Genetics, Erasmus Medical Centre, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Malgorzata I Srebniak
- Department of Clinical Genetics, Erasmus Medical Centre, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
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4
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van Bever Y, Groenenberg IAL, Knapen MFCM, Dessens AB, Hannema SE, Wolffenbuttel KP, Diderich KEM, Hoefsloot LH, Srebniak MI, Bruggenwirth HT. Prenatal ultrasound finding of atypical genitalia: Counseling, genetic testing and outcomes. Prenat Diagn 2023; 43:162-182. [PMID: 35808910 DOI: 10.1002/pd.6205] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To report uptake of genetic counseling (GC) and prenatal genetic testing after the finding of atypical genitalia on prenatal ultrasound (US) and the clinical and genetic findings of these pregnancies. METHODS A retrospective cohort study (2017-2019) of atypical fetal genitalia in a large expert center for disorders/differences of sex development. We describe counseling aspects, invasive prenatal testing, genetic and clinical outcome of fetuses apparently without [group 1, n = 22 (38%)] or with [group 2, n = 36 (62%)] additional anomalies on US. RESULTS In group 1, 86% of parents opted for GC versus 72% in group 2, and respectively 58% and 15% of these parents refrained from invasive testing. Atypical genitalia were postnatally confirmed in 91% (group 1) and 64% (group 2), indicating a high rate of false positive US diagnosis of ambiguous genitalia. Four genetic diagnoses were established in group 1 (18%) and 10 in group 2 (28%). The total genetic diagnostic yield was 24%. No terminations of pregnancy occurred in group 1. CONCLUSIONS For optimal care, referral for an expert fetal US scan, GC and invasive diagnostics including broad testing should be offered after prenatal detection of isolated atypical genitalia.
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Affiliation(s)
- Yolande van Bever
- DSD-Expert Center, Erasmus MC, Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Irene A L Groenenberg
- DSD-Expert Center, Erasmus MC, Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.,Department of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Maarten F C M Knapen
- DSD-Expert Center, Erasmus MC, Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.,Department of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Arianne B Dessens
- DSD-Expert Center, Erasmus MC, Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Sabine E Hannema
- DSD-Expert Center, Erasmus MC, Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.,Department of Pediatric Endocrinology, Erasmus MC, University Medical Center Rotterdam, The Netherlands.,Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Paediatric Endocrinology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Katja P Wolffenbuttel
- DSD-Expert Center, Erasmus MC, Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.,Department of Urology and Pediatric Urology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Karin E M Diderich
- Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Lies H Hoefsloot
- Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Malgorzata I Srebniak
- Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Hennie T Bruggenwirth
- DSD-Expert Center, Erasmus MC, Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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5
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Reilly ML, Ain NU, Muurinen M, Tata A, Huber C, Simon M, Ishaq T, Shaw N, Rusanen S, Pekkinen M, Högler W, Knapen MFCM, van den Born M, Saunier S, Naz S, Cormier-Daire V, Benmerah A, Makitie O. Biallelic KIF24 Variants Are Responsible for a Spectrum of Skeletal Disorders Ranging From Lethal Skeletal Ciliopathy to Severe Acromesomelic Dysplasia. J Bone Miner Res 2022; 37:1642-1652. [PMID: 35748595 PMCID: PMC9545074 DOI: 10.1002/jbmr.4639] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 06/01/2022] [Accepted: 06/14/2022] [Indexed: 11/14/2022]
Abstract
Skeletal dysplasias comprise a large spectrum of mostly monogenic disorders affecting bone growth, patterning, and homeostasis, and ranging in severity from lethal to mild phenotypes. This study aimed to underpin the genetic cause of skeletal dysplasia in three unrelated families with variable skeletal manifestations. The six affected individuals from three families had severe short stature with extreme shortening of forelimbs, short long-bones, and metatarsals, and brachydactyly (family 1); mild short stature, platyspondyly, and metaphyseal irregularities (family 2); or a prenatally lethal skeletal dysplasia with kidney features suggestive of a ciliopathy (family 3). Genetic studies by whole genome, whole exome, and ciliome panel sequencing identified in all affected individuals biallelic missense variants in KIF24, which encodes a kinesin family member controlling ciliogenesis. In families 1 and 3, with the more severe phenotype, the affected subjects harbored homozygous variants (c.1457A>G; p.(Ile486Val) and c.1565A>G; p.(Asn522Ser), respectively) in the motor domain which plays a crucial role in KIF24 function. In family 2, compound heterozygous variants (c.1697C>T; p.(Ser566Phe)/c.1811C>T; p.(Thr604Met)) were found C-terminal to the motor domain, in agreement with a genotype-phenotype correlation. In vitro experiments performed on amnioblasts of one affected fetus from family 3 showed that primary cilia assembly was severely impaired, and that cytokinesis was also affected. In conclusion, our study describes novel forms of skeletal dysplasia associated with biallelic variants in KIF24. To our knowledge this is the first report implicating KIF24 variants as the cause of a skeletal dysplasia, thereby extending the genetic heterogeneity and the phenotypic spectrum of rare bone disorders and underscoring the wide range of monogenetic skeletal ciliopathies. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Madeline Louise Reilly
- Imagine Institute, Laboratory of Inherited Kidney Diseases, Institut National de la Santé et de la Recherche Médicale (INSERM) Unités Mixtes de Recherche (UMR) 1163, Université Paris Cité, Paris, France
| | - Noor Ul Ain
- School of Biological Sciences, University of the Punjab, Lahore, Pakistan.,Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mari Muurinen
- Folkhälsan Research Center, Helsinki, Finland.,Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Alice Tata
- Imagine Institute, Laboratory of Inherited Kidney Diseases, Institut National de la Santé et de la Recherche Médicale (INSERM) Unités Mixtes de Recherche (UMR) 1163, Université Paris Cité, Paris, France
| | - Céline Huber
- Imagine Institute, Laboratory of Molecular and Physiopathological bases of Osteochondrodysplasia, Institut National de la Santé et de la Recherche Médicale (INSERM) Unités Mixtes de Recherche (UMR) 1163, Université Paris Cité, Paris, France.,Department of Genetics, Reference Centre for Skeletal Dysplasia, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France
| | - Marleen Simon
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Tayyaba Ishaq
- School of Biological Sciences, University of the Punjab, Lahore, Pakistan
| | - Nick Shaw
- Department of Endocrinology & Diabetes, Birmingham Children's Hospital, Birmingham, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | | | - Minna Pekkinen
- Folkhälsan Research Center, Helsinki, Finland.,Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Wolfgang Högler
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Maarten F C M Knapen
- Department of Obstetrics and Fetal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Myrthe van den Born
- Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sophie Saunier
- Imagine Institute, Laboratory of Inherited Kidney Diseases, Institut National de la Santé et de la Recherche Médicale (INSERM) Unités Mixtes de Recherche (UMR) 1163, Université Paris Cité, Paris, France
| | - Sadaf Naz
- School of Biological Sciences, University of the Punjab, Lahore, Pakistan
| | - Valérie Cormier-Daire
- Imagine Institute, Laboratory of Molecular and Physiopathological bases of Osteochondrodysplasia, Institut National de la Santé et de la Recherche Médicale (INSERM) Unités Mixtes de Recherche (UMR) 1163, Université Paris Cité, Paris, France.,Department of Genetics, Reference Centre for Skeletal Dysplasia, Assistance Publique-Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France
| | - Alexandre Benmerah
- Imagine Institute, Laboratory of Inherited Kidney Diseases, Institut National de la Santé et de la Recherche Médicale (INSERM) Unités Mixtes de Recherche (UMR) 1163, Université Paris Cité, Paris, France
| | - Outi Makitie
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Folkhälsan Research Center, Helsinki, Finland.,Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
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6
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van Heurn LJ, Coumans ABC, Derikx JPM, Bekker MN, Bilardo KM, Duin LK, Knapen MFCM, Pajkrt E, Sikkel E, van Heurn LWE, Oepkes D. Factors associated with poor outcome in fetuses prenatally diagnosed with sacrococcygeal teratoma. Prenat Diagn 2021; 41:1430-1438. [PMID: 34327722 PMCID: PMC9292788 DOI: 10.1002/pd.6026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 11/08/2022]
Abstract
AIM OF THE STUDY Outcome of fetuses, prenatally diagnosed with sacrococcygeal teratoma (SCT), is still poorly documented. This study assesses the incidence and prenatal predictors of outcome in all fetuses prenatally diagnosed with SCT. METHODS This is a retrospective study on all fetuses prenatally diagnosed with SCT from 1998 to 2018 in the Netherlands. Poor outcome was defined as terminations of pregnancy (TOP) because of expected unfavorable outcome, intrauterine fetal death, or early neonatal death. Potential risk factors for poor outcome were analyzed. MAIN RESULTS Eighty-four fetuses were included. Sixteen (19.0%) TOPs were excluded from statistical analysis. Eleven of the remaining 68 fetuses had poor outcome. Overall mortality was 32.1%, with a mortality excluding TOPs of 13.1%. Thirteen fetal interventions were performed in 11 (13.1%) fetuses. Potential risk factors for poor outcome were the presence of fetal hydrops (OR: 21.0, CI: 2.6-275.1, p = 0.012) and cardiomegaly (OR: 10.3, CI: 1.9-55.8, p = 0.011). CONCLUSIONS The overall mortality of fetuses prenatally diagnosed with SCTs including tTOP was 32.1%. This high mortality rate was mainly due to termination of pregnancy. Mortality excluding TOP was 13.1%. Potential risk factors for poor outcome were fetal hydrops and cardiomegaly.
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Affiliation(s)
- Lieke J van Heurn
- Department of P(a)ediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Audrey B C Coumans
- Department of Obstetrics and Gynaecology, Maastricht UMC +, Maastricht, The Netherlands
| | - Joep P M Derikx
- Department of P(a)ediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Katia M Bilardo
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Leonie K Duin
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten F C M Knapen
- Department of Obstetrics and Fetal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Esther Sikkel
- Department of Obstetrics and Gynecology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - L W Ernest van Heurn
- Department of P(a)ediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dick Oepkes
- Department of Obstetrics and Fetal Medicine, Leiden University Medical Center, Leiden, The Netherlands
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7
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Srebniak MI, Knapen MFCM, Joosten M, Diderich KEM, Galjaard S, Van Opstal D. Patient-friendly integrated first trimester screening by NIPT and fetal anomaly scan. Mol Cytogenet 2021; 14:4. [PMID: 33422094 PMCID: PMC7797124 DOI: 10.1186/s13039-020-00525-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/28/2020] [Indexed: 11/29/2022] Open
Abstract
Many major structural fetal anomalies can be diagnosed by first trimester fetal anomaly scan. NIPT can accurately detect aneuploidies and large chromosomal aberrations in cfDNA in maternal blood plasma. This study shows how a patient-friendly first trimester screening for both chromosomal and structural fetal anomalies in only two outpatient visits can be provided. Genotype-first approach assures not only the earliest diagnosis of trisomy 21 (the most prevalent chromosome aberration), but also completion of the screening at 12–14 weeks. To ensure proper management and avoid unnecessary anxiety abnormal NIPT different from trisomy 21, 18 and 13 should be referred for genetic counseling.
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Affiliation(s)
| | - Maarten F C M Knapen
- Department of Obstetrics and Fetal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Marieke Joosten
- Department of Clinical Genetics, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Karin E M Diderich
- Department of Clinical Genetics, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Sander Galjaard
- Department of Obstetrics and Fetal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Diane Van Opstal
- Department of Clinical Genetics, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
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8
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Diderich KEM, Romijn K, Joosten M, Govaerts LCP, Polak M, Bruggenwirth HT, Wilke M, van Slegtenhorst MA, van Bever Y, Brooks AS, Mancini GMS, van de Laar IMBH, Kromosoeto JNR, Knapen MFCM, Go ATJI, Van Opstal D, Hoefsloot LH, Galjaard RJH, Srebniak MI. The potential diagnostic yield of whole exome sequencing in pregnancies complicated by fetal ultrasound anomalies. Acta Obstet Gynecol Scand 2020; 100:1106-1115. [PMID: 33249554 PMCID: PMC8247008 DOI: 10.1111/aogs.14053] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/30/2020] [Accepted: 11/22/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The aim of this retrospective cohort study was to determine the potential diagnostic yield of prenatal whole exome sequencing in fetuses with structural anomalies on expert ultrasound scans and normal chromosomal microarray results. MATERIAL AND METHODS In the period 2013-2016, 391 pregnant women with fetal ultrasound anomalies who received normal chromosomal microarray results, were referred for additional genetic counseling and opted for additional molecular testing pre- and/or postnatally. Most of the couples received only a targeted molecular test and in 159 cases (40.7%) whole exome sequencing (broad gene panels or open exome) was performed. The results of these molecular tests were evaluated retrospectively, regardless of the time of the genetic diagnosis (prenatal or postnatal). RESULTS In 76 of 391 fetuses (19.4%, 95% CI 15.8%-23.6%) molecular testing provided a genetic diagnosis with identification of (likely) pathogenic variants. In the majority of cases (91.1%, 73/76) the (likely) pathogenic variant would be detected by prenatal whole exome sequencing analysis. CONCLUSIONS Our retrospective cohort study shows that prenatal whole exome sequencing, if offered by a clinical geneticist, in addition to chromosomal microarray, would notably increase the diagnostic yield in fetuses with ultrasound anomalies and would allow early diagnosis of a genetic disorder irrespective of the (incomplete) fetal phenotype.
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Affiliation(s)
- Karin E M Diderich
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Kathleen Romijn
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marieke Joosten
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Marike Polak
- Department of Psychology, Education & Child Studies (DPECS), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | | | - Martina Wilke
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Yolande van Bever
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Alice S Brooks
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Grazia M S Mancini
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Joan N R Kromosoeto
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Maarten F C M Knapen
- Department of Obstetrics and Prenatal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.,Foundation Prenatal Screening Southwest Region of the Netherlands, Rotterdam, The Netherlands
| | - Attie T J I Go
- Department of Obstetrics and Prenatal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Diane Van Opstal
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Lies H Hoefsloot
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
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9
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Heetkamp KM, Peters IA, Bertens LCM, Knapen MFCM. An unwanted pregnancy and language proficiency level are associated with first antenatal visit after the first trimester: Results from a prospective cohort study. Midwifery 2020; 89:102784. [PMID: 32592981 DOI: 10.1016/j.midw.2020.102784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/08/2020] [Accepted: 06/09/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the association between the reasons for a 'late' first antenatal visit and the influence of several maternal determinants and practical limitations on the timing of the first antenatal visit. DESIGN A prospective cohort study. SETTING Southwest region of The Netherlands, mainly characterised by large urban and suburban areas. PARTICIPANTS Women receiving information and counselling about prenatal screening between April 2010 and December 2010 were included (n = 9,268). MEASUREMENTS AND FINDINGS Timing of first antenatal visit, categorised as: 'in time' (<12+0 weeks of gestation), 'late' (≥12-23+6 weeks of gestation) and 'very late' (≥24 weeks of gestation). An unplanned or unwanted pregnancy was the most frequently reported reason for delay of the first antenatal visit (30.7%) especially in Surinamese women (79%), and women younger than 20 years (63%) or older than 40 years (50.0%). Compared to women who timed their first antenatal visit 'in time', women with a delay in their first visit were more often younger than 20 or older than 40 years of age, high order multiparous (P ≥3), with a previous miscarriage, and had an absent Dutch language proficiency level. The latter showed the strongest association with a 'very late' first antenatal visit (OR 4.96, 95%CI 2.45-10.05). KEY CONCLUSIONS Language proficiency level was highly associated with a delay in the timing of the first antenatal visit. When women timed their first antenatal visit late, having an unplanned or unwanted pregnancy was the most frequently reported reason for this delay. IMPLICATIONS FOR PRACTICE Findings from this study can be used to inform and develop interventions to improve timely antenatal care use.
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Affiliation(s)
- Kirsten M Heetkamp
- Rotterdam University of Applied Sciences, Research Centre Innovations in Care, Rotterdam, The Netherlands; Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Ingrid A Peters
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Loes C M Bertens
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maarten F C M Knapen
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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10
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Petersen OB, Smith E, Van Opstal D, Polak M, Knapen MFCM, Diderich KEM, Bilardo CM, Arends LR, Vogel I, Srebniak MI. Nuchal translucency of 3.0-3.4 mm an indication for NIPT or microarray? Cohort analysis and literature review. Acta Obstet Gynecol Scand 2020; 99:765-774. [PMID: 32306377 PMCID: PMC7318216 DOI: 10.1111/aogs.13877] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/13/2020] [Accepted: 04/16/2020] [Indexed: 12/15/2022]
Abstract
Introduction Currently fetal nuchal translucency (NT) ≥3.5 mm is an indication for invasive testing often followed by chromosomal microarray. The aim of this study was to assess the risks for chromosomal aberrations in fetuses with an NT 3.0‐3.4 mm, to determine whether invasive prenatal testing would be relevant in these cases and to assess the residual risks in fetuses with normal non‐invasive prenatal test (NIPT) results. Material and methods A retrospective study and meta‐analysis of literature cases with NT between 3.0 and 3.4 mm and 2 cohorts of pregnant women referred for invasive testing and chromosomal microarray was performed: Rotterdam region (with a risk >1:200 and NT between 3.0 and 3.4 mm) tested in the period July 2012 to June 2019 and Central Denmark region (with a risk >1:300 and NT between 3.0 and 3.4 mm) tested between September 2015 and December 2018. Results A total of 522 fetuses were referred for invasive testing and chromosomal microarray. Meta‐analysis indicated that in 1:7.4 (13.5% [95% CI 8.2%‐21.5%]) fetuses a chromosomal aberration was diagnosed. Of these aberrant cases, 47/68 (69%) involved trisomy 21, 18, and 13 and would potentially be detected by all NIPT approaches. The residual risk for missing a (sub)microscopic chromosome aberration depends on the NIPT approach and is highest if NIPT was performed only for common trisomies–1:21 (4.8% [95% CI 3.2%‐7.3%]). However, it may be substantially lowered if a genome‐wide 10‐Mb resolution NIPT test was offered (~1:464). Conclusions Based on these data, we suggest that the NT cut‐off for invasive testing could be 3.0 mm (instead of 3.5 mm) because of the high risk of 1:7.4 for a chromosomal aberration. If women were offered NIPT first, there would be a significant diagnostic delay because all abnormal NIPT results need to be confirmed by diagnostic testing. If the woman had already received a normal NIPT result, the residual risk of 1:21 to 1:464 for chromosome aberrations other than common trisomies, dependent on the NIPT approach, should be raised. If a pregnant woman declines invasive testing, but still wants a test with a broader coverage of clinically significant conditions then the genome‐wide >10‐Mb resolution NIPT test, which detects most aberrations, could be proposed.
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Affiliation(s)
- Olav B Petersen
- Center for Fetal Medicine, Pregnancy and Ultrasound, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Eric Smith
- Center for Prenatal Ultrasound Screening BovenMaas, Rotterdam, The Netherlands
| | - Diane Van Opstal
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Marike Polak
- Department of Psychology, Education & Child Studies (DPECS), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maarten F C M Knapen
- Department of Obstetrics and Fetal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Caterina M Bilardo
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands.,Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Lidia R Arends
- Department of Psychology, Education & Child Studies (DPECS), Erasmus University Rotterdam, Rotterdam, The Netherlands.,Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
| | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University, Aarhus, Denmark.,Department for Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
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11
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Bever YV, Brüggenwirth HT, Wolffenbuttel KP, Dessens AB, Groenenberg IAL, Knapen MFCM, De Baere E, Cools M, van Ravenswaaij-Arts CMA, Sikkema-Raddatz B, Claahsen-van der Grinten H, Kempers M, Rinne T, Hersmus R, Looijenga L, Hannema SE. Under-reported aspects of diagnosis and treatment addressed in the Dutch-Flemish guideline for comprehensive diagnostics in disorders/differences of sex development. J Med Genet 2020; 57:581-589. [PMID: 32303604 PMCID: PMC7476274 DOI: 10.1136/jmedgenet-2019-106354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 01/02/2020] [Accepted: 01/22/2020] [Indexed: 12/14/2022]
Abstract
We present key points from the updated Dutch-Flemish guideline on comprehensive diagnostics in disorders/differences of sex development (DSD) that have not been widely addressed in the current (inter)national literature. These points are of interest to physicians working in DSD (expert) centres and to professionals who come across persons with a DSD but have no (or limited) experience in this area. The Dutch-Flemish guideline is based on internationally accepted principles. Recent initiatives striving for uniform high-quality care across Europe, and beyond, such as the completed COST action 1303 and the European Reference Network for rare endocrine conditions (EndoERN), have generated several excellent papers covering nearly all aspects of DSD. The Dutch-Flemish guideline follows these international consensus papers and covers a number of other topics relevant to daily practice. For instance, although next-generation sequencing (NGS)-based molecular diagnostics are becoming the gold standard for genetic evaluation, it can be difficult to prove variant causality or relate the genotype to the clinical presentation. Network formation and centralisation are essential to promote functional studies that assess the effects of genetic variants and to the correct histological assessment of gonadal material from DSD patients, as well as allowing for maximisation of expertise and possible cost reductions. The Dutch-Flemish guidelines uniquely address three aspects of DSD. First, we propose an algorithm for counselling and diagnostic evaluation when a DSD is suspected prenatally, a clinical situation that is becoming more common. Referral to ultrasound sonographers and obstetricians who are part of a DSD team is increasingly important here. Second, we pay special attention to healthcare professionals not working within a DSD centre as they are often the first to diagnose or suspect a DSD, but are not regularly exposed to DSDs and may have limited experience. Their thoughtful communication to patients, carers and colleagues, and the accessibility of protocols for first-line management and efficient referral are essential. Careful communication in the prenatal to neonatal period and the adolescent to adult transition are equally important and relatively under-reported in the literature. Third, we discuss the timing of (NGS-based) molecular diagnostics in the initial workup of new patients and in people with a diagnosis made solely on clinical grounds or those who had earlier genetic testing that is not compatible with current state-of-the-art diagnostics.
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Affiliation(s)
- Yolande van Bever
- Department of Clinical Genetics and DSD Expert Center Erasmus Medical Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hennie T Brüggenwirth
- Department of Clinical Genetics and DSD Expert Center Erasmus Medical Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Katja P Wolffenbuttel
- Department of Pediatric Urology and DSD Expert Center Erasmus Medical Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Arianne B Dessens
- Department of Child and Adolescent Psychiatry and DSD Expert Center Erasmus Medical Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Irene A L Groenenberg
- Department of Obstetrics and Prenatal Medicine and DSD Expert Center Erasmus Medical Center, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Maarten F C M Knapen
- Department of Obstetrics and Prenatal Medicine and DSD Expert Center Erasmus Medical Center, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Elfride De Baere
- Center for Medical Genetics, University Hospital Ghent Center Medical Genetics, Ghent, Belgium
| | - Martine Cools
- Department of Internal Medicine and Paediatrics and Department of Pediatric Endocrinology, University Hospital Ghent, Ghent, Belgium
| | | | - Birgit Sikkema-Raddatz
- Department of Genetics and DSD team, University Medical Center Groningen, Groningen, The Netherlands
| | - Hedi Claahsen-van der Grinten
- Department of Pediatric Endocrinology and DSD Expert Center Radboud UMC, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Marlies Kempers
- Department of Clinical genetics and DSD Expert Center Radboud UMC, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tuula Rinne
- Department of Clinical genetics and DSD Expert Center Radboud UMC, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Remko Hersmus
- Department of Pathology, DSD Expert Center ErasmusMC, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands
| | - Leendert Looijenga
- Department of Pathology, DSD Expert Center ErasmusMC, Erasmus MC-University Medical Centre, Rotterdam, The Netherlands.,Department of Pathology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Sabine E Hannema
- Department of Pediatric Endocrinology and DSD Expert Center ErasmusMC, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands.,Department of Pediatrics, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
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12
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Srebniak MI, Knapen MFCM, Govaerts LCP, Polak M, Joosten M, Diderich KEM, van Zutven LJCM, Prinsen KAKE, Riedijk S, Go ATJI, Galjaard RJH, Hoefsloot LH, Van Opstal D. Social and medical need for whole genome high resolution NIPT. Mol Genet Genomic Med 2019; 8:e1062. [PMID: 31790156 PMCID: PMC6978273 DOI: 10.1002/mgg3.1062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Two technological innovations in the last decade significantly influenced the diagnostic yield of prenatal cytogenetic testing: genomic microarray allowing high resolution analysis and noninvasive prenatal testing (NIPT) focusing on aneuploidy. To anticipate future trends in prenatal screening and diagnosis, we evaluated the number of invasive tests in our center and the number of aberrant cases diagnosed in the last decade. METHODS We retrospectively analyzed fetal chromosomal aberrations diagnosed in 2009-2018 in 8,608 pregnancies without ultrasound anomalies. RESULTS The introduction of NIPT as the first-tier test led to a substantial decrease in the number of invasive tests and a substantially increased diagnostic yield of aneuploidies in the first trimester. However, we have also noted a decreased detection of submicroscopic aberrations, since the number of invasive tests substantially decreased. We have observed that pregnant women were interested in broader scope of prenatal screening and diagnosis than detection of common trisomies. CONCLUSION Since the frequency of syndromic disorders caused by microdeletions/microduplications is substantial and current routine NIPT and ultrasound investigations are not able to detect them, we suggest that a noninvasive test with resolution comparable to microarrays should be developed, which will also meet patient's needs.
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Affiliation(s)
| | - Maarten F C M Knapen
- Department of Obstetrics and Fetal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | | | - Marike Polak
- Institute of Psychology, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Marieke Joosten
- Department of Clinical Genetics, Erasmus MC, Rotterdam, the Netherlands
| | | | | | - Krista A K E Prinsen
- Department of Obstetrics and Fetal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Sam Riedijk
- Department of Clinical Genetics, Erasmus MC, Rotterdam, the Netherlands
| | - Attie T J I Go
- Department of Obstetrics and Fetal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | | | - Lies H Hoefsloot
- Department of Clinical Genetics, Erasmus MC, Rotterdam, the Netherlands
| | - Diane Van Opstal
- Department of Clinical Genetics, Erasmus MC, Rotterdam, the Netherlands
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13
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Peters IA, Heetkamp KM, Ursem NTC, Steegers EAP, Denktaş S, Knapen MFCM. Ethnicity and Language Proficiency Differences in the Provision of and Intention to Use Prenatal Screening for Down's Syndrome and Congenital Anomalies. A Prospective, Non-selected, Register-Based Study in the Netherlands. Matern Child Health J 2019; 22:343-354. [PMID: 28884405 PMCID: PMC5845051 DOI: 10.1007/s10995-017-2364-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective We aimed to conduct an analysis of the associations between the information provision procedure of prenatal screening for Down's syndrome and congenital anomalies and the intention to participate in prenatal screening (PS) of ethnicity groups and Dutch language proficiency groups. Design Using a prospective web-based registration form, we asked counselors (midwives, general practitioners, nurses and gynecologists) to report whether and how they offered information about PS to pregnant women. Duration The study was conducted from 2008 to 2010. Participants We collected data on the characteristics of the women who received an information offer about PS from counselors. Measurements Measures included socio-demographic and language proficiency level (LPL) characteristics, key elements of the provision procedure of PS, and intentional participation in PS. Findings The dataset represents 37% of the total population in the study area. Women with a non-native Dutch background and/or insufficient Dutch LPL received fewer information offers about PS, faced a reduced chance of receiving counseling, and showed lower intentional participation rates for PS. Key Conclusions Women with a non-native Dutch background and/or with an insufficient LPL are underserved in the Dutch PS program. These findings present evidence indicating that the fundamental principle of the Dutch Population Screening Act, namely, equal access to PS for all pregnant women, is not being realized. Implications for Practice Therefore, the study findings are important for national and international healthcare, policy makers and governmental professionals to allow ethnic and LPL-related differences in the provision and intentional uptake of PS.
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Affiliation(s)
- Ingrid A Peters
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Wytemaweg 80, Na-1515, 3015 GE, 3000 CA, Rotterdam, The Netherlands. .,Foundation Prenatal Screening Southwest Region of the Netherlands, Wytemaweg 80, Na-1509, 3015 GE, Rotterdam, The Netherlands.
| | - Kirsten M Heetkamp
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Wytemaweg 80, Na-1515, 3015 GE, 3000 CA, Rotterdam, The Netherlands.,Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands
| | - Nicolette T C Ursem
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Wytemaweg 80, Na-1515, 3015 GE, 3000 CA, Rotterdam, The Netherlands.,Foundation Prenatal Screening Southwest Region of the Netherlands, Wytemaweg 80, Na-1509, 3015 GE, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Wytemaweg 80, Na-1515, 3015 GE, 3000 CA, Rotterdam, The Netherlands
| | - Semiha Denktaş
- Department Social and Behavioural Sciences, EUC/Erasmus University Rotterdam, Nieuwemarkt 1a, 3011 HP, Rotterdam, The Netherlands
| | - Maarten F C M Knapen
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Wytemaweg 80, Na-1515, 3015 GE, 3000 CA, Rotterdam, The Netherlands.,Foundation Prenatal Screening Southwest Region of the Netherlands, Wytemaweg 80, Na-1509, 3015 GE, Rotterdam, The Netherlands
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14
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Saes L, Govaerts LCP, Knapen MFCM, Lugtenburg PJ, Boere IA, Galjaard RJH. [Incidental detection of maternal malignancy in non-invasive prenatal test]. Ned Tijdschr Geneeskd 2019; 163:D2779. [PMID: 30698367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Since 2017, the non-invasive prenatal test (NIPT) has been offered to all pregnant woman in the Netherlands in the context of the TRIDENT-2 study, which has been implemented as a trial within the Dutch national screening programme for Down's, Edwards' and Patau's syndrome. The NIPT examines cell-free DNA in maternal blood. A small proportion of this DNA is of placental origin, but a vast proportion originates from the expectant mother. Findings other than the aforementioned syndromes are considered incidental. Occasionally, maternal malignancy is suspected in asymptomatic women as a result of aberrant NIPT results. In this case series, we present three patients with suspected malignancy based on NIPT results. We recommend the implementation of clinical guidelines for when this situation arises.
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Affiliation(s)
- Lotte Saes
- Erasmus MC, Kanker Instituut, Rotterdam
- Contact: L. Saes
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15
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Srebniak MI, Joosten M, Knapen MFCM, Arends LR, Polak M, van Veen S, Go ATJI, Van Opstal D. Frequency of submicroscopic chromosomal aberrations in pregnancies without increased risk for structural chromosomal aberrations: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018; 51:445-452. [PMID: 28556491 DOI: 10.1002/uog.17533] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/08/2017] [Accepted: 05/18/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To establish, based on a systematic literature review, the frequency of pathogenic submicroscopic chromosomal aberrations in fetuses that are not at increased risk for unbalanced structural chromosomal aberrations, with the aim of determining whether high-resolution testing for submicroscopic aberrations is beneficial in a general pregnant population. METHODS EMBASE, PubMed, Web of Science and CENTRAL databases were searched systematically on 3 June 2016 for all relevant articles on the prevalence of pathogenic submicroscopic copy number variants (CNVs) in fetuses referred for prenatal invasive testing because of advanced maternal age (AMA) or parental anxiety (ANX). Relevant full-text articles were analyzed and the prevalence of submicroscopic CNVs was calculated based on the extracted data. Meta-analysis was conducted in a pooled cohort of 10 614 fetuses based on the 10 largest studies (n > 300) of a total of 19 that were relevant. RESULTS Pooled estimate analysis indicated that 0.84% (95% CI, 0.55-1.30%) of fetuses that had invasive testing because of AMA/ANX carried a pathogenic clinically significant submicroscopic aberration. The onset/penetrance of submicroscopic findings was studied in 10 314 fetuses reported in eight papers that presented aberrant cases with all necessary details to allow assessment of the findings. The pooled estimates resulting from meta-analysis of the data indicated that an early-onset syndromic disorder was detected in 0.37% (95% CI, 0.27-0.52%) of cases, a susceptibility CNV was found in 0.30% (95% CI, 0.14-0.67%) and late-onset diseases were reported in 0.11% (95% CI, 0.05%-0.21%). The prevalence of early-onset syndromic disorders caused by a submicroscopic aberration was calculated to be 1:270. When the risk for submicroscopic aberrations is added to the individual risk for microscopic chromosomal aberrations, all pregnant women have a risk of higher than 1 in 180 for a relevant chromosomal aberration, and pregnant women under 36 years of age have a higher risk for submicroscopic pathogenic aberrations than for Down syndrome. CONCLUSION This systematic review shows that a significant proportion of fetuses in a general pregnant population carry a submicroscopic pathogenic CNV. Based on these figures, all women should be informed on their individual risk for all pathogenic chromosomal aberrations and not only for common trisomies. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M I Srebniak
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - M Joosten
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - M F C M Knapen
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands
- Foundation Prenatal Screening Southwest Region of the Netherlands, Rotterdam, The Netherlands
| | - L R Arends
- Department of Psychology, Education & Child Studies (DPECS), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
| | - M Polak
- Department of Psychology, Education & Child Studies (DPECS), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - S van Veen
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - A T J I Go
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands
| | - D Van Opstal
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
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16
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Posthumus AG, Peters IA, Borsboom GJ, Knapen MFCM, Bonsel GJ. Inequalities in uptake of prenatal screening according to ethnicity and socio-economic status in the four largest cities of the Netherlands (2011-2013). Prenat Diagn 2017. [PMID: 28621806 DOI: 10.1002/pd.5089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES In the Netherlands, all women are claimed to have equal access to prenatal screening (PS). Prior research demonstrated substantial inequalities in PS uptake associated with socioeconomic status (SES) and ethnic background. The suggested pathway was a lack of intention to participate in PS among these subgroups. We studied the background of inequalities in PS participation, challenging intention heterogeneity as the single explanation. METHODS Multivariable logistic regression analyses of the national PS registry, focusing on the four largest cities in the Netherlands (n = 4578, years 2011-2013), stratified by SES. OUTCOME MEASURES (1) any uptake of PS (yes/no) and (2) uptake (one/two tests) for women who intended to participate in two tests. Determinants included intention, ethnicity, practice, and age. RESULTS Of non-Western women, 85.7% were screened versus 89.7% of Western women. Intention was an important explanatory factor in all models. However, after correction for intention, ethnicity remained a significant determinant for differences in uptake. Ethnicity and SES also interacted, indicating that non-Western women in low SES areas had the lowest uptake (corrected for intention). CONCLUSIONS FOR PRACTICE Socioeconomic status and ethnicity related inequalities in PS uptake are only partially explained by intention heterogeneity; other pathways, in particular provider-related determinants, may play a role. © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Anke G Posthumus
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ingrid A Peters
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Foundation Prenatal Screening Southwest Region of the Netherlands, Rotterdam, The Netherlands
| | - Gerard J Borsboom
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Maarten F C M Knapen
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Foundation Prenatal Screening Southwest Region of the Netherlands, Rotterdam, The Netherlands
| | - Gouke J Bonsel
- Department of Obstetrics and Gynecology, Utrecht Medical Centre (UMCU), Utrecht, The Netherlands
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17
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van der Weerd K, van Noord C, Loeve M, Knapen MFCM, Visser W, de Herder WW, Franssen G, van der Marel CD, Feelders RA. ENDOCRINOLOGY IN PREGNANCY: Pheochromocytoma in pregnancy: case series and review of literature. Eur J Endocrinol 2017; 177:R49-R58. [PMID: 28381449 DOI: 10.1530/eje-16-0920] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 03/29/2017] [Accepted: 04/05/2017] [Indexed: 11/08/2022]
Abstract
Pheochromocytoma in pregnancy is extremely rare. Early recognition is crucial as antepartum diagnosis can largely decrease maternal and fetal mortality rates. As symptoms of pheochromocytoma are rather similar to those of other far more common causes of hypertension during pregnancy, timely diagnosis is a challenge. In pregnant patients, similar to non-pregnant patients, increased plasma and/or 24-h urine (nor)metanephrine concentrations most reliably confirm the diagnosis of pheochromocytoma. MRI and ultrasound are the only imaging modalities that can be used safely during pregnancy to localize the tumor. During pregnancy, pretreatment consists of alpha blockade as usual. However, dosing of α-adrenergic receptor blockers during pregnancy is a challenge as hypertension must be treated while preserving adequate uteroplacental circulation. When the diagnosis is made within the first 24 weeks of pregnancy, it is generally recommended to remove the tumor in the second trimester, while resection is generally postponed till after delivery when the diagnosis is made in the third trimester and medical pretreatment is sufficient. Both during and after pregnancy, laparoscopic surgery is the preferred approach for resection of the tumor. There is no consensus in literature about the preferred route and timing of delivery. Therefore, in our opinion, decisions should be made on an individual basis by an experienced and dedicated multidisciplinary team. Over the last decades, maternal and fetal prognosis has improved considerably. Further increasing awareness of this rare diagnosis and treatment of these patients by a dedicated team in a tertiary referral hospital are critical factors for optimal maternal and fetal outcome.
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Affiliation(s)
- K van der Weerd
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - C van Noord
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - M Loeve
- Department of Anesthesiology, Unit of Obstetric Anesthesiology
| | - M F C M Knapen
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Foundation Prenatal Screening Southwest Region of the Netherlands, Rotterdam, The Netherlands
| | - W Visser
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - W W de Herder
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - G Franssen
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - R A Feelders
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Ursem NTC, Peters IA, Kraan-van der Est MN, Reijerink-Verheij JCIY, Knapen MFCM, Cohen-Overbeek TE. An Audit of Second-Trimester Fetal Anomaly Scans Based on a Novel Image-Scoring Method in the Southwest Region of the Netherlands. J Ultrasound Med 2017; 36:1171-1179. [PMID: 28299806 DOI: 10.7863/ultra.16.06055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Since 2007 the second-trimester fetal anomaly scan is offered to all pregnant women as part of the national prenatal screening program in the Netherlands. Dutch population-based screening programs generally have a well-described system to achieve quality assurance. Because of the absence of a uniform system to monitor the actual performance of the fetal anomaly scan in 2012, we developed a standardized image-scoring method. The aim of this study was to evaluate the scanning performance of all sonographers in the southwestern region of the Netherlands using this image-scoring method. METHODS Each sonographer was requested to set up a digital portfolio. A portfolio consists of five logbooks from five different pregnant women, each containing 25 fetal anatomical structures and six biometric measures of randomly selected fetal anomaly scans. RESULTS During the study period, 425 logbooks of 85 sonographers were assessed as part of the audit process. Seventy-three out of 85 sonographers (86%) met the criteria in the primary audit, and 12 sonographers required individual hands-on training. A successful assessment was achieved for 11 sonographers in the re-audit and one sonographer ceased her contract. Moreover, 2.1% of the required images were not digitally stored and therefore could not be reviewed. CONCLUSIONS Quality assessment using the image-scoring method demonstrated that most of the sonographers met the expectations of the audit process, but those who had subpar performance met the expectations after retraining.
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Affiliation(s)
- Nicolette T C Ursem
- Foundation Prenatal Screening Southwest Region of the Netherlands, Rotterdam, the Netherlands
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Ingrid A Peters
- Foundation Prenatal Screening Southwest Region of the Netherlands, Rotterdam, the Netherlands
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | | | - Maarten F C M Knapen
- Foundation Prenatal Screening Southwest Region of the Netherlands, Rotterdam, the Netherlands
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Titia E Cohen-Overbeek
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Peters IA, Posthumus AG, Reijerink-Verheij JCIY, Van Agt HME, Knapen MFCM, Denktaş S. Effect of culturally competent educational films about prenatal screening on informed decision making of pregnant women in the Netherlands. Patient Educ Couns 2017; 100:776-782. [PMID: 27887753 DOI: 10.1016/j.pec.2016.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 11/09/2016] [Accepted: 11/12/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To evaluate the effect of a culturally competent educational film (CCEF) on informed decision making (IDM) regarding prenatal screening (PS) in a study population consisting of multicultural pregnant women. METHODS A cross-sectional study with 262 women in the control group and 117 in the intervention group. All counselled participants received a self-report questionnaire to obtain data on IDM and only the intervention group received the CCEF. Twenty two percent of the study population had an ethnic minority background and 52% had a low or medium educational level. RESULTS After exposure to the CCEF, knowledge about the Fetal Anomaly Scan (FAS) was significantly increased in ethnic minority women and in 'medium' and 'highly' educated women. Among women in the intervention group who had the intention to participate in FAS, there was an increase of 11% in IDM and a decrease of 12% in uninformed decision making. CONCLUSION CCEF leads to a significant increase in the level of knowledge in medium and highly educated groups as well as non-western ethnic minority groups. The increase in IDM among intentional participants in the FAS is promising as well. CCEF's are a valuable complement to counseling about PS.
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Affiliation(s)
- I A Peters
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus, University Medical Centre, Rotterdam, The Netherlands; Foundation Prenatal Screening Southwest region of the Netherlands, Rotterdam, The Netherlands.
| | - A G Posthumus
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus, University Medical Centre, Rotterdam, The Netherlands
| | | | - H M E Van Agt
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M F C M Knapen
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus, University Medical Centre, Rotterdam, The Netherlands; Foundation Prenatal Screening Southwest region of the Netherlands, Rotterdam, The Netherlands
| | - S Denktaş
- Department Social and Behavioural Sciences, Erasmus University College, Erasmus University Rotterdam, Rotterdam, The Netherlands
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de Wit MC, Srebniak MI, Joosten M, Govaerts LCP, Kornelisse RF, Papatsonis DNM, de Graaff K, Knapen MFCM, Bruggenwirth HT, de Vries FAT, Van Veen S, Van Opstal D, Galjaard RJH, Go ATJI. Prenatal and postnatal findings in small-for-gestational-age fetuses without structural ultrasound anomalies at 18-24 weeks. Ultrasound Obstet Gynecol 2017; 49:342-348. [PMID: 27102944 DOI: 10.1002/uog.15949] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/09/2016] [Accepted: 04/15/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To assess phenotypic and genotypic characteristics of small-for-gestational-age (SGA) fetuses without structural anomalies at 18-24 weeks' gestation. METHODS This retrospective study included structurally normal singleton fetuses with an abdominal circumference ≤ 5th percentile on detailed ultrasound examination between 18 and 24 weeks' gestation. Cases were stratified according to the absence or presence of other abnormal ultrasound findings, such as abnormal amniotic fluid or soft markers. All patients were offered invasive prenatal testing with rapid aneuploidy detection by qualitative fluorescence polymerase chain reaction (QF-PCR) and, if normal, consecutive single nucleotide polymorphism (SNP) array was also offered. Detailed postnatal follow-up (≥ 5 months) was performed. In cases in which a syndromic phenotype became apparent within 5 months after birth and SNP array had not been performed prenatally, it was performed postnatally. RESULTS A total of 211 pregnancies were eligible for inclusion. Of the 158 cases with isolated SGA on ultrasound, 36 opted for invasive prenatal testing. One case of trisomy 21 and one case of a submicroscopic abnormality (a susceptibility locus for neurodevelopmental disease) were detected. Postnatal follow-up showed a postnatal apparent syndromic phenotype in 10 cases. In one case this was due to trisomy 21 and the other nine (5.8%; 95% CI, 2.8-10.0%) cases had normal SNP array results. In 32/53 cases with SGA and associated ultrasound abnormalities, parents opted for invasive testing. One case of trisomy 21 and one of triploidy were found. In 11 cases a syndromic phenotype became apparent after birth. One was due to trisomy 21 and in one case a submicroscopic anomaly (a susceptibility locus) was found. The remaining syndromic cases (17.3%; 95% CI, 8.7-29.0%) had normal SNP array results. CONCLUSION Testing for chromosomal anomalies should be offered in cases of SGA between 18 and 24 weeks' gestation. Whole chromosome anomalies occur in 1.3% (95% CI, 0.2-3.9%) of isolated SGA and 5.8% (95% CI, 1.5-14.0%) of associated SGA. In 0.6% (95% CI, 0.1-2.8%) and 1.9% (95% CI, 0.2-8.2%), respectively, SNP array detected a susceptibility locus for neurodevelopmental disease that would not be detected by karyotyping, QF-PCR or non-invasive prenatal testing. Therefore, and because the genetic causes of SGA are diverse, we suggest SNP array testing in cases of SGA. Thorough postnatal examination and follow-up of infants that presented with reduced fetal growth is important because chromosomally normal syndromic phenotypes occur frequently in SGA fetuses. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M C de Wit
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M I Srebniak
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Joosten
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - L C P Govaerts
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R F Kornelisse
- Department of Neonatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - D N M Papatsonis
- Department of Obstetrics and Gynecology, Amphia Hospital, Breda, The Netherlands
| | - K de Graaff
- Department of Obstetrics and Gynecology, Reinier de Graaf Groep, Delft, The Netherlands
| | - M F C M Knapen
- Foundation Prenatal Screening Southwestern region of The Netherlands, Rotterdam, The Netherlands
| | - H T Bruggenwirth
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - F A T de Vries
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - S Van Veen
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - D Van Opstal
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R J H Galjaard
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A T J I Go
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
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21
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Srebniak MI, de Wit MC, Diderich KEM, Govaerts LCP, Joosten M, Knapen MFCM, Bos MJ, Looye-Bruinsma GAG, Koningen M, Go ATJI, Galjaard RJH, Van Opstal D. Enlarged NT (≥3.5 mm) in the first trimester - not all chromosome aberrations can be detected by NIPT. Mol Cytogenet 2016; 9:69. [PMID: 27610202 PMCID: PMC5015200 DOI: 10.1186/s13039-016-0279-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since non-invasive prenatal testing (NIPT) in maternal blood became available, we evaluated which chromosome aberrations found in our cohort of fetuses with an enlarged NT in the first trimester of pregnancy (tested with SNP microarray) could be detected by NIPT as well. METHOD 362 fetuses were referred for cytogenetic testing due to an enlarged NT (≥3.5 mm). Chromosome aberrations were investigated using QF-PCR, karyotyping and whole genome SNP array. RESULTS After invasive testing a chromosomal abnormality was detected in 137/362 (38 %) fetuses. 100/362 (28 %) cases concerned trisomy 21, 18 or 13, 25/362 (7 %) an aneuploidy of sex chromosomes and 3/362 (0.8 %) triploidy. In 6/362 (1.6 %) a pathogenic structural unbalanced chromosome aberration was seen and in 3/362 (0.8 %) a susceptibility locus for neurodevelopmental disorders was found. We estimated that in 2-10 % of fetuses with enlarged NT a chromosome aberration would be missed by current NIPT approaches. CONCLUSION Based on our cohort of fetuses with enlarged NT we may conclude that NIPT, depending on the approach, will miss chromosome aberrations in a significant percentage of pregnancies. Moreover all abnormal NIPT results require confirmatory studies with invasive testing, which will delay definitive diagnosis in ca. 30 % of patients. These figures are important for pretest counseling enabling pregnant women to make informed choices on the prenatal test. Larger cohorts of fetuses with an enlarged NT should be investigated to assess the additional diagnostic value of high resolution array testing for this indication.
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Affiliation(s)
- Malgorzata I Srebniak
- Department of Clinical Genetics, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Merel C de Wit
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Karin E M Diderich
- Department of Clinical Genetics, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Lutgarde C P Govaerts
- Department of Clinical Genetics, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Marieke Joosten
- Department of Clinical Genetics, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Maarten F C M Knapen
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands ; Foundation Prenatal Screening Southwest region of The Netherlands, Wytemaweg 80, Na-1509, 3015 CN Rotterdam, The Netherlands
| | - Marnix J Bos
- Department of Clinical Genetics, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Gerda A G Looye-Bruinsma
- Department of Clinical Genetics, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Mieke Koningen
- Department of Clinical Genetics, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Attie T J I Go
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Robert Jan H Galjaard
- Department of Clinical Genetics, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Diane Van Opstal
- Department of Clinical Genetics, Erasmus Medical Center, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
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22
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Srebniak MI, van Zutven LJCM, Petit F, Bouquillon S, van Heel IPJ, Knapen MFCM, Cornette JMJ, Kremer A, Van Opstal D, Diderich KEM. Interstitial 6q21q23 duplication - variant of variable phenotype and incomplete penetrance or benign duplication? Mol Cytogenet 2016; 9:43. [PMID: 27274769 PMCID: PMC4891832 DOI: 10.1186/s13039-016-0253-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chromosome 6q duplication syndrome is a chromosome abnormality associated with characteristic phenotypic features such as intellectual disability (ID), short stature, feeding difficulties, microcephaly, dysmorphic features (prominent forehead, downslanting palpebral fissures, flat nasal bridge, tented upper lip, micrognathia, short webbed neck) and joint contractures. Only a few cases of pure partial 6q trisomy have been published and the severity of the phenotype seems to depend on the breakpoint position. Unfortunately, most of these cases were identified using karyotyping or FISH, so breakpoints at the molecular level and thus gene content are not known. CASES PRESENTATION We report the first two families with an interstitial 6q duplication identified by karyotyping where the gene content and breakpoints were characterized with microarray. In family 1, the 6q22.1q23.2 duplication was detected in a female patient with ID. In family 2, the 6q21q22.33 duplication was identified in a male fetus with multiple congenital malformations. In both families, the duplication seems to show phenotypic heterogeneity and in family 1 also incomplete penetrance suggesting the co-existence of an "additional hit" in affected patients. This "additional hit" was identified in the first family to be a microduplication in 16p11.2, a known susceptibility locus (SL) for neurodevelopmental disorders, that co-segregated with an abnormal phenotype in the affected family members. CONCLUSIONS Our study shows that interstitial 6q21q23 duplication may represent a private variant that is benign, but may also contribute to developmental disorders of variable expressivity in a "multi-hit" model. Finding the "additional hit" within the family is therefore very important for genetic counseling and assessment of the CNV penetrance within the particular family.
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Affiliation(s)
- Malgorzata I Srebniak
- Department of Clinical Genetics, Erasmus MC, Ee2475, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Laura J C M van Zutven
- Department of Clinical Genetics, Erasmus MC, Ee2475, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Florence Petit
- Department of Clinical Genetics, University Hospital, Lille, France
| | | | - Ilse P J van Heel
- Department of Clinical Genetics, Erasmus MC, Ee2475, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Maarten F C M Knapen
- Department of Obstetrics and Gynecology, subdivision Obstetrics and Prenatal Medicine, Erasmus MC, Rotterdam, The Netherlands ; Stichting Prenatale Screening Zuidwest Nederland, Wytemaweg 80, Na-1509, 3015, GE Na-1503 Rotterdam, The Netherlands
| | - Jerome M J Cornette
- Department of Obstetrics and Gynecology, subdivision Obstetrics and Prenatal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Andreas Kremer
- Department of Bioinformatics Erasmus MC, Rotterdam, The Netherlands
| | - Diane Van Opstal
- Department of Clinical Genetics, Erasmus MC, Ee2475, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Karin E M Diderich
- Department of Clinical Genetics, Erasmus MC, Ee2475, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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24
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Keller CC, Joosten M, Middeldorp AM, Knapen MFCM. Fetal anemia caused by the Guadalajara variant of G6PD deficiency. Prenat Diagn 2015; 35:1255-7. [PMID: 26279483 DOI: 10.1002/pd.4677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/16/2015] [Accepted: 08/12/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Caroline C Keller
- Department of Obstetrics and Prenatal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Marieke Joosten
- Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, the Netherlands
| | | | - Maarten F C M Knapen
- Department of Obstetrics and Prenatal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands.,Stichting Prenatale Screening Zuidwest Nederland, Rotterdam, the Netherlands
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van de Mheen L, Everwijn SMP, Knapen MFCM, Haak MC, Engels MAJ, Manten GTR, Zondervan HA, Wirjosoekarto SAM, van Vugt JMG, Erwich JJHM, Bilardo CM, van Pampus MG, de Groot CJM, Mol BWJ, Pajkrt E. Pregnancy outcome after fetal reduction in women with a dichorionic twin pregnancy. Hum Reprod 2015; 30:1807-12. [PMID: 26093542 DOI: 10.1093/humrep/dev132] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 05/01/2015] [Indexed: 12/13/2022] Open
Abstract
STUDY QUESTION What are the pregnancy outcomes for women with a twin pregnancy that is reduced to a singleton pregnancy? SUMMARY ANSWER Fetal reduction of a twin pregnancy significantly improves gestational age at birth and neonatal birthweight, however at an increased risk of pregnancy loss and preterm delivery. WHAT IS KNOWN ALREADY Women with a multiple pregnancy are at increased risk for preterm delivery. Fetal reduction can be considered in these women. STUDY DESIGN, SIZE, AND DURATION Retrospective cohort study of 118 women with a twin pregnancy reduced to a singleton pregnancy between 2000 and 2010. PARTICIPANTS/MATERIALS, SETTING, AND METHODS We compared the outcome of pregnancy in consecutive women with a dichorionic twin pregnancy that was reduced to a singleton pregnancy to that of women with a dichorionic twin pregnancy that was managed expectantly and women with a primary singleton pregnancy. Reductions were performed between 10-23(6/7) weeks' gestation by intracardiac or intrathoracic injection of potassium chloride, mostly for congenital anomalies. We compared median gestational age, pregnancy loss <24 weeks, preterm delivery <32 weeks, neonatal birthweight and perinatal deaths. MAIN RESULTS AND THE ROLE OF CHANCE We studied 118 women with a twin pregnancy that was reduced to a singleton, 818 women with an ongoing dichorionic twin pregnancy and 611 women with a primary singleton pregnancy. Loss of the entire pregnancy <24 weeks and preterm delivery occurred significantly more in the reduction group compared with the ongoing twin group (11.9 versus 3.1% <24 weeks, P< 0.001 and 18.6 versus 11.5% <32 weeks, respectively, P < 0.001). In the reduction group, the percentage of women without any surviving child was significantly higher compared with the ongoing twin and primary singleton group (14.4, 3.4 and 0.7%, respectively, P < 0.001). Median gestational age was 38.9 weeks (interquartile range (IQR) 34.7-40.3) for reduced pregnancies, 37.1 weeks (IQR 35.3-38.1) for ongoing twin pregnancies and 40.1 (IQR 39.1-40.9) for primary singletons (P < 0.001 for all comparisons). LIMITATIONS, REASONS FOR CAUTION The main limitations of the study were its retrospective character, and the fact that indications for reduction were heterogeneous. WIDER IMPLICATIONS OF THE FINDINGS In women with a dichorionic twin pregnancy fetal reduction increases median gestational age only at considerable risk of complete early pregnancy loss. STUDY FUNDING/COMPETING INTERESTS The study was not funded. None of the authors has conflicts of interest.
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Affiliation(s)
- L van de Mheen
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - S M P Everwijn
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - M F C M Knapen
- Department of Obstetrics and Prenatal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M C Haak
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - M A J Engels
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - G T R Manten
- Department of Obstetrics and Gynecology, University Medical Center, Utrecht, The Netherlands
| | - H A Zondervan
- Department of Obstetrics and Gynecology, Rijnstate Hospital, Arnhem, The Netherlands
| | - S A M Wirjosoekarto
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J M G van Vugt
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J J H M Erwich
- Department of Obstetrics and Gynecology, University Medical Center, Groningen, The Netherlands
| | - C M Bilardo
- Department of Obstetrics and Gynecology, University Medical Center, Groningen, The Netherlands
| | - M G van Pampus
- Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - C J M de Groot
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - B W J Mol
- The Robinson Institute, School of Reproductive Health and Paediatrics, University of Adelaide, Adelaide, Australia
| | - E Pajkrt
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
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26
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Srebniak MI, Van Opstal D, Joosten M, Diderich KEM, de Vries FAT, Riedijk S, Knapen MFCM, Go ATJI, Govaerts LCP, Galjaard RJH. Whole-genome array as a first-line cytogenetic test in prenatal diagnosis. Ultrasound Obstet Gynecol 2015; 45:363-372. [PMID: 25488734 DOI: 10.1002/uog.14745] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/17/2014] [Accepted: 11/21/2014] [Indexed: 06/04/2023]
Affiliation(s)
- M I Srebniak
- Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, The Netherlands
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27
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van der Steen SL, Diderich KEM, Riedijk SR, Verhagen-Visser J, Govaerts LCP, Joosten M, Knapen MFCM, Van Opstal D, Srebniak MI, Tibben A, Galjaard RJH. Pregnant couples at increased risk for common aneuploidies choose maximal information from invasive genetic testing. Clin Genet 2014; 88:25-31. [PMID: 25134982 DOI: 10.1111/cge.12479] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/01/2014] [Accepted: 08/05/2014] [Indexed: 01/01/2023]
Abstract
Genomic array detects more pathogenic chromosome aberrations than conventional karyotyping (CK), including genetic variants associated with a susceptibility for neurodevelopmental disorders; susceptibility loci (SL). Consensus regarding the scope of invasive prenatal diagnosis (PND) pregnant couples should be offered is lacking. This study examined pregnant couples' preferences, doubts and satisfaction regarding the scope of invasive PND. Eighty-two couples choosing prenatal screening (PNS) and 59 couples choosing invasive PND were offered a choice between 5 (comparable to CK) and 0.5 Mb resolution array analysis outcomes, the latter with or without reporting SL. A pre-test self-report questionnaire and post-test telephone interview assessed their choices in-depth. Actual (PND) and hypothetical (PNS) choices differed significantly (p < 0.001). Ninety-five percent of the couples in the PND group chose 0.5 Mb array, vs 69% in the PNS group. Seven percent of the PND group wished not to be informed of SL. Ninety percent was satisfied with their choice and wished to decide about the scope themselves. Pregnant couples wish to make their own choices regarding the scope of invasive PND. It therefore seems justified to offer them a choice in both the resolution of array and disclosure of SL.
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Affiliation(s)
| | | | | | | | | | | | - M F C M Knapen
- Department of Obstetrics and Prenatal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands.,Foundation of Prenatal Screening South-West, Rotterdam, the Netherlands
| | | | | | - A Tibben
- Department Clinical Genetics, Leiden University Medical Centre, Leiden, the Netherlands
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28
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Siljee JE, Knegt AC, Knapen MFCM, Bekker MN, Visser GHA, Schielen PCJI. Positive predictive values for detection of trisomies 21, 18 and 13 and termination of pregnancy rates after referral for advanced maternal age, first trimester combined test or ultrasound abnormalities in a national screening programme (2007-2009). Prenat Diagn 2014; 34:259-64. [DOI: 10.1002/pd.4302] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 12/03/2013] [Accepted: 12/14/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Jacqueline E. Siljee
- Reference Laboratory for Pre- and Neonatal Screening/Laboratory for Infectious Diseases and Screening; National Institute for Public Health and the Environment; Bilthoven The Netherlands
| | - Alida C. Knegt
- Department of Clinical Genetics; University Medical Center Amsterdam; Amsterdam The Netherlands
| | - Maarten F. C. M. Knapen
- Department of Obstetrics and Prenatal Medicine; Erasmus MC Rotterdam, Stichting Prenatale Screening; Rotterdam The Netherlands
| | - Mireille N. Bekker
- Department of Obstetrics, Prenatal Diagnosis and Therapy; Radboud University Medical Center; Nijmegen The Netherlands
| | | | - Peter C. J. I. Schielen
- Reference Laboratory for Pre- and Neonatal Screening/Laboratory for Infectious Diseases and Screening; National Institute for Public Health and the Environment; Bilthoven The Netherlands
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29
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Speksnijder L, Cohen-Overbeek TE, Knapen MFCM, Lunshof SM, Hoogeboom AJM, van den Ouwenland AM, de Coo IFM, Lequin MH, Bolz HJ, Bergmann C, Biesecker LG, Willems PJ, Wessels MW. A de novo GLI3 mutation in a patient with acrocallosal syndrome. Am J Med Genet A 2013; 161A:1394-400. [PMID: 23633388 DOI: 10.1002/ajmg.a.35874] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 01/02/2013] [Indexed: 01/15/2023]
Abstract
Acrocallosal syndrome is characterized by postaxial polydactyly, macrocephaly, agenesis of the corpus callosum, and severe developmental delay. In a few patients with this disorder, a mutation in the KIF7 gene has been reported, which was associated with impaired GLI3 processing and dysregulaton of GLI3 transcription factors. A single patient with acrocallosal syndrome and a de novo p.Ala934Pro mutation in GLI3 has been reported, whereas diverse and numerous GLI3 mutations have also been described in syndromes with overlapping clinical manifestations, including Greig cephalopolysyndactyly syndrome, Pallister-Hall syndrome, trigonocephaly with craniosynostosis and polydactyly, oral-facial-digital syndrome, and non-syndromic polydactyly. Here, we describe a second patient with acrocallosal syndrome, who has a de novo, novel c.2786T>C mutation in GLI3, which predicts p.Leu929Pro. This mutation is in the same domain as the mutation in the previously reported patient. These data confirm that mutations in GLI3 are a cause of the acrocallosal phenotype.
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Affiliation(s)
- Leonie Speksnijder
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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30
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Meuwissen MEC, Lequin MH, Bindels-de Heus K, Bruggenwirth HT, Knapen MFCM, Dalinghaus M, de Coo R, van Bever Y, Winkelman BHJ, Mancini GMS. ACTA2 mutation with childhood cardiovascular, autonomic and brain anomalies and severe outcome. Am J Med Genet A 2013; 161A:1376-80. [PMID: 23613326 DOI: 10.1002/ajmg.a.35858] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 12/20/2012] [Indexed: 01/10/2023]
Abstract
Thoracic aortic aneurysm and dissection (TAAD) are associated with connective tissue disorders like Marfan syndrome and Loeys-Dietz syndrome, caused by mutations in the fibrillin-1, the TGFβ-receptor 1- and -2 genes, the SMAD3 and TGFβ2 genes, but have also been ascribed to ACTA2 gene mutations in adults, spread throughout the gene. We report on a novel de novo c.535C>T in exon 6 leading to p.R179C aminoacid substitution in ACTA2 in a toddler girl with primary pulmonary hypertension, persistent ductus arteriosus, extensive cerebral white matter lesions, fixed dilated pupils, intestinal malrotation, and hypotonic bladder. Recently, de novo ACTA2 R179H substitutions have been associated with a similar phenotype and additional cerebral developmental defects including underdeveloped corpus callosum and vermis hypoplasia in a single patient. The patient here shows previously undescribed abnormal lobulation of the frontal lobes and position of the gyrus cinguli and rostral dysplasis of the corpus callosum; she died at the age of 3 years during surgery due to vascular fragility and rupture of the ductus arteriosus. Altogether these observations support a role of ACTA2 in brain development, especially related to the arginine at position 179. Although all previously reported patients with R179H substitution successfully underwent the same surgery at younger ages, the severe outcome of our patient warns against the devastating effects of the R179C substitution on vasculature.
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Affiliation(s)
- Marije E C Meuwissen
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
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31
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Beurskens LWJE, Schrijver LH, Tibboel D, Wildhagen MF, Knapen MFCM, Lindemans J, de Vries J, Steegers-Theunissen RPM. Dietary vitamin A intake below the recommended daily intake during pregnancy and the risk of congenital diaphragmatic hernia in the offspring. ACTA ACUST UNITED AC 2013; 97:60-6. [PMID: 23283831 DOI: 10.1002/bdra.23093] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 09/17/2012] [Accepted: 09/25/2012] [Indexed: 01/26/2023]
Abstract
BACKGROUND Vitamin A has been related to the etiology of congenital diaphragmatic hernia (CDH). We performed a case-control study to investigate whether maternal dietary vitamin A intake is related to CDH in the offspring. METHODS Thirty-one pregnancies diagnosed with CDH and 46 control pregnancies were included during the study. After CDH diagnosis and inclusion of controls by risk set sampling, maternal vitamin A intake was investigated with a food frequency questionnaire. Serum retinol and retinol-binding protein were determined. Univariable and multivariable logistic regression models were used to calculate risk estimates with adjustment for potential confounders. RESULTS We found no significant differences in the overall nutrient and vitamin A intake between case and control mothers. After stratification in body mass index (BMI) categories, case mothers with normal weight showed a lower energy adjusted vitamin A intake (685 vs. 843 μg retinol activity equivalents [RAEs] / day; p = 0.04) and a slightly lower serum retinol (1.58 vs. 1.67 μmol/L; p = 0.08) than control mothers. Vitamin A intake <800 μg retinol activity equivalents (recommended daily intake) in normal weight mothers was associated with a significantly increased CDH risk (odds ratio [OR], 7.2; 95% confidence interval [CI], 1.5-34.4; p = 0.01). Associations were not significantly different in underweight and overweight mothers. CONCLUSIONS In normal-weight mothers, dietary vitamin A intake during pregnancy below the recommended daily intake is significantly associated with an increased risk of a child with CDH. This finding supports the retinoid hypothesis in human CDH, but warrants further investigation in larger study populations. Birth Defects Research (Part A), 2013. © 2013 Wiley Periodicals, Inc.
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Raijmakers MTM, Roelofs HMJ, Steegers EAP, Steegers-Theunissen R RÉPM, Mulder TPJ, Knapen MFCM, Wong WY, Peters WHM. Glutathione and glutathione S-transferases A1-1 and P1-1 in seminal plasma may play a role in protecting against oxidative damage to spermatozoa. Fertil Steril 2003; 79:169-72. [PMID: 12524083 DOI: 10.1016/s0015-0282(02)04404-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To study the levels of glutathione, glutathione S-transferase A1-1, and glutathione S-transferase P1-1 in seminal fluid of fertile and subfertile men. DESIGN Retrospective case-control study. SETTING Departments of gastroenterology, obstetrics and gynecology, and epidemiology and biostatistics in a university medical center. PATIENT(S) Twenty-five subfertile men visiting the fertility clinic and 25 fertile men from midwife practices were recruited. INTERVENTION(S) Collection of semen of subfertile and fertile men. MAIN OUTCOME MEASURE(S) Plasma levels of glutathione and glutathione S-transferases A1-1 and P1-1 in relation to seminal characteristics. RESULT(S) Glutathione, glutathione S-transferase A1-1, as well as glutathione S-transferase P1-1 were found in considerable amounts in seminal fluid of subfertile and fertile men. No differences between groups were found for glutathione S-transferases A1-1 and P1-1. Also, no associations with sperm count, motility, or morphology could be detected. Fertile men had significantly higher glutathione levels as compared with the case of subfertile men. Associations of glutathione with sperm motility quality (r(s) = 0.321) and abnormal sperm morphology (r(s) = -0.496) were found. CONCLUSION(S) The presence of glutathione S-transferases A1-1 and P1-1 in seminal fluid suggests a role in the protection against (oxidative) damage of spermatozoa, whereas glutathione may play a role in male fertility.
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Affiliation(s)
- Maarten T M Raijmakers
- Department of Gastroenterology, University Medical Center Nijmegen, Nijmegen, The Netherlands
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33
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Mulder TPJ, Knapen MFCM, van der Mooren MJ, Demacker PD, Roes EM, Steegers EAP, Peters WHM. Effects of Hormone Replacement Therapy on Plasma Glutathione S-Transferase A1-1 Concentrations in Healthy Postmenopausal Women. Clin Chem 1998. [DOI: 10.1093/clinchem/44.3.666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Theo P J Mulder
- Depts. of Gastroenterol., Obstet. and Gynecol., and General Intern. Med., Univ. Hosp. St. Radboud, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Maarten F C M Knapen
- Depts. of Gastroenterol., Obstet. and Gynecol., and General Intern. Med., Univ. Hosp. St. Radboud, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marius J van der Mooren
- Depts. of Gastroenterol., Obstet. and Gynecol., and General Intern. Med., Univ. Hosp. St. Radboud, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Pierre D Demacker
- Depts. of Gastroenterol., Obstet. and Gynecol., and General Intern. Med., Univ. Hosp. St. Radboud, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Eva-Maria Roes
- Depts. of Gastroenterol., Obstet. and Gynecol., and General Intern. Med., Univ. Hosp. St. Radboud, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Eric A P Steegers
- Depts. of Gastroenterol., Obstet. and Gynecol., and General Intern. Med., Univ. Hosp. St. Radboud, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Wilbert H M Peters
- Depts. of Gastroenterol., Obstet. and Gynecol., and General Intern. Med., Univ. Hosp. St. Radboud, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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