Incidence of sex chromosome aneuploidy in a prenatal population: 27-year longitudinal study in Northern Italy

OBJECTIVES

The availability of cell-free (cf) DNA as a prenatal screening tool affords an opportunity for non-invasive identification of sex chromosome aneuploidy (SCA). The aims of this longitudinal study were to investigate the evolution and frequency of both invasive prenatal diagnostic testing, using amniocentesis and chorionic villus sampling (CVS), and the detection of SCA in cfDNA samples from a large unselected cohort in Northern Italy.

METHODS

The results of genetic testing from CVS and amniotic fluid samples received from public and private centers in Italy from 1995 to 2021 were collected. Chromosomal analysis was performed by routine Q-banding karyotype. Regression analyses and descriptive statistics were used to determine population data trends regarding the frequency of prenatal diagnostic testing and the identification of SCA, and these were compared with the changes in indication for prenatal diagnostic tests and available screening options.

RESULTS

Over a period of 27 years, there were 13 939 526 recorded births and 231 227 invasive procedures were performed, resulting in the prenatal diagnosis of 933 SCAs. After the commercial introduction of cfDNA use in 2015, the frequency of invasive procedures decreased significantly (P = 0.03), while the frequency of prenatal SCA detection increased significantly (P = 0.007). Between 2016 and 2021, a high-risk cfDNA result was the indication for 31.4% of detected sex chromosome trisomies, second only to advanced maternal age.

CONCLUSIONS

Our findings suggest that the inclusion of SCA in prenatal cfDNA screening tests can increase the prenatal diagnosis of affected individuals. As the benefits of early ascertainment are increasingly recognized, it is essential that healthcare providers are equipped with comprehensive and evidence-based information regarding the associated phenotypic differences and the availability of targeted effective interventions to improve neurodevelopmental and health outcomes for affected individuals. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Reading Skills in Males with 47,XXY: Risk Factors and The Influence of Hormonal Replacement Treatment (HRT)

PURPOSE

47,XXY is often associated with reduced expressive language and literacy skills. This retrospective cross-sectional study investigated risk factors [hormone replacement deficiency, pre-or post-natal diagnosis, and history of family learning disabilities (FLD)] associated with reading skills in 152 males.

METHODS

We analyzed Woodcock Reading Mastery Test scores among seven prenatally diagnosed male HRT groups using analysis of variance along with Anova and two postnatally diagnosed male HRT groups (No-T and T) using t-tests. Treated, prenatally diagnosed males with FLD were compared to an identically treated prenatal HRT group with no history of FLD using a t-test.

RESULTS

In prenatally diagnosed males, significant treatment differences were observed on several reading scales (e.g., Total Reading: χ2 = 17.96, p = 0.006), where the highest modality HRT group (M =119.87) outperformed the untreated group (M = 99.88). In the postnatal analysis, we observed a significant effect of treatment on Basic Skills (p = 0.01). Despite equal HRT status, males with FLD (M = 105.79) exhibited reduced Total Reading skills compared to those (p32= 0.0006).

CONCLUSIONS

Our findings in this pilot study reveal that the most optimal reading trajectory is associated with a prenatal diagnosis, absence of FLD, and the highest modality HRT.

A longitudinal perspective of hormone replacement therapies (HRTs) on neuromotor capabilities in males with 47,XXY (Klinefelter syndrome)

PURPOSE

The purpose of this study was to delineate the effects of variable hormone replacement therapies on neuromotor function in a large cohort of males with 47,XXY from birth to adulthood.

METHODS

A total of 270 participants aged 16 days to 17 years 11 months prenatally diagnosed with 47,XXY were assessed by their pediatric endocrinologist and were administered hormone replacement therapies accordingly. Infants and school-aged children with 47,XXY were administered neuromotor assessments during routine neurodevelopmental evaluations. For statistical analysis, participants were segregated on the basis of treatment status. Two-tailed t tests, 1-way analysis of variance, and post hoc analysis determined significant group differences on each assessment.

RESULTS

In infants, the early hormonal treatment (EHT) group performed significantly better than the untreated group on fine motor and motor composite domains. In school-aged children, we observed significantly improved scores on fine motor control, coordination, agility, and strength domains among males treated with EHT (or any combination thereof) compared with those who did not receive early treatment.

CONCLUSION

The highest treated combination group was associated with the highest neuromotor function, although the EHT group also often performed better than the other groups. This suggests EHT may be essential in promoting long-term optimal neuromotor outcome in males with an additional X.