Cell-free DNA screening for trisomy 21 in twin pregnancy: a large multicenter cohort study.

Autor: Dugoff L; Division of Reproductive Genetics, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. Electronic address: Lorraine.Dugoff@pennmedicine.upenn.edu., Koelper NC; Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women's Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA., Chasen ST; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NewYork Presbyterian-Weill Cornell Medical Center, New York, NY., Russo ML; Division of Maternal-Fetal Medicine, Women & Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI., Roman AS; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Health, New York, NY., Limaye MA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Health, New York, NY., Ranzini AC; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The MetroHealth System, Cleveland, OH., Clifford CM; Division of Maternal-Fetal Medicine, University of Michigan, Ann Arbor, MI., Biggio JR Jr; Section of Maternal Fetal Medicine, Women's Service Line, Department of Obstetrics and Gynecology, Ochsner Health, New Orleans, LA., Subramaniam A; Division of Maternal-Fetal Medicine, Center for Women's Reproductive Health, Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL., Seasely A; Division of Maternal-Fetal Medicine, Center for Women's Reproductive Health, Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL., Patil AS; Department of Obstetrics and Gynecology, The University of Arizona College of Medicine-Phoenix, Phoenix, AZ., Weed S; Franciscan Maternal-Fetal Medicine Associates, Tacoma, WA., Page JM; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The University of Utah Healthcare and Intermountain Healthcare, Salt Lake City, UT., Nicholas S; Axia Women's Health Main Line Perinatal Associates, Wynnewood, PA., Idler J; Allegheny Health Network, Drexel University College of Medicine, Pittsburgh, PA., Rao RR; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA., Crowder A; Centura, Littleton, CO., Shree R; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA., McLennan G; LabCorp, San Diego, CA., Bromley B; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA.
Jazyk: angličtina
Zdroj: American journal of obstetrics and gynecology [Am J Obstet Gynecol] 2023 Oct; Vol. 229 (4), pp. 435.e1-435.e7. Date of Electronic Publication: 2023 Apr 06.
DOI: 10.1016/j.ajog.2023.04.002
Abstrakt: Background: Analysis of cell-free DNA from maternal blood provides effective screening for trisomy 21 in singleton pregnancies. Data on cell-free DNA screening in twin gestations are promising although limited. In previous twin studies, cell-free DNA screening was primarily performed in the second trimester and many studies did not report chorionicity.
Objective: This study aimed to evaluate the screening performance of cell-free DNA for trisomy 21 in twin pregnancies in a large, diverse cohort. A secondary aim was to evaluate screening performance for trisomy 18 and trisomy 13.
Study Design: This was a retrospective cohort study of twin pregnancies from 17 centers for which cell-free DNA screening was performed from December 2011 to February 2020 by one laboratory using massively parallel sequencing technology. Medical record review was conducted for all newborns and data on the birth outcome, the presence of any congenital abnormalities, phenotypic appearance at birth, and any chromosomal testing that was undertaken in the antenatal or postnatal period were extracted. Cases with a possible fetal chromosomal abnormality with no genetic test results were reviewed by a committee of maternal-fetal medicine geneticists. Cases with a vanishing twin and inadequate follow-up information were excluded. A minimum of 35 confirmed cases of trisomy 21 was required to capture a sensitivity of at least 90% with a prevalence of at least 1.9% with 80% power. Test characteristics were calculated for each outcome.
Results: A total of 1764 samples were sent for twin cell-free DNA screening. Of those, 78 cases with a vanishing twin and 239 cases with inadequate follow-up were excluded, leaving a total of 1447 cases for inclusion in the analysis. The median maternal age was 35 years and the median gestational age at cell-free DNA testing was 12.3 weeks. In total, 81% of the twins were dichorionic. The median fetal fraction was 12.4%. Trisomy 21 was detected in 41 of 42 pregnancies, yielding a detection rate of 97.6% (95% confidence interval, 83.8-99.7). There was 1 false negative and no false positive cases. Trisomy 21 was detected in 38 out of 39 dichorionic twin pregnancies, yielding a detection rate of 97.4% (95% confidence interval, 82.6-99.7). Trisomy 18 was detected in 10 of the 10 affected pregnancies. There was 1 false positive case. Trisomy 13 was detected in 4 of the 5 cases, yielding a detection rate of 80% (95% confidence interval, 11.1-99.2). There was one false negative and no false positive cases. The nonreportable rate was low at 3.9 %.
Conclusion: Cell-free DNA testing is effective in screening for trisomy 21 in twin gestations from the first trimester of pregnancy. Detection of trisomy 21 was high in dichorionic and monochorionic twins, and the nonreportable result rates were low. This study included high numbers of cases of trisomy 18 and 13 when compared with the current literature. Although screening for these conditions in twins seems to be promising, the numbers were too small to make definitive conclusions regarding the screening efficacy for these conditions. It is possible that cell-free DNA testing performance may differ among laboratories and vary with screening methodologies.
(Copyright © 2023. Published by Elsevier Inc.)
Databáze: MEDLINE
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