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FREE FETAL DNA AS A SCREENING TEST FOR ANEUPLOIDY – DOES IT ADD UP?

Published online by Cambridge University Press:  21 September 2015

CAROLINE OGILVIE*
Affiliation:
Guy's & St Thomas’ NHS Foundation Trust – Genetics, 2 West Park, Mottingham, London, UK.
*
Professor Caroline Ogilvie, Guy's & St Thomas’ NHS Foundation Trust – Genetics, 2 West Park, Mottingham, London, SE1 9RT. Email: Caroline.Ogilvie@genetics.kcl.ac.uk

Extract

The possibility of prenatal screening for genetic disorders was raised as early as the mid-1950s, and with the introduction in 1966 of amniocentesis for sampling fetal material, it became possible to identify pregnancies with trisomy 21 (Down syndrome), the most common prenatal genetic abnormality. The fetal cells in the amniotic fluid could be cultured, then harvested, followed by chromosome spreading on microscope slides. These chromosome spreads, each representing the chromosomes from a single cell nucleus, could be stained, visualised by light microscopy and counted to establish the chromosome number. However, diagnosis of Down syndrome was expensive, and in the early days of amniocentesis, there was an associated risk of miscarriage; most countries therefore recommended this procedure only for women who were identified as having a raised risk of chromosome abnormality. As it is well established that raised maternal age increases the risk of Down syndrome, amniocentesis was first offered only to women above an age cut-off (usually 35). However, although the risk to an individual woman of having a Down syndrome pregnancy is greater in this age group, the majority of Down syndrome babies are born to younger women, due to the preponderance of pregnancies in the younger group.

Type
Opinion
Copyright
Copyright © Cambridge University Press 2015 

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References

REFERENCES

1. Fuchs, F, Riis, P. Antenatal sex determination. Nature 1956; 177: 330.Google Scholar
2. Martin, D, Gardner, MO, Rappaport, VJ. Identifying ultrasound markers for down syndrome. Medscape Womens Health 1997; 2: 2, doi:wh3135 [pii].Google Scholar
3. Benacerraf, BR, Neuberg, D, Bromley, B, Frigoletto, FD Jr. Sonographic scoring index for prenatal detection of chromosomal abnormalities. J Ultrasound Med 1992; 11: 449–58.Google Scholar
4. Shipp, TD, Benacerraf, BR. Second trimester ultrasound screening for chromosomal abnormalities. Prenat Diagn 2002; 22: 296307, doi:10.1002/pd.307.Google Scholar
5. Wald, NJ. Antenatal screening for down syndrome. Prog Clin Biol Res 1995; 393: 2742.Google Scholar
6. Ogle, RF, Chitty, LS. Prenatal screening for down syndrome. Hosp Med 1998; 59: 632–6.Google ScholarPubMed
7. Chitty, L, Prenatal screening for chromosome abnormalities. Br Med Bull 1998; 54: 839–56.Google Scholar
8. Smidt-Jensen, S, Hahnemann, N. Transabdominal fine needle biopsy from chorionic villi in the first trimester. Prenat Diagn 1984; 4: 163–9.Google Scholar
9. Spathas, DH, Divane, A, Maniatis, GM, Ferguson-Smith, ME, Ferguson-Smith, MA. Prenatal detection of trisomy 21 in uncultured amniocytes by fluorescence in situ hybridization: a prospective study. Prenat Diagn 1994; 14: 1049–54.Google Scholar
10. Klinger, K, Greg, L, Donna, S, Robert, H, Linda, L, Pat, L et al. Rapid detection of chromosome aneuploidies in uncultured amniocytes by using fluorescence in situ hybridization (FISH). Am J Hum Genet 1992; 51: 5565.Google Scholar
11. Morris, A, Boyd, E, Dhanjal, S, Lowther, GW, Aitken, DA, Young, J et al. Two years’ prospective experience using fluorescence in situ hybridization on uncultured amniotic fluid cells for rapid prenatal diagnosis of common chromosomal aneuploidies. Prenat Diagn 1999; 19: 546–51, doi:10.1002/(SICI)1097-0223(199906)19:6<546::AID-PD589>3.0.CO;2-8 [pii].3.0.CO;2-8>CrossRefGoogle ScholarPubMed
12. Mansfield, ES. Diagnosis of Down syndrome and other aneuploidies using quantitative polymerase chain reaction and small tandem repeat polymorphisms. Hum Mol Genet 1993; 2: 4350.Google Scholar
13. Pertl, B, Yau, SC, Sherlock, J, Davies, AF, Mathew, CG, Adinolfi, M. Rapid molecular method for prenatal detection of Down's syndrome. Lancet 1994; 343: 1197–8.Google Scholar
14. Mann, K, Fox, SP, Abbs, SJ, Yau, SC, Scriven, PN, Docherty, Z et al. Development and implementation of a new rapid aneuploidy diagnostic service within the UK national health service and implications for the future of prenatal diagnosis. Lancet 2001; 358: 1057–61, doi:S0140-6736(01)06183-9 [pii] 10.1016/S0140-6736(01)06183-9.CrossRefGoogle ScholarPubMed
15. Ogilvie, CM, Lashwood, A, Chitty, L, Waters, JJ, Scriven, PN, Flinter, F. The future of prenatal diagnosis: rapid testing or full karyotype? An audit of chromosome abnormalities and pregnancy outcomes for women referred for Down's Syndrome testing. BJOG 2005; 112: 1369–75, doi:BJO00695 [pii] 10.1111/j.1471-0528.2005.00695.x.Google Scholar
16. Hills, A, Donaghue, C, Waters, J, Waters, K, Sullivan, C, Kulkarni, A et al. QF-PCR as a stand-alone test for prenatal samples: the first 2 years’ experience in the London region. Prenat Diagn 2010; 30: 509–17, doi:10.1002/pd.2503.Google Scholar
17. Wapner, RJ, Martin, CL, Levy, B, Ballif, BC, Eng, CM, Zachary, JM et al. Chromosomal microarray versus karyotyping for prenatal diagnosis. N Engl J Med 2012; 367: 2175–84, doi:10.1056/NEJMoa1203382.Google Scholar
18. Ahn, JW, Bint, S, Irving, MD, Kyle, PM, Akolekar, R, Mohammed, SN et al. A new direction for prenatal chromosome microarray testing: software-targeting for detection of clinically significant chromosome imbalance without equivocal findings. PeerJ 2014; 2: e354, doi:10.7717/peerj.354 [pii].Google Scholar
19. Tabor, A, Philip, J, Madsen, M, Bang, J, Obel, EB, Nørgaard-Pedersen, B et al. Randomised controlled trial of genetic amniocentesis in 4606 low-risk women. Lancet 1986; 1: 1287–93.Google Scholar
20. Sundberg, K, Bang, J, Smidt-Jensen, S, Brocks, V, Lundsteen, C, Parner, J et al. Randomised study of risk of fetal loss related to early amniocentesis versus chorionic villus sampling. Lancet 1997; 350: 697703, doi:S0140-6736(97)02449-5 [pii] 10.1016/S0140-6736(97)02449-5.Google Scholar
21. Nicolaides, K, Brizot Mde, L, Patel, F, Snijders, R. Comparison of chorionic villus sampling and amniocentesis for fetal karyotyping at 10–13 weeks’ gestation. Lancet 1994; 344: 435–9.Google Scholar
22. Ogilvie, C, Akelokar, R. Procedure-related pregnancy loss following invasive prenatal sampling - time for a new approach to risk assessment and counseling? Expert Rev Obstet Gynecol 2013; 8 (2): 135142.CrossRefGoogle Scholar
23. Akolekar, R, Beta, J, Picciarelli, G, Ogilvie, C, D’Antonio, F. Procedure-related risk of miscarriage following amniocentesis and chorionic villus sampling: a systematic review and meta-analysis. Ultrasound Obstet Gynecol 2015; 45: 1626, doi:10.1002/uog.14636.Google Scholar
24. Akolekar, R, Bower, S, Flack, N, Bilardo, CM, Nicolaides, KH. Prediction of miscarriage and stillbirth at 11–13 weeks and the contribution of chorionic villus sampling. Prenat Diagn 2011; 31: 3845, doi:10.1002/pd.2644.Google Scholar
25. Lo, YM, Corbetta, N, Chamberlain, PF, Rai, V, Sargent, IL, Redman, CW et al. Presence of fetal DNA in maternal plasma and serum. Lancet 1997; 350: 485–7, doi:S0140-6736(97)02174-0 [pii] 10.1016/S0140-6736(97)02174-0.Google Scholar
26. Chiu, RW, Sun, H, Akolekar, R, Clouser, C, Lee, C, McKernan, K et al. Maternal plasma DNA analysis with massively parallel sequencing by ligation for noninvasive prenatal diagnosis of trisomy 21. Clin Chem 2010; 56: 459–63, doi:clinchem.2009.136507 [pii] 10.1373/clinchem.2009.136507.Google Scholar
27. Gil, MM, Quezada, MS, Revello, R, Akolekar, R, Nicolaides, KH. Analysis of cell-free DNA in maternal blood in screening for fetal aneuploidies: updated meta-analysis. Ultrasound Obstet Gynecol 2015; 45: 249–66, doi:10.1002/uog.14791.Google Scholar
28. Wolstenholme, J, Rooney, DE, Davison, EV. Confined placental mosaicism, IUGR, and adverse pregnancy outcome: a controlled retrospective UK collaborative survey. Prenat Diagn 1994; 14: 345–61.Google Scholar
29. Donaghue, C, Mann, K, Docherty, Z, Ogilvie, CM. Detection of mosaicism for primary trisomies in prenatal samples by QF-PCR and karyotype analysis. Prenat Diagn 2005; 25: 6572, doi:10.1002/pd.1086.CrossRefGoogle ScholarPubMed
30. Zhang, H, Gao, Y, Jiang, F, Fu, M, Yuan, Y, Guo, Y et al. Non-invasive prenatal testing for trisomies 21, 18 and 13: clinical experience from 146 958 pregnancies. Ultrasound Obstet Gynecol 2015; 45: 530–8, doi:10.1002/uog.14792.Google Scholar
31. Wang, Y, Chen, Y, Tian, F, Zhang, J, Song, Z, Wu, Y et al. Maternal mosaicism is a significant contributor to discordant sex chromosomal aneuploidies associated with noninvasive prenatal testing. Clin Chem 2014; 60: 251–9, doi:clinchem.2013.215145 [pii] 10.1373/clinchem.2013.215145.Google Scholar
32. Curnow, KJ, Wilkins-Haug, L, Ryan, A, Kirkizlar, E, Stosic, M, Hall, MP et al. Detection of triploid, molar, and vanishing twin pregnancies by a single-nucleotide polymorphism-based noninvasive prenatal test. Am J Obstet Gynecol 2015; 212: 79 e71–79, doi:S0002-9378(14)01054-0 [pii] 10.1016/j.ajog.2014.10.012.Google Scholar
33. McCullough, RM, Almasri, EA 1, Guan, X 1, Geis, JA 1, Hicks, SC 1, Mazloom, AR et al. Non-invasive prenatal chromosomal aneuploidy testing–clinical experience: 100,000 clinical samples. PLoS One 2014; 9: e109173, doi:10.1371/journal.pone.0109173 PONE-D-13-55248 [pii].CrossRefGoogle Scholar
34. Cuckle, H, Benn, P, Pergament, E. Maternal cfDNA screening for down syndrome–a cost sensitivity analysis. Prenat Diagn 2013; 33: 636–42, doi:10.1002/pd.4157.Google Scholar
35. Morris, S, Karlsen, S, Chung, N, Hill, M, Chitty, LS. Model-based analysis of costs and outcomes of non-invasive prenatal testing for Down's syndrome using cell free fetal DNA in the UK National Health Service. PLoS One 2014; 9: e93559, doi:10.1371/journal.pone.0093559 PONE-D-13-44615 [pii].Google Scholar
36. Wald, NJ, Bestwick, JP. Performance of antenatal reflex DNA screening for Down's syndrome. J Med Screen 2015, doi:0969141315581005 [pii] 10.1177/0969141315581005.Google Scholar
37. Dar, P, Curnow, KJ, Gross, SJ, Hall, MP, Stosic, M, Demko, Z et al. Clinical experience and follow-up with large scale single-nucleotide polymorphism-based noninvasive prenatal aneuploidy testing. Am J Obstet Gynecol 2014; 211: 527 e521–7e517, doi:S0002-9378(14)00818-7 [pii] 10.1016/j.ajog.2014.08.006.Google Scholar
38. Futch, T, Spinosa, J, Bhatt, S, de Feo, E, Rava, RP, Sehnert, AJ. Initial clinical laboratory experience in noninvasive prenatal testing for fetal aneuploidy from maternal plasma DNA samples. Prenat Diagn 2013; 33: 569–74, doi:10.1002/pd.4123.Google Scholar
39. Brady, P, Brison, N, Van Den Bogaert, K, de Ravel, T, Peeters, H, Van Esch, H et al. Clinical implementation of NIPT - technical and biological challenges. Clin Genet 2015, doi:10.1111/cge.12598.Google Scholar