Document Detail


Advances in prenatal screening for Down syndrome: II first trimester testing, integrated testing, and future directions.
MedLine Citation:
PMID:  12204419     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The acceptability of prenatal screening and diagnosis of Down syndrome is dependent, in part, on the gestational age at which the testing is offered. First trimester screening could be advantageous if it has sufficient efficacy and can be effectively delivered. ISSUES: Two first trimester maternal serum screening markers, pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (beta-hCG), are useful for identifying women at increased risk for fetal Down syndrome. In addition, measurement of an enlarged thickness of the subcutaneous fluid-filled space at the back of the neck of the developing fetus (referred to as nuchal translucency or NT) has been demonstrated to be an indicator for these high-risk pregnancies. When these three parameters are combined, estimates for Down syndrome efficacy exceed those currently attainable in the second trimester. Women who are screen-positive in the first trimester can elect to receive cytogenetic testing of a chorionic villus biopsy. The first trimester tests could also, theoretically, be combined with the second trimester maternal serum screening tests (integrated screening) to obtain even higher levels of efficacy. There are, however, several practical limitations to first trimester and integrated screening. These include scheduling of testing within relatively narrow gestational age intervals, availability of appropriately trained ultrasonographers for NT measurement, risks associated with chorionic villus biopsy, and costs. There is also increasing evidence that an enlarged NT measurement is indicative of a high risk for spontaneous abortion and for fetal abnormalities that are not detectable by cytogenetic analysis. Women whose fetuses show enlarged NT, therefore, need first trimester counseling regarding their Down syndrome risks and the possibility of other adverse pregnancy outcomes. Follow-up ultrasound and fetal echocardiography in the second trimester are also indicated. CONCLUSION: First trimester screening appears to be a highly effective method to screen for Down syndrome. Women with screen-positive results based on NT measurement appear to be at increased risk for diverse fetal abnormalities. The finding of a normal fetal karyotype may not, therefore, carry a high level of reassurance for a normal baby.
Authors:
Peter A Benn
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Clinica chimica acta; international journal of clinical chemistry     Volume:  324     ISSN:  0009-8981     ISO Abbreviation:  Clin. Chim. Acta     Publication Date:  2002 Oct 
Date Detail:
Created Date:  2002-09-02     Completed Date:  2002-11-25     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1302422     Medline TA:  Clin Chim Acta     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1-11     Citation Subset:  IM    
Copyright Information:
Copyright 2002 Elsevier Science B.V.
Affiliation:
Division of Human Genetics, Department of Pediatrics, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-6140, USA. benn@nso1.uchc.edu
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MeSH Terms
Descriptor/Qualifier:
Biological Markers / analysis,  blood
Down Syndrome / blood,  diagnosis*,  ultrasonography
Female
Humans
Pregnancy
Pregnancy Trimester, First*
Pregnancy Trimester, Second
Prenatal Diagnosis / methods*,  trends*
Sensitivity and Specificity
Ultrasonography, Prenatal
Chemical
Reg. No./Substance:
0/Biological Markers

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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