Obstet Gynecol Sci.  2018 Jul;61(4):453-460. 10.5468/ogs.2018.61.4.453.

Change in rates of prenatal tests for chromosomal abnormality over a 12-year period in women of advanced maternal age

Affiliations
  • 1Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea. obdrmhk@naver.com
  • 2Institute of Health and Environment, Seoul National University, Seoul, Korea.

Abstract


OBJECTIVE
In 2007, the American College of Obstetricians and Gynecologists (ACOG) recommended that all pregnant women be offered screening or diagnostic tests for chromosomal abnormalities regardless of their age. Noninvasive prenatal testing (NIPT) for common chromosomal aneuploidies was introduced as a screening test in case of high-risk pregnancies. We assessed the rates of prenatal tests in women aged 35 years and older.
METHODS
A retrospective study was conducted to compare the rates of amniocentesis, chorionic villus sampling (CVS), serum screening, and NIPT from January 2005 through March 2017 in women aged 35 years and older. We divided the initial 12 months after NIPT introduction into 4-month intervals, beginning in April 2016 through March 2017.
RESULTS
The rates of amniocentesis were 56% before the ACOG statement, 38% between the ACOG statement and NIPT introduction, and 10% after NIPT introduction (P=0.001). The rates of CVS during the same periods were 0.5%, 2.1%, and 4.3% (P=0.016), respectively. The rates of serum screening were 44.2%, 61.3%, and 55.1% (P=0.049), respectively. During the 3 quarters after NIPT introduction, the rates of amniocentesis were 16.2%, 12.3%, and 7.3% (P=0.002), respectively; the rates of serum screening were 62%, 54%, and 46% (P=0.03), respectively; and the rates of NIPT were 19.9%, 30.3%, and 39.5% (P=0.007), respectively. The rates of CVS over the same periods were not significantly different.
CONCLUSION
The ACOG statement and NIPT introduction significantly decreased the rate of amniocentesis in women of advanced maternal age. NIPT also reduced the rate of serum screening.

Keyword

Noninvasive prenatal testing; Prenatal diagnosis; Maternal age

MeSH Terms

Amniocentesis
Aneuploidy
Chorionic Villi Sampling
Chromosome Aberrations*
Diagnostic Tests, Routine
Female
Humans
Mass Screening
Maternal Age*
Pregnancy
Pregnancy, High-Risk
Pregnant Women
Prenatal Diagnosis
Retrospective Studies

Figure

  • Fig. 1 Rates of amniocentesis, chorionic villus sampling, and serum screening in singleton pregnant women aged 35 years and older over a 12-year period including the release of the 2007 American College of Obstetricians and Gynecologists statement and the 2016 noninvasive prenatal test introduction. ACOG, American College of Obstetricians and Gynecologists; NIPT, noninvasive prenatal test.

  • Fig. 2 Rates of amniocentesis, chorionic villus sampling, serum screening, and noninvasive prenatal test in singleton pregnant women aged 35 years and older during the 12 months after the 2016 noninvasive prenatal test introduction. NIPT, noninvasive prenatal test.

  • Fig. 3 Rates of the different prenatal tests among the 3 periods of before the 2007 American College of Obstetricians and Gynecologists statement, between the American College of Obstetricians and Gynecologists statement and noninvasive prenatal test introduction, and after the 2016 noninvasive prenatal test introduction. The mean rates of amniocentesis are shown in (A), chorionic villus sampling in (B), and serum screening in (C). Data are represented as % ±standard deviation. ACOG, American College of Obstetricians and Gynecologists; NIPT, noninvasive prenatal test; CVS, chorionic villus sampling. a)Significantly different from before the American College of Obstetricians and Gynecologists statement (P<0.05); b)Significantly different from the period between the American College of Obstetricians and Gynecologists statement and noninvasive prenatal test introduction (P<0.05).

  • Fig. 4 Rates of the different prenatal tests in the 3 quarters during 1 year after the April 2016 noninvasive prenatal test introduction. The mean rates of amniocentesis are shown in (A), chorionic villus sampling in (B), serum screening in (C), and noninvasive prenatal test in (D). Data represented as % ±standard deviation. NIPT, noninvasive prenatal test; CVS, chorionic villus sampling. a)Significantly different from the first quarter after noninvasive prenatal test (P<0.05); b)Significantly different from the second quarter after noninvasive prenatal test (P<0.05).


Reference

1. Statistics Korea. Planned report, change in birth in Seoul for the past 10 years [Internet]. Daejeon (KR): Statistics Korea;c2017. cited 2017 Jan 2. Available from: http://kostat.go.kr/office/giro/rogi_nw/2.
2. Jeong SO, Han YJ, Lee SW, Kwak DW, Chung JH, Ahn HK, et al. Observed frequency of fetal trisomy between 16 and 24 gestational weeks in pregnant women older than 34 years at delivery. J Genet Med. 2016; 12:92–95.
Article
3. Kim YJ, Lee JE, Kim SH, Shim SS, Cha DH. Maternal age-specific rates of fetal chromosomal abnormalities in Korean pregnant women of advanced maternal age. Obstet Gynecol Sci. 2013; 56:160–166.
Article
4. ACOG Committee on Practice Bulletins. ACOG Practice Bulletin No. 77: screening for fetal chromosomal abnormalities. Obstet Gynecol. 2007; 109:217–227.
5. Driscoll DA, Morgan MA, Schulkin J. Screening for Down syndrome: changing practice of obstetricians. Am J Obstet Gynecol. 2009; 200:459.e1–459.e9.
Article
6. Darnes DR, Hashmi S, Monga M, Sullivan C, Vidaeff A, Berens P, et al. First-trimester screening and its impact on uptake of diagnostic testing. Prenat Diagn. 2011; 31:892–896.
Article
7. Palomaki GE, Kloza EM, Lambert-Messerlian GM, Haddow JE, Neveux LM, Ehrich M, et al. DNA sequencing of maternal plasma to detect Down syndrome: an international clinical validation study. Genet Med. 2011; 13:913–920.
Article
8. Norton ME, Brar H, Weiss J, Karimi A, Laurent LC, Caughey AB, et al. Non-Invasive Chromosomal Evaluation (NICE) Study: results of a multicenter prospective cohort study for detection of fetal trisomy 21 and trisomy 18. Am J Obstet Gynecol. 2012; 207:137.e1–137.e8.
Article
9. Committee on Practice Bulletins-Obstetrics, Committee on Genetics, and the Society for Maternal-Fetal Medicine. ACOG practice bulletin No. 163: screening for fetal aneuploidy. Obstet Gynecol. 2016; 127:e123–e137.
10. Larion S, Warsof SL, Romary L, Mlynarczyk M, Peleg D, Abuhamad AZ. Uptake of noninvasive prenatal testing at a large academic referral center. Am J Obstet Gynecol. 2014; 211:651.e1–651.e7.
Article
11. Rose NC, Lagrave D, Hafen B, Jackson M. The impact of utilization of early aneuploidy screening on amniocenteses available for training in obstetrics and fetal medicine. Prenat Diagn. 2013; 33:242–244.
Article
12. Grinshpun-Cohen J, Miron-Shatz T, Ries-Levavi L, Pras E. Factors that affect the decision to undergo amniocentesis in women with normal Down syndrome screening results: it is all about the age. Health Expect. 2015; 18:2306–2317.
Article
13. Friel LA, Czerwinski JL, Singletary CN. The impact of noninvasive prenatal testing on the practice of maternal-fetal medicine. Am J Perinatol. 2014; 31:759–764.
14. Pettit KE, Hull AD, Korty L, Jones MC, Pretorius DH. The utilization of circulating cell-free fetal DNA testing and decrease in invasive diagnostic procedures: an institutional experience. J Perinatol. 2014; 34:750–753.
Article
15. Beamon CJ, Hardisty EE, Harris SC, Vora NL. A single center's experience with noninvasive prenatal testing. Genet Med. 2014; 16:681–687.
Article
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