Abstract
In China, the medical guidelines recommend performing noninvasive prenatal testing (NIPT) with caution for pregnant women aged 35 years or older. However, the Mother and Child Health Care Law suggests that all primiparous women whose age is older than 35 years undergo prenatal diagnosis. These two inconsistent suggestions/recommendations have made obstetricians confused about whether to offer NIPT to these older pregnant women. To face this issue and find out the solution we performed a retrospective study of 189,809 NIPT samples collected from 28 provincial-leveled administrative units in China. Of 1,564 women with high-risk pregnancies who underwent NIPT, 459 (29.3%) did not participate in follow-up. The compound sensitivity and specificity of NIPT for trisomies 21, 18 and 13 detection was 99.1% (95% CI, 98.0%–99.6%) and 99.9% (95% CI, 98.8%–99.9%), respectively. In secundiparous women, NIPT showed high sensitivity and specificity similar to that in primiparous women. The observed risk for trisomies 21 and 18 significantly increased when the maternal age was 39 and older. After the publication of the current NIPT policy, the follow-up rate at our center was 91.9%; however, a large number of women are not in maternal and infant care networks nationwide, and that makes the follow-up rate outside our center relatively low. Our study shows that to balance the prevention of major aneuploidies and the limited resources for prenatal diagnosis, the cut-off age of 35 for invasive prenatal diagnosis might be unnecessary. Although the NIPT guidelines are well written, how to practice it effectively, especially in less industrialized areas, is worth discussing.
Similar content being viewed by others
References
ACOG. (2015). Committee Opinion No. 640: cell-free dna screening for fetal aneuploidy. Obstet Gynecol 126, e31–37.
ACOG. (2016). Practice Bulletin No. 162: Prenatal diagnostic testing for genetic disorders. Obstet Gynecol 127, e108–122.
Benn, P., Borrell, A., Cuckle, H., Dugoff, L., Gross, S., Johnson, J.A., Maymon, R., Odibo, A., Schielen, P., Spencer, K., et al. (2012). Prenatal detection of Down Syndrome using Massively Parallel Sequencing (MPS): a rapid response statement from a committee on behalf of the Board of the International Society for Prenatal Diagnosis, 24 October 2011. Prenat Diagn 32, 1–2.
Chiu, R.W.K., Chan, K.C.A., Gao, Y., Lau, V.Y.M., Zheng, W., Leung, T.Y., Foo, C.H.F., Xie, B., Tsui, N.B.Y., Lun, F.M.F., et al. (2008). Noninvasive prenatal diagnosis of fetal chromosomal aneuploidy by massively parallel genomic sequencing of DNA in maternal plasma. Proc Natl Acad Sci USA 105, 20458–20463.
Devers, P.L., Cronister, A., Ormond, K.E., Facio, F., Brasington, C.K., and Flodman, P. (2013). Noninvasive prenatal testing/noninvasive prenatal diagnosis: the position of the National Society of Genetic Counselors. J Genet Counsel 22, 291–295.
Dobson, L.J., Reiff, E.S., Little, S.E., Wilkins-Haug, L., and Bromley, B. (2016). Patient choice and clinical outcomes following positive noninvasive prenatal screening for aneuploidy with cell-free DNA (cfDNA). Prenat Diagn 36, 456–462.
Fan, H.C., Blumenfeld, Y.J., Chitkara, U., Hudgins, L., and Quake, S.R. (2008). Noninvasive diagnosis of fetal aneuploidy by shotgun sequencing DNA from maternal blood. Proc Natl Acad Sci USA 105, 16266–16271.
Franasiak, J.M., Forman, E.J., Hong, K.H., Werner, M.D., Upham, K.M., Treff, N.R., and Scott Jr., R.T. (2014). The nature of aneuploidy with increasing age of the female partner: a review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening. Fertil Steril 101, 656–663.e1.
General Office of the State Council. (2001). Measures for Implementation of the Law of the People’s Republic of China on Maternal and Infant Care.
Gil, M.M., Accurti, V., Santacruz, B., Plana, M.N., and Nicolaides, K.H. (2017). Analysis of cell-free DNA in maternal blood in screening for aneuploidies: updated meta-analysis. Ultrasound Obstet Gynecol 50, 302–314.
Gregg, A.R., Skotko, B.G., Benkendorf, J.L., Monaghan, K.G., Bajaj, K., Best, R.G., Klugman, S., and Watson, M.S. (2016). Noninvasive prenatal screening for fetal aneuploidy, 2016 update: a position statement of the American College of Medical Genetics and Genomics. Genet Med 18, 1056–1065.
Hu, H., Liu, H., Peng, C., Deng, T., Fu, X., Chung, C., Zhang, E., Lu, C., Zhang, K., Liang, Z., et al. (2016). Clinical experience of non-invasive prenatal chromosomal aneuploidy testing in 190,277 patient samples. Cur Mol Med 16, 759–766.
Li, H.T., Xue, M., Hellerstein, S., Cai, Y., Gao, Y., Zhang, Y., Qiao, J., Blustein, J., and Liu, J.M. (2019). Association of China’s universal two child policy with changes in births and birth related health factors: national, descriptive comparative study. BMJ 40, l4680.
Liao, C., Yin, A., Peng, C., Fu, F., Yang, J., Li, R., Chen, Y., Luo, D., Zhang, Y., Ou, Y., et al. (2014). Noninvasive prenatal diagnosis of common aneuploidies by semiconductor sequencing. Proc Natl Acad Sci USA 111, 7415–7420.
Lo, Y.M.D., Lun, F.M.F., Chan, K.C.A., Tsui, N.B.Y., Chong, K.C., Lau, T. K., Leung, T.Y., Zee, B.C.Y., Cantor, C.R., and Chiu, R.W.K. (2007). Digital PCR for the molecular detection of fetal chromosomal aneuploidy. Proc Natl Acad Sci USA 104, 13116–13121.
Lun, F.M.F., Tsui, N.B.Y., Chan, K.C.A., Leung, T.Y., Lau, T.K., Charoenkwan, P., Chow, K.C.K., Lo, W.Y.W., Wanapirak, C., Sanguansermsri, T., et al. (2008). Noninvasive prenatal diagnosis of monogenic diseases by digital size selection and relative mutation dosage on DNA in maternal plasma. Proc Natl Acad Sci USA 105, 19920–19925.
Newberger, D.S. (2000). Down syndrome: prenatal risk assessment and diagnosis. Am Fam Physician 62, 825–832, 837–838.
NHFPC. (2016). Technical guidelines for cell-free DNA testing for prenatal screening and diagnosis.
Norton, M.E., Jacobsson, B., Swamy, G.K., Laurent, L.C., Ranzini, A.C., Brar, H., Tomlinson, M.W., Pereira, L., Spitz, J.L., Hollemon, D., et al. (2015). Cell-free DNA analysis for noninvasive examination of trisomy. N Engl J Med 372, 1589–1597.
Snyder, H.L., Curnow, K.J., Bhatt, S., and Bianchi, D.W. (2016). Follow-up of multiple aneuploidies and single monosomies detected by noninvasive prenatal testing: implications for management and counseling. Prenat Diagn 36, 203–209.
van der Meulen, J.H., Mol, B.W., Pajkrt, E., van Lith, J.M., and Voorn, W. (1999). Use of the disutility ratio in prenatal screening for Down’s syndrome. Br J Obstet Gynaecol 106, 108–115.
Warsof, S.L., Larion, S., and Abuhamad, A.Z. (2015). Overview of the impact of noninvasive prenatal testing on diagnostic procedures. Prenat Diagn 35, 972–979.
Yamada, T., Sekizawa, A., Fujii, Y., Hirose, T., Samura, O., Suzumori, N., Miura, K., Sawai, H., Hirahara, F., Murotsuki, J., et al. (2018). Maternal age-specific risk for trisomy 21 based on the clinical performance of NIPT and empirically derived NIPT age-specific positive and negative predictive values in Japan. J Hum Genet 63, 1035–1040.
Yin, A., Peng, C., Zhao, X., Caughey, B.A., Yang, J., Liu, J., Huang, W., Liu, C., Luo, D., Liu, H., et al. (2015). Noninvasive detection of fetal subchromosomal abnormalities by semiconductor sequencing of maternal plasma DNA. Proc Natl Acad Sci USA 112, 14670–14675.
Zhang, H., Gao, Y., Jiang, F., Fu, M., Yuan, Y., Guo, Y., Zhu, Z., Lin, M., Liu, Q., Tian, Z., et al. (2015). Non-invasive prenatal testing for trisomies 21, 18 and 13: clinical experience from 146958 pregnancies. Ultrasound Obstet Gynecol 45, 530–538.
Acknowledgements
This work was supported by grants from the National Key Technology R&D Program (2015BAI13B06).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Compliance and ethics Deng T., Zhu X., and He M. are employees and Xu X. and Zhang Z. are former employees of Beijing CapitalBio Medical Laboratory. Other authors declare no conflict of interest.
Electronic supplementary material
11427_2019_9600_MOESM1_ESM.docx
Table S1 There was no significant difference in the distribution of maternal age, gestational age, gravidity, and parity between the follow-up and lost to follow-up groups in high-risk women
Rights and permissions
About this article
Cite this article
Tian, C., Deng, T., Zhu, X. et al. Evidence of compliance with and effectiveness of guidelines for noninvasive prenatal testing in China: a retrospective study of 189,809 cases. Sci. China Life Sci. 63, 319–328 (2020). https://doi.org/10.1007/s11427-019-9600-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11427-019-9600-0