Assessment of the value of reporting partial screening results in prenatal screening for Down syndrome.
Prenatal screening for Down syndrome can be performed using the first trimester Combined Test [nuchal translucency (NT), pregnancy-associated plasma protein A (PAPP-A), free beta-human chorionic gonadotrophin (hCG) and maternal age] or the Integrated Test (for example, NT and PAPP-A in the first trimester and two or more serum markers in the second trimester, all with maternal age). We investigated the value of providing partial results when using the Combined Test or Integrated Test to identify women with a high enough risk of having an affected pregnancy based on NT and maternal age alone such that there would be little advantage in combining this information with data on the serum markers. We also assessed whether in programmes using the Integrated Test it is worthwhile reporting partial results based on risk using first trimester markers and not obtaining a second trimester blood sample. Published data based on 480 affected and 96 839 unaffected pregnancies were used for the present study. Using NT and age alone, about 0.14% of all women screened would have such a high risk that they would always remain screen-positive after the Combined Test and only 0.06% would remain screen-positive after the Integrated Test. Similarly, about 0.07% of all women screened who have a high risk based on NT, PAPP-A and age would remain screen-positive after the Integrated Test. These percentages are too small to justify reporting two risk estimates for all women, given the confusion this would generate. It is therefore not worthwhile reporting partial risk estimates in screening programmes using the Combined Test or Integrated Test.
Hackshaw
A K
AK
Department of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Queen Mary and Westfield College, University of London, London, UK. a.k.hackshaw@mds.qmw.ac.uk
Wald
N J
NJ
D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D004314:Down Syndrome / Q000175:diagnosis*; D005260:Female; D005820:Genetic Testing / Q000379:methods*; D006801:Humans; D008423:Maternal Age; D009333:Neck / Q000000981:diagnostic imaging / Q000196:embryology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D018566:Pregnancy, High-Risk; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis; D011296:Prenatal Diagnosis / Q000379:methods*; D018570:Risk Assessment; D016216:Ultrasonography, Prenatal
D018997:Chorionic Gonadotropin, beta Subunit, Human; D011266:Pregnancy-Associated Plasma Protein-A