Prenatal diagnosis of Down syndrome: ten year experience in the Israeli population.
Second trimester maternal serum biochemical markers, introduced between 1990 and 1995, were supplemented with new ultrasound methods at 14-16 weeks and first trimester biochemical markers between 1995 and 2000. This study evaluated the effectiveness of a Down syndrome (DS) prevention program among the Israeli Jewish population between 1990 and 2000. We collected data on the total number of prenatal tests performed on Israeli Jewish women, DS cases detected prenatally and DS livebirths in Israel during these years. We also studied the use of the newer screening tests in 1990, 1992, and 2000. Between 1990 and 1995, use of chromosomal studies for DS in this population increased from 11.3% to 21.6% and the percentage of cases detected prenatally from 53% to 70%. However, between 1996 and 2000, even with the new screening methods, the utilization rate remained similar (20.7% and 19.8%, respectively) and the percentage detected prenatally decreased to 61% in 2000. The total cost per case detected increased from $47,971 US dollars in 1990 to $75,229 US dollars in 1992, and to $190,171 US dollars in 2000. Between 1990 and 1995, improvement in the percentage of cases detected prenatally was associated with a significant increase in the amniocentesis rate-both are attributed to the introduction of second trimester maternal serum biochemical marker tests. Unexpectedly, the introduction between 1995 and 2000 of new genetic methods to assess the DS risk did not improve the percentage detected or reduce the amniocentesis rate, and was accompanied by an increased cost per case detected.
Shohat
Mordechai
M
Department of Medical Genetics, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel. mshohat@ccsg.tau.ac.il
Frimer
Helena
H
Shohat-Levy
Vered
V
Esmailzadeh
Hormoz
H
Appelman
Zvi
Z
Ben-Neriah
Ziva
Z
Dar
Hanna
H
Orr-Urtreger
Avi
A
Amiel
Aliza
A
Gershoni
Ruth
R
Manor
Esther
E
Barkai
Gad
G
Shalev
Stavit
S
Gelman-Kohen
Zully
Z
Reish
Orit
O
Lev
Dorit
D
Davidov
Bella
B
Goldman
Boleslaw
B
D006063:Chorionic Gonadotropin / Q000097:blood; D004314:Down Syndrome / Q000175:diagnosis* / Q000235:genetics / Q000517:prevention & control; D004964:Estriol / Q000097:blood; D005260:Female; D006801:Humans; D007557:Israel; D007585:Jews / Q000235:genetics; D008403:Mass Screening / Q000191:economics / Q000379:methods / Q000639:trends; D008423:Maternal Age; D011247:Pregnancy; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First / Q000097:blood; D011262:Pregnancy Trimester, Second / Q000097:blood; D011296:Prenatal Diagnosis / Q000379:methods*; D016216:Ultrasonography, Prenatal; D000509:alpha-Fetoproteins / Q000032:analysis
D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins; D004964:Estriol