title: Chromosomal microarray analysis as a first-line test in pregnancies with a priori low risk for the detection of submicroscopic chromosomal abnormalities.
abstract: In this study, we aimed to explore the utility of chromosomal microarray analysis (CMA) in groups of pregnancies with a priori low risk for detection of submicroscopic chromosome abnormalities, usually not considered an indication for testing, in order to assess whether CMA improves the detection rate of prenatal chromosomal aberrations. A total of 3000 prenatal samples were processed in parallel using both whole-genome CMA and conventional karyotyping. The indications for prenatal testing included: advanced maternal age, maternal serum screening test abnormality, abnormal ultrasound findings, known abnormal fetal karyotype, parental anxiety, family history of a genetic condition and cell culture failure. The use of CMA resulted in an increased detection rate regardless of the indication for analysis. This was evident in high risk groups (abnormal ultrasound findings and abnormal fetal karyotype), in which the percentage of detection was 5.8% (7/120), and also in low risk groups, such as advanced maternal age (6/1118, 0.5%), and parental anxiety (11/1674, 0.7%). A total of 24 (0.8%) fetal conditions would have remained undiagnosed if only a standard karyotype had been performed. Importantly, 17 (0.6%) of such findings would have otherwise been overlooked if CMA was offered only to high risk pregnancies.The results of this study suggest that more widespread CMA testing of fetuses would result in a higher detection of clinically relevant chromosome abnormalities, even in low risk pregnancies. Our findings provide substantial evidence for the introduction of CMA as a first-line diagnostic test for all pregnant women undergoing invasive prenatal testing, regardless of risk factors.
authors.affiliation: GENOMA- Molecular Genetics Laboratory, Rome, Italy. fiorentino@laboratoriogenoma.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Fiorentino
authors.forename: Stefania
authors.initials: S
authors.lastname: Napoletano
authors.forename: Fiorina
authors.initials: F
authors.lastname: Caiazzo
authors.forename: Mariateresa
authors.initials: M
authors.lastname: Sessa
authors.forename: Sara
authors.initials: S
authors.lastname: Bono
authors.forename: Letizia
authors.initials: L
authors.lastname: Spizzichino
authors.forename: Anthony
authors.initials: A
authors.lastname: Gordon
authors.forename: Andrea
authors.initials: A
authors.lastname: Nuccitelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rizzo
authors.forename: Marina
authors.initials: M
authors.lastname: Baldi
mesh_terms: D059786:Abnormal Karyotype; D002869:Chromosome Aberrations; D025063:Chromosome Disorders / Q000175:diagnosis* / Q000209:etiology / Q000235:genetics*; D005260:Female; D005820:Genetic Testing; D006801:Humans; D008423:Maternal Age; D046228:Microarray Analysis / Q000379:methods*; D011247:Pregnancy; D011296:Prenatal Diagnosis; D016216:Ultrasonography, Prenatal