title: Performance of prenatal screening using maternal serum and ultrasound markers for Down syndrome in Chinese women: a systematic review and meta-analysis.
abstract: BACKGROUND
  Controversies about the performance of conventional prenatal screening using maternal serum and ultrasound markers (PSMSUM) in detecting Down syndrome (DS) have been raised as a result of a recently available noninvasive prenatal test based on cell-free fetal DNA sequencing.
  
  
  OBJECTIVE
  To evaluate the screening performance of PSMSUM in detecting DS in Chinese women.
  
  
  METHODS
  An exhaustive literature search of MEDLINE, Embase, the Cochrane Library, ISI Web of Science and China BioMedical Disc.
  
  
  METHODS
  Primary studies, published from January 2004 to November 2014, which examined the screening accuracy of PSMSUM in pregnant Chinese women, compared with a reference standard, either chromosomal verification or inspection of the newborn.
  
  
  METHODS
  Data were extracted as screening positive/negative results for Down and non-Down syndrome pregnancies, allowing estimation of sensitivities and specificities. Risks of bias within and across studies were assessed. Screening accuracy measures were pooled using a bivariate random effects regression model.
  
  
  RESULTS
  Seventy-eight studies, involving six categories of PSMSUM, were included. Second-trimester double serum [pooled sensitivity (SEN) = 0.80, pooled specificity (SPE) = 0.95] and triple-serum (pooled SEN = 0.79, pooled SPE = 0.96) screening were the predominant PSMSUM methods. The screening performances of these methods achieved the national standard but varied enormously across studies. First-trimester combined screening (pooled SEN = 0.92, pooled SPE = 0.93) and second-trimester quadruple serum screening (median SEN = 0.86, median SPE = 0.96) performed better, but were rarely used.
  
  
  CONCLUSIONS
  Second-trimester maternal serum screening has the potential to achieve satisfactory screening performance in middle- and low-income countries. The reported enormous range in screening performance of second-trimester PSMSUM calls for urgent implementation of methods for performance optimization.
  
  
  CONCLUSIONS
  Meta-analysis results show good accuracy of maternal serum and ultrasound screening for trisomy 21 in Chinese women.
authors.affiliation: Key Lab of Health Technology Assessment, Ministry of Health (Fudan University), School of Public Health, Fudan University, Shanghai, China.|Collaborative Innovation Centre of Social Risks Governance in Health, School of Public Health, Fudan University, Shanghai, China.
authors.forename: S
authors.initials: S
authors.lastname: Tu
authors.affiliation: Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Rosenthal
authors.affiliation: Key Lab of Health Technology Assessment, Ministry of Health (Fudan University), School of Public Health, Fudan University, Shanghai, China.
authors.forename: D
authors.initials: D
authors.lastname: Wang
authors.affiliation: Key Lab of Health Technology Assessment, Ministry of Health (Fudan University), School of Public Health, Fudan University, Shanghai, China.
authors.forename: J
authors.initials: J
authors.lastname: Huang
authors.affiliation: Key Lab of Health Technology Assessment, Ministry of Health (Fudan University), School of Public Health, Fudan University, Shanghai, China. yychen@shmu.edu.cn.|Collaborative Innovation Centre of Social Risks Governance in Health, School of Public Health, Fudan University, Shanghai, China. yychen@shmu.edu.cn.
authors.forename: Y
authors.initials: Y
authors.lastname: Chen
mesh_terms: D044466:Asian People; D015415:Biomarkers / Q000097:blood*; D002681:China; D006063:Chorionic Gonadotropin / Q000097:blood; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D004314:Down Syndrome / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008423:Maternal Age; D062145:Maternal Serum Screening Tests; D011247:Pregnancy; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis; D011296:Prenatal Diagnosis / Q000379:methods*; D014463:Ultrasonography; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D015415:Biomarkers; D006063:Chorionic Gonadotropin; D018997:Chorionic Gonadotropin, beta Subunit, Human; D000509:alpha-Fetoproteins; D011266:Pregnancy-Associated Plasma Protein-A
keywords: Down syndrome; prenatal screening; systematic review; trisomy 21