title: The clinical utility of DNA-based screening for fetal aneuploidy by primary obstetrical care providers in the general pregnancy population.
abstract: To assess the clinical utility of cell-free DNA (cfDNA)-based screening for aneuploidies offered through primary obstetrical care providers to a general pregnancy population.
  
  
  
  Patient educational materials were developed and validated and providers were trained. Serum was collected for reflexive testing of cfDNA failures. Providers and patients were surveyed concerning knowledge, decision making, and satisfaction. Pregnancy outcome was determined by active or passive ascertainment.
  
  
  
  Between September 2014 and July 2015, 72 providers screened 2,691 women. The five largest participating practices increased uptake by 8 to 40%. Among 2,681 reports, 16 women (0.6%) were screen-positive for trisomy 21, 18, or 13; all saw genetic professionals. Twelve were confirmed (positive predictive value (PPV), 75%; 95% CI, 48-93%) and four were false-positives (0.15%). Of 150 failures (5.6%), 79% had a negative serum or subsequent cfDNA test; no aneuploidies were identified. Of 100 women surveyed, 99 understood that testing was optional, 96 had their questions answered, and 95 received sufficient information. Pretest information was provided by the physician/certified nurse midwife (55) or office nurse/educator (40); none was provided by genetic professionals.
  
  
  
  This first clinical utility study of cfDNA screening found higher uptake rates, patient understanding of basic concepts, and easy incorporation into routine obstetrical practices. There were no reported cases of aneuploidy among cfDNA test failures.Genet Med advance online publication 12 January 2017.
authors.affiliation: Department of Pathology and Laboratory Medicine, Women &Infants Hospital, Providence, Rhode Island, USA.|Department of Pathology and Laboratory Medicine, Alpert School of Medicine at Brown University, Providence, Rhode Island, USA.
authors.forename: Glenn E
authors.identifier: 0000-0001-6154-8449
authors.initials: GE
authors.lastname: Palomaki
authors.affiliation: Department of Pathology and Laboratory Medicine, Women &Infants Hospital, Providence, Rhode Island, USA.
authors.forename: Edward M
authors.identifier: 0000-0002-7494-7470
authors.initials: EM
authors.lastname: Kloza
authors.affiliation: Department of Obstetrics and Gynecology, Women &Infants Hospital, Providence, Rhode Island, USA.|Current affiliation: Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Barbara M
authors.initials: BM
authors.lastname: O'Brien
authors.affiliation: Department of Pathology and Laboratory Medicine, Women &Infants Hospital, Providence, Rhode Island, USA.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Eklund
authors.affiliation: Department of Pathology and Laboratory Medicine, Women &Infants Hospital, Providence, Rhode Island, USA.|Department of Pathology and Laboratory Medicine, Alpert School of Medicine at Brown University, Providence, Rhode Island, USA.|Department of Obstetrics and Gynecology, Women &Infants Hospital, Providence, Rhode Island, USA.
authors.forename: Geralyn M
authors.identifier: 0000-0002-9440-3411
authors.initials: GM
authors.lastname: Lambert-Messerlian
mesh_terms: D000293:Adolescent; D000328:Adult; D000782:Aneuploidy; D001291:Attitude of Health Personnel; D000073888:Cell-Free Nucleic Acids / Q000032:analysis / Q000097:blood; D002474:Cell-Free System; D004247:DNA / Q000097:blood; D004314:Down Syndrome / Q000235:genetics; D005260:Female; D005333:Fetus; D005820:Genetic Testing / Q000706:statistics & numerical data*; D006801:Humans; D019359:Knowledge; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods; D011296:Prenatal Diagnosis / Q000379:methods* / Q000592:standards; D014314:Trisomy / Q000235:genetics; D000073839:Trisomy 13 Syndrome / Q000235:genetics; D000073842:Trisomy 18 Syndrome / Q000235:genetics
chemical_list: D000073888:Cell-Free Nucleic Acids; D004247:DNA