Subscribe to RSS
DOI: 10.1055/s-0042-1744461
Behavior of the Genetic Markers at Screening during the First Trimester of Pregnancy in Euploid Fetuses
Comportamento dos marcadores genéticos na triagem durante o primeiro trimestre de gravidez em fetos euploides Funding/Acknowledgments This study was conducted with the support of the El Bosque Research Group of Maternal Fetal Medicine and Gynecology, Ecodiagnóstico El Bosque S. A. S (PMMFGEB-011), and Universidad El Bosque (PCI-2013-472)..Abstract
Objective This study aims to describe the behavior of chromosomopathy screenings in euploid fetuses.
Methods This is a prospective descriptive study with 566 patients at 11 to 14 weeks of gestation. The associations between ultrasound scans and serological variables were studied. For the quantitative variables we used the Spearman test; for the qualitative with quantitative variables the of Mann-Whitney U-test; and for qualitative variables, the X2 test was applied. Significance was set at p ≤ 0.05.
Results We have found that gestational age has correlation with ductus venosus, nuchal translucency, free fraction of β subunit of human chorionic gonadotropin, pregnancy-associated plasma protein-A and placental growth factor; there is also a correlation between history of miscarriages and nasal bone. Furthermore, we correlated body mass index with nuchal translucency, free fraction of β subunit of human chorionic gonadotropin, and pregnancy-associated plasma protein-A. Maternal age was associated with free fraction of β subunit of human chorionic gonadotropin and pregnancy-associated plasma protein-A.
Conclusion Our study demonstrates for the first time the behavior of the biochemical and ultrasonographic markers of chromosomopathy screenings during the first trimester in euploid fetuses in Colombia. Our information is consistent with international reference values. Moreover, we have shown the correlation of different variables with maternal characteristics to determine the variables that could help with development of a screening process during the first trimester with high detection rates.
Resumo
Objetivo Este estudo tem como objetivo descrever o comportamento do rastreamento de cromossomopatias em fetos euploides.
Métodos Trata-se de um estudo prospectivo descritivo com 566 pacientes, entre 11 e 14 semanas de gestação. A associação entre a ultrassonografia e as variáveis sorológicas foi estudada. Para as variáveis quantitativas foi utilizado o teste de Spearman; para as qualitativas com variáveis quantitativas foi utilizado o teste U de Mann-Whitney e para as variáveis qualitativas foi aplicado o teste X2. A significância foi fixada em p ≤ 0,05.
Resultados Constatou-se que a idade gestacional tem correlação com o ducto venoso, translucência nucal, fração livre da subunidade β da gonadotrofina coriônica humana, proteína plasmática A associada à gravidez e fator de crescimento placentário; há também correlação entre a história de abortos e o osso nasal. Além disso, correlacionamos o índice de massa corporal com translucência nucal, fração livre da subunidade β da gonadotrofina coriônica humana e proteína plasmática A associada à gravidez. A idade materna foi relacionada com fração livre da subunidade β da gonadotrofina coriônica humana e proteína plasmática A associada à gravidez.
Conclusão Nosso estudo demonstra pela primeira vez o comportamento dos marcadores bioquímicos e ultrassonográficos de triagem de cromossomas durante o primeiro trimestre em fetos euploides na Colômbia. Nossa informação é consistente com a referência de valores internacionais. Além disso, mostram-se as relações das diferentes variáveis com as características maternas para determinar as variáveis capazes de ajudar no desenvolvimento de um processo de rastreamento durante o primeiro trimestre com alta taxa de detecção.
Palavras-chave
marcadores genéticos - triagem - ultrassonografia - anormalidade cromossômica - gravidezContributions
All authors substantially contributed to the conception and design of the study, data collection, analysis and interpretation, writing of the article, its clinical review, and approval of its final version.
Publication History
Received: 11 November 2021
Accepted: 02 February 2022
Article published online:
06 June 2022
© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
References
- 1 Christianson A, Howson CP, Modell B. March of Dimes global report on birth defects: the hidden toll of dying and disabled children [Internet]. White Plains: March of Dimes Birth Defects Foundation;. 2006 [cited 2021 Aug 12]. Available from: https://www.marchofdimes.org/materials/global-report-on-birth-defects-the-hidden-toll-of-dying-and-disabled-children-executive-summary.pdf
- 2 Restrepo Cano GA. [Prenatal diagnosis of congenital anormalies; an absent policy in Colombia]. Rev Fac Med (Caracas) 2016; 24 (01) 102-110 DOI: 10.18359/rmed.2764. Spanish.
- 3 Wright D, Syngelaki A, Bradbury I, Akolekar R, Nicolaides KH. First-trimester screening for trisomies 21, 18 and 13 by ultrasound and biochemical testing. Fetal Diagn Ther 2014; 35 (02) 118-126 DOI: 10.1159/000357430.
- 4 Nussbaum RL, McInnes RR, Willard HF. Thompson & Thompson genetics in medicine. Chicago: Saunders; 2007
- 5 Parga Soler MN, Martínez Machuca S, Martín Idoeta O, Sánchez-Pastor Ruiz M. Diagnóstico prenatal y cribado de cromosomopatías. [Prenatal diagnosis and chromosomal abnormalities screening]. Med Fam Ginecol Obstet. 2001; 11 (10) 590-598 Spanish.
- 6 Santorum M, Wright D, Syngelaki A, Karagioti N, Nicolaides KH. Accuracy of first-trimester combined test in screening for trisomies 21, 18 and 13. Ultrasound Obstet Gynecol 2017; 49 (06) 714-720 DOI: 10.1002/uog.17283.
- 7 Kagan KO, Wright D, Nicolaides KH. First-trimester contingent screening for trisomies 21, 18 and 13 by fetal nuchal translucency and ductus venosus flow and maternal blood cell-free DNA testing. Ultrasound Obstet Gynecol 2015; 45 (01) 42-47 DOI: 10.1002/uog.14691.
- 8 Franco C. [Evaluation of the nasal bone, ductus venosus and tricuspid regurgitation for the screening of Down Syndrome. Its Utility in intermediate risks] [thesis].. Madrid: Universidad Autónoma de Madrid;; 2013. . Spanish.
- 9 Nicolaides KH. Turning the pyramid of prenatal care. Fetal Diagn Ther 2011; 29 (03) 183-196 DOI: 10.1159/000324320.
- 10 Veduta A, Vayna AM, Duta S. et al. The first trimester combined test for aneuploidies - a single center experience. J Matern Fetal Neonatal Med 2018; 31 (16) 2091-2096 DOI: 10.1080/14767058.2017.1336220.
- 11 Cancino E, León H, Otálora R, Pérez E, Sarmiento R, Yates A. [Guidelines of prenatal control and risk factors] [Internet]. Bogotá: Secretaría Distrital de Salud de Bogotá/ASBOG; [s.d.] [cited 2021 Aug 12]. Spanish. Available from: http://www.saludcapital.gov.co/DDS/Publicaciones/GUIA%201.%20%20CONTROL%20PRENATAL%20Y%20FACTORES%20DE%20RIESGO.pdf
- 12 Ministerio de Salud y Protección Social - Colciencias.. [Guideline of clinical practice. Detection of congenital anomalies in newborns] [Internet]. Colombia: Minsalud; 2013 [cited 2021 Jun 10]. (Guide no. 3). Spanish. Available from: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/INEC/IETS/GPC_Ptes_AC.pdf
- 13 Ministerio de Salud y Protección Social - Colciencias.. [Clinical practice guide ministry of health for prevention, early detection and treatment of complications of pregnancy, childbirth and the puerperium] [Internet]. Colombia: MinSalud; 2013 [cited 2021 Jun 10]. Spanish. Available from: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/INEC/IETS/Gu%C3%ADa.completa.Embarazo.Parto.2013.pdf
- 14 Asociación Médica Mundial (AMM).. [Declaration of Helsinki. Ethical principles for medical research in humans] [Internet]. 2017 [cited 2021 Jun 10]. Spanish. Available from: https://www.wma.net/es/policies-post/declaracion-de-helsinki-de-la-amm-principios-eticos-para-las-investigaciones-medicas-en-seres-humanos/
- 15 Ministerio de Salud. [Resolution number 8430 of 1993] [Internet]. Bogotá: MinSalud;; 1993 [cited 2021 Jul 20]. Spanish. Available from: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/RESOLUCION-8430-DE-1993.PDF
- 16 Nicolaides KH. The 11–13 + 6 weeks scan. London: The Fetal Medicine Foundation;; 2004
- 17 Matias A, Gomes C, Flack N, Montenegro N, Nicolaides KH. Screening for chromosomal abnormalities at 10-14 weeks: the role of ductus venosus blood flow. Ultrasound Obstet Gynecol 1998; 12 (06) 380-384 DOI: 10.1046/j.1469-0705.1998.12060380.x.
- 18 Spencer K, Souter V, Tul N, Snijders R, Nicolaides KH. A screening program for trisomy 21 at 10-14 weeks using fetal nuchal translucency, maternal serum free β-human chorionic gonadotropin and pregnancy-associated plasma protein-A. Ultrasound Obstet Gynecol 1999; 13 (04) 231-237 DOI: 10.1046/j.1469-0705.1999.13040231.x.
- 19 Kasdaglis T, Aberdeen G, Turan O. et al. Placental growth factor in the first trimester: relationship with maternal factors and placental Doppler studies. Ultrasound Obstet Gynecol 2010; 35 (03) 280-285 DOI: 10.1002/uog.7548.
- 20 Yu B, Lu BY, Zhang B. et al. Overall evaluation of the clinical value of prenatal screening for fetal-free DNA in maternal blood. Medicine (Baltimore) 2017; 96 (27) e7114 DOI: 10.1097/MD.0000000000007114.
- 21 Sørensen S, Momsen G, Sundberg K, Friis-Hansen L, Jørgensen FS. First-trimester risk calculation for trisomy 13, 18, and 21: comparison of the screening efficiency between 2 locally developed programs and commercial software. Clin Chem 2011; 57 (07) 1023-1031 DOI: 10.1373/clinchem.2010.161299.
- 22 Shiefa S, Amargandhi M, Bhupendra J, Moulali S, Kristine T. First trimester maternal serum screening using biochemical markers PAPP-A and free β-HCG for Down Syndrome, Patau Syndrome and Edward Syndrome. Indian J Clin Biochem 2013; 28 (01) 3-12 DOI: 10.1007/s12291-012-0269-9.
- 23 Kalayci H, Yilmaz Baran Ş, Doğan Durdağ G. et al. Reference values of the ductus venosus pulsatility index for pregnant women between 11 and 13+6 weeks of gestation. J Matern Fetal Neonatal Med 2020; 33 (07) 1134-1139 DOI: 10.1080/14767058.2018.1517152.
- 24 Nicolaides KH. Nuchal translucency and other first-trimester sonographic markers of chromosomal abnormalities. Am J Obstet Gynecol 2004; 191 (01) 45-67 DOI: 10.1016/j.ajog.2004.03.090.
- 25 Cuckle HS, Spencer K, Nicolaides KH. Down syndrome screening marker levels in women with a previous aneuploidy pregnancy. Prenat Diagn 2005; 25 (01) 47-50 DOI: 10.1002/pd.1082.
- 26 Maiz N, Valencia C, Kagan KO, Wright D, Nicolaides KH. Ductus venosus Doppler in screening for trisomies 21, 18 and 13 and Turner syndrome at 11-13 weeks of gestation. Ultrasound Obstet Gynecol 2009; 33 (05) 512-517 DOI: 10.1002/uog.6330.
- 27 Florjański J, Fuchs T, Zimmer M, Homola W, Pomorski M, Blok D. The role of ductus venosus Doppler flow in the diagnosis of chromosomal abnormalities during the first trimester of pregnancy. Adv Clin Exp Med 2013; 22 (03) 395-401
- 28 Cicero S, Bindra R, Rembouskos G, Spencer K, Nicolaides KH. Integrated ultrasound and biochemical screening for trisomy 21 using fetal nuchal translucency, absent fetal nasal bone, free beta-hCG and PAPP-A at 11 to 14 weeks. Prenat Diagn 2003; 23 (04) 306-310 DOI: 10.1002/pd.588.
- 29 Zoppi MA, Ibba RM, Axiana C, Floris M, Manca F, Monni G. Absence of fetal nasal bone and aneuploidies at first-trimester nuchal translucency screening in unselected pregnancies. Prenat Diagn 2003; 23 (06) 496-500 DOI: 10.1002/pd.628.
- 30 Díaz V, Guevara R, Brito J. Translucencia nucal fetal y ductus venosus como marcadores ecográficos de cromosomopatías. Invest Clin 2008; 49 (04) 523-532
- 31 Theodoropoulos P, Lolis D, Papageorgiou C, Papaioannou S, Plachouras N, Makrydimas G. Evaluation of first-trimester screening by fetal nuchal translucency and maternal age. Prenat Diagn 1998; 18 (02) 133-137
- 32 Jou HJ, Wu SC, Li TC, Hsu HC, Tzeng CY, Hsieh FJ. Relationship between fetal nuchal translucency and crown-rump length in an Asian population. Ultrasound Obstet Gynecol 2001; 17 (02) 111-114 DOI: 10.1046/j.1469-0705.2001.00332.x.
- 33 Khambalia AZ, Roberts CL, Morris J, Tasevski V, Nassar N. Maternal body weight and first trimester screening for chromosomal anomalies. Aust N Z J Obstet Gynaecol 2014; 54 (05) 490-492 DOI: 10.1111/ajo.12231.
- 34 Zaragoza E, Akolekar R, Poon LC, Pepes S, Nicolaides KH. Maternal serum placental growth factor at 11-13 weeks in chromosomally abnormal pregnancies. Ultrasound Obstet Gynecol 2009; 33 (04) 382-386 DOI: 10.1002/uog.6331.
- 35 Sifakis S, Akolekar R, Kappou D, Mantas N, Nicolaides KH. Maternal serum IGF-I, IGFBP-1 and IGFBP-3 at 11-13 weeks in trisomy 21 and trisomy 18 pregnancies. Eur J Obstet Gynecol Reprod Biol 2011; 157 (02) 166-168 DOI: 10.1016/j.ejogrb.2011.03.029.