A newly available DNA-based prenatal blood test that can identify a pregnancy with Down syndrome can also identify two additional chromosome abnormalities: trisomy 18 (Edwards syndrome) and trisomy 13 (Patau syndrome). The test for all three defects can be offered as early as 10 weeks of pregnancy to women who have been identified as being at high risk for these abnormalities.
These are the results of an international, multicenter study published on-line today in the journal Genetics in Medicine. The study, the largest and most comprehensive done to date, adds to the documented capability (study published in Genetics in Medicine in October 2011) of the tests by examining results in 62 pregnancies with trisomy 18 and 12 pregnancies with trisomy 13. Together with the Down syndrome pregnancies reported earlier, 286 trisomic pregnancies and 1,702 normal pregnancies are included in the report.
The research was led by Glenn Palomaki, PhD, and Jacob Canick, PhD, of the Division of Medical Screening and Special Testing in the Department of Pathology and Laboratory Medicine at Women & Infants Hospital of Rhode Island and The Warren Alpert Medical School of Brown University, and included scientists at Sequenom Inc. and Sequenom Center for Molecular Medicine, San Diego, CA, and an independent academic laboratory at the University of California at Los Angeles.
The test identified 100% (59/59) of the trisomy 18 and 91.7% (11/12) of the trisomy 13 pregnancies. The associated false positive rates were 0.28 and 0.97%, respectively. Overall, testing failed to provide a clinical interpretation in 17 women (0.9%); three of these women had a trisomy 18 pregnancy. By slightly raising the definition of a positive test for chromosome 18 and 13, the detection rate remained constant, but the false positive rate could be as low as 0.1%. These findings, along with the detailed information learned from testing such a large number of samples, demonstrate that the new test will be highly effective when offered to women considering invasive testing.
"Our previous work demonstrated the ability to identify Down syndrome, the most common trisomy. These new data extend the finding to the next two most common trisomies and will allow for wider use of such testing with the ability to identify all three common trisomies," said Dr. Palomaki. "The new DNA test can now also be offered to women identified as being as high risk for trisomy 18 or trisomy 13, as well those at high risk for Down syndrome."
"This highly sensitive and specific DNA test has the potential to impact on couples' decision-making," says Dr. Canick. "A woman whose pregnancy was identified as high risk who earlier would have chosen not to have invasive diagnostic testing, might now consider the DNA test as a safe way to obtain further information, before making a final decision." The US Centers for Disease Control and Prevention estimated in 1995 that about one in every 200 invasive diagnostic procedures will cause a pregnancy miscarriage.
Trisomy 18, also called Edwards syndrome, is a serious disorder with up to 70% of first trimester affected fetuses being spontaneously lost during pregnancies. Among those born alive, half die within a week with only 5% surviving the first year. All have serious medical and developmental problems. About 1,330 infants with trisomy 18 would be born in the US each year in the absence of prenatal diagnosis. Trisomy 13, also called Patau syndrome, is less common but equally serious. About 600 infants with trisomy 13 would be born in the US each year in the absence of prenatal diagnosis. Like Down syndrome, trisomy 18 and trisomy 13 are more common as maternal age increases. For comparison, about 7,730 Down syndrome cases would be born each year in the absence of prenatal diagnosis. Current prenatal screening tests for trisomy 18 and trisomy 13 rely on both biochemical and ultrasound markers. For more information visit the US National Library of Medicine PubMed Health.
This industry-sponsored project, awarded to Drs. Palomaki and Canick and Women & Infants Hospital in 2008, enrolled 4,500 women at 27 prenatal diagnostic centers throughout the world. Women & Infants also served as one of the enrollment centers under the direction of maternal-fetal medicine specialist and director of Perinatal Genetics, Barbara O'Brien, MD.
"It is clinically more relevant that all three trisomies can be detected by this test," said Dr. O'Brien. "Having access to such a comprehensive, DNA-based test that can be done early in pregnancy will give us more information so that we can better guide which patients should consider diagnostic testing."
Women & Infants Hospital has been an international center for prenatal screening research. For more than three decades, Drs. Palomaki and Canick have collaborated with others in developing and improving screening tests for Down syndrome and other fetal abnormalities. In 1988, Drs. Palomaki and Canick were involved in the development of triple marker screening. The team was able to convert its findings into prenatal screening tests now used throughout the world. Dr. Canick's lab in 1998 was the first in the US to offer quad marker screening and in the past decade was the laboratory center for the NIH-funded FASTER Trial which compared first and second trimester screening.
About Women & Infants Hospital
Women & Infants Hospital of Rhode Island, a Care New England hospital, is one of the nation's leading specialty hospitals for women and newborns. A U.S.News Best Hospital in Gynecology and Best Children's Hospital in Neonatology, Women & Infants was ranked number one in the Providence metro area and a top-performer in cancer, and has achieved a 5-star rating in Maternity Care for 2011 from HealthGrades. The primary teaching affiliate of The Warren Alpert Medical School of Brown University for obstetrics, gynecology and newborn pediatrics, as well as a number of specialized programs in women's medicine, Women & Infants is the seventh largest obstetrical service in the country with more than 8,500 deliveries per year. In 2009, Women & Infants opened the country's largest, single-family room neonatal intensive care unit.
New England's premier hospital for women and newborns, Women & Infants and Brown offer fellowship programs in gynecologic oncology, maternal-fetal medicine, urogynecology and reconstructive pelvic surgery, neonatal-perinatal medicine, pediatric and perinatal pathology, gynecologic pathology and cytopathology, and reproductive endocrinology and infertility. It is home to the nation's only mother-baby perinatal psychiatric partial hospital, as well as the nation's only fellowship program in obstetric medicine.
Women & Infants has been designated as a Breast Center of Excellence from the American College of Radiography; a Center for In Vitro Maturation Excellence by SAGE In Vitro Fertilization; a Center of Biomedical Research Excellence by the National Institutes of Health; and a Neonatal Resource Services Center of Excellence. It is one of the largest and most prestigious research facilities in high risk and normal obstetrics, gynecology and newborn pediatrics in the nation, and is a member of the National Cancer Institute's Gynecologic Oncology Group.
About Brown University
Founded in 1764 and a member of the Ivy League, Brown University is globally acclaimed for its culture of independent thinking and academic excellence. For decades, Brown faculty and students have pursued multidisciplinary research in areas such as brain science, digital humanities, nanoscience, and population studies. Since 2002, under a strategic plan, Brown has invested significantly in research, resulting in a 65 percent gain in external research awards, a 33 percent increase in graduate enrollment, and a rise in total faculty of 16 percent.
Journal
Genetics in Medicine