Platt Lawrence D, Janicki Mary Beth, Prosen Tracy, Goldberg James D, Adashek Joseph, Figueroa Reinaldo, Rodis John, Liao Wayne, Sehnert Amy J, Snyder Holly L, Warsof Steven L
Center for Fetal Medicine and Women's Ultrasound and the Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, Hartford, CT.
Am J Obstet Gynecol. 2014 Oct;211(4):368.e1-7. doi: 10.1016/j.ajog.2014.03.065. Epub 2014 Apr 3.
Noninvasive prenatal testing using cell-free DNA is a new alternative to screen for common fetal aneuploidies. It is not known what impact regional location may play on noninvasive prenatal testing implementation and downstream invasive prenatal procedure use in the United States.
Six different regionally based centers collected data on noninvasive prenatal testing indication and results between February and November 2012, as well as their invasive prenatal procedure rates before and after offering noninvasive prenatal testing. Statistical analyses were performed using the 2-proportion Z-test.
Of 1477 patients who underwent noninvasive prenatal testing; 693 (47%) were from centers in the West; 522 (35.3%) from centers in the East; and 262 (17.7%) from 1 center in the Midwest. Statistically significant differences were observed between West Coast and nonWest Coast sites for gestational age (14.1 weeks; P ≤ .0001). Advanced maternal age (AMA-only) was the most frequent indication in 5 of 6 sites (range, 21.8-62.9%) A total of 98 invasive prenatal procedures performed on 94 (6.4%) patients of which 64 (65.3%) were performed at centers in the West. More invasive procedures were performed following negative noninvasive prenatal testing results (n = 61) than abnormal noninvasive prenatal testing results (n = 30). The overall rate of patients undergoing invasive procedure after an abnormal noninvasive prenatal testing result was 32.6% (30 of 92). All 6 centers reported a decrease in invasive procedure volume after noninvasive prenatal testing introduction.
This study demonstrates differences in clinical implementation of noninvasive prenatal testing across regionally dispersed centers in the United States, suggesting patient demographics and views toward prenatal testing influence use as well as downstream management.
使用游离DNA进行无创产前检测是筛查常见胎儿非整倍体的一种新方法。在美国，尚不清楚地区位置对无创产前检测的实施以及下游侵入性产前检查的使用有何影响。
六个不同的地区中心收集了2012年2月至11月期间无创产前检测的指征和结果数据，以及提供无创产前检测前后的侵入性产前检查率。采用双比例Z检验进行统计分析。
在1477例接受无创产前检测的患者中，693例（47%）来自西部中心；522例（35.3%）来自东部中心；262例（17.7%）来自中西部的1个中心。西海岸和非西海岸地区在孕周方面存在统计学显著差异（14.1周；P≤0.0001）。高龄产妇（仅高龄）是6个地区中5个地区最常见的指征（范围为21.8%-62.9%）。共对94例（6.4%）患者进行了98次侵入性产前检查，其中64次（65.3%）在西部中心进行。无创产前检测结果为阴性后进行的侵入性检查（n=61）多于异常结果后（n=30）。无创产前检测结果异常后接受侵入性检查的患者总体比例为32.6%（92例中的30例）。所有6个中心均报告在引入无创产前检测后侵入性检查量有所减少。
本研究表明，美国各地区分散中心在无创产前检测的临床实施方面存在差异，提示患者人口统计学特征和对产前检测的看法会影响其使用以及下游管理。
