Prospective study of the feasibility and effectiveness of a second‐trimester quadruple test for Down syndrome in Thailand

Kaewsuksai, Peeranan; Jitsurong, Siroj

doi:10.1002/ijgo.12290

Cited by 4 publications

(10 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For DS screening in the second trimester, either the quadruple or quad test has been an acceptable option in both developed and developing countries [5,6,8]. The screening period for these tests is between 14 and 22 weeks gestation, with reported detection rates of between 78 and 85% [10][11][12][13][14]. The reported risk cutoff varies among studies between 1 in 250 to 300 [10-12, 14, 22-24], and also there are differences in false positive rates of between 4.4 and 8.6% [9][10][11][12][13][14].…”

Section: Plos Onementioning

confidence: 99%

“…The screening period for these tests is between 14 and 22 weeks gestation, with reported detection rates of between 78 and 85% [10][11][12][13][14]. The reported risk cutoff varies among studies between 1 in 250 to 300 [10-12, 14, 22-24], and also there are differences in false positive rates of between 4.4 and 8.6% [9][10][11][12][13][14]. In this study, we chose a risk cutoff of 1:250 or greater because this is widely used [10][11][12][13][14].…”

Section: Plos Onementioning

confidence: 99%

“…The reported risk cutoff varies among studies between 1 in 250 to 300 [10-12, 14, 22-24], and also there are differences in false positive rates of between 4.4 and 8.6% [9][10][11][12][13][14]. In this study, we chose a risk cutoff of 1:250 or greater because this is widely used [10][11][12][13][14]. Using the WF in our patients gave a detection rate of 75% with a false positive rate of 9.1% and overall accuracy of 90.1%, which was a lower detection rate than in previous studies but comparable with the study of Kaewsuksai et al [14].…”

Section: Plos Onementioning

confidence: 99%

“…In this study, we chose a risk cutoff of 1:250 or greater because this is widely used [10][11][12][13][14]. Using the WF in our patients gave a detection rate of 75% with a false positive rate of 9.1% and overall accuracy of 90.1%, which was a lower detection rate than in previous studies but comparable with the study of Kaewsuksai et al [14]. In our study, although we had a similar study population and we used a similar analytical technique process as the Kaewsuksai study, when the quadruple serums were re-calculated using the TF in our regression equation, the diagnostic performance was better than using the MoMs calculated with the WF and comparable with previous studies [10][11][12][13].…”

Section: Plos Onementioning

confidence: 99%

“…Although maternal serum quadruple screening detection rates of between 75 and 85% have been reported [10][11][12][13][14][15], these studies also found different false positive screening rates of 5 to 14%, which can lead to unnecessarily high numbers of invasive procedures and high laboratory costs for karyotyping, which are burdensome for low-resource countries. One of the reasons for the high false positive rates is the ethnic factor.…”

Section: Introductionmentioning

confidence: 96%

See 4 more Smart Citations

Ethnic-specific reference range affects the efficacy of quadruple test as a universal screening for Down syndrome in a developing country

et al. 2021

View full text Add to dashboard Cite

Objective To evaluate the efficacy of the quadruple test for potential use as a Thai national policy for Down syndrome (DS) screening and establish an accurate equation for risk estimation of Down syndrome based on gestational age, weight and the ethnic-specific reference range of our population. Methods A prospective study was conducted on singleton pregnancies at 14 to 21 weeks of gestation to evaluate the efficacy of quadruple DS screening using the automatically calculated Western European descent factor (WF) in our population and the impact of screening using a specific Thai ethnic factor as well as to establish an equation for the risk estimation of DS based on gestational age, weight and a local Thai ethnic factor to correct for the impact of ethnic factor on the screening efficacy. Results Of a total of 5,515 women, 12 cases of DS and 8 cases of other aneuploidies were found. The detection rate, false positive rate and specificity were 75.0%, 9.1% and 90.9%, respectively, by automatic calculation with the widely used WF; the screening efficacy was lower when used in Asian populations than in other studies. The best-fitted regression equation of serum quadruple screening of AFP, free β-hCG, uE3 and inhibin A was established by adjustment for gestational age (GA) in days, maternal weight and our Thai-specific ethnic reference range which was created for this study. Calculations with our Thai-specific ethnic model gave a better detection rate of 83.3%, a false positive rate of 9.6% and specificity of 90.4%. Conclusion The serum quadruple test had a lower detection rate than expected when the risk estimation was based on the WF reference range. The serum quadruple test using WF had significantly different levels when corrected with our ethnic-specific factor. Using our local ethnic specific model could increase the detection rate of DS screening in Thailand with a minimal increase in false positive rates. Our findings indicate that DS screening should be adjusted with an appropriate individual ethnic factor when used for national screening.

show abstract

Section: Plos Onementioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

See 3 more Smart Citations

Ethnic-specific reference range affects the efficacy of quadruple test as a universal screening for Down syndrome in a developing country

et al. 2021

View full text Add to dashboard Cite

show abstract

Prenatal screening tests and prevalence of fetal aneuploidies in a tertiary hospital in Thailand

et al. 2023

View full text Add to dashboard Cite

This study evaluated prenatal screening test performance and the prevalence of common aneuploidies at Siriraj Hospital, Thailand. We collected data from screening tests which are first-trimester test, quadruple test, and noninvasive prenatal tests (NIPT) between January 2016 and December 2020. Thirty percent (7,860/25,736) of pregnancies received prenatal screening tests for aneuploidies disorders, and 17.8% underwent prenatal diagnosis tests without screening. The highest percentage of screening tests was first-trimester test (64.5%). The high-risk results were 4% for first-trimester test, 6.6% for quadruple test, and 1.3% for NIPT. The serum screening tests for trisomy 13 and 18 had no true positives; therefore, we could not calculate sensitivity. For the first-trimester test, the sensitivity for trisomy 21 was 71.4% (95% confidence intervals (CI) 30.3–94.9); specificity for trisomy 13 and 18 was 99.9% (95% CI 99.8–99.9); and for trisomy 21 was 96.1% (95% CI 95.6–96.7). For the quadruple test, the specificity for trisomy 18 was 99.6% (95% CI 98.9–99.8), while the sensitivity and specificity for trisomy 21 were 50% (95% CI 26.7–97.3) and 93.9% (95% CI 92.2–95.3), respectively. NIPT had 100% sensitivity and specificity for trisomy 13, 18 and 21, and there were neither false negatives nor false positives. For pregnant women < 35 years, the prevalence of trisomy 13, 18, and 21 per 1,000 births was 0.28 (95% CI 0.12–0.67), 0.28 (95% CI 0.12–0.67), and 0.89 (95% CI 0.54–1.45), respectively. For pregnant women ≥35 years, the prevalence of trisomy 13, 18, and 21 per 1,000 births was 0.26 (95% CI 0.06–1.03), 2.59 (95% CI 1.67–4.01), and 7.25 (95% CI 5.58–9.41), respectively. For all pregnancies, the prevalence of trisomy 13, 18, and 21 per 1,000 births was 0.27 (95% CI 0.13–0.57), 0.97 (95% CI 0.66–1.44), 2.80 (95% CI 2.22–3.52), respectively.

show abstract

Economic evaluation of prenatal screening for fetal aneuploidies in Thailand

Wongkrajang,

Jittikoon,

Udomsinprasert

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

Historically, there has been a lack of cost-effectiveness data regarding the inclusion of universal non-invasive prenatal testing (NIPT) for trisomy 21, 18, and 13 in the benefit package of the Universal Health Coverage (UHC) in Thailand. Therefore, this study aimed to perform the cost-benefit analysis of prenatal screening tests and calculate the budget impact that would result from the implementation of a universal NIPT program. A decision-tree model was employed to evaluate cost and benefit of different prenatal chromosomal abnormalities screenings: 1) first-trimester screening (FTS), 2) NIPT, and 3) definitive diagnostic (amniocentesis). The comparison was made between these screenings and no screening in three groups of pregnant women: all ages, < 35 years, and ≥ 35 years. The analysis was conducted from societal and governmental perspectives. The costs comprised direct medical, direct non-medical, and indirect costs, while the benefit was cost-avoidance associated with caring for children with trisomy and the loss of productivity for caregivers. Parameter uncertainties were evaluated through one-way and probabilistic sensitivity analyses. From a governmental perspective, all three methods were found to be cost-beneficial. Among them, FTS was identified as the most cost-beneficial, especially for pregnant women aged ≥ 35 years. From a societal perspective, the definitive diagnostic test was not cost-effective, but the other two screening tests were. The most sensitive parameters for FTS and NIPT strategies were the productivity loss of caregivers and the incidence of trisomy 21. Our study suggested that NIPT was the most cost-effective strategy in Thailand, if the cost was reduced to 47 USD. This evidence-based information can serve as a crucial resource for policymakers when making informed decisions regarding the allocation of resources for prenatal care in Thailand and similar context.

show abstract

Prospective study of the feasibility and effectiveness of a second‐trimester quadruple test for Down syndrome in Thailand

Abstract: The quadruple test was found to be a feasible and efficient method for screening for Down syndrome in the second trimester of pregnancy in a Thai clinical setting. The test should be performed for pregnant women before an invasive test for Down syndrome.

Cited by 4 publications

References 21 publications

Ethnic-specific reference range affects the efficacy of quadruple test as a universal screening for Down syndrome in a developing country

Ethnic-specific reference range affects the efficacy of quadruple test as a universal screening for Down syndrome in a developing country

Prenatal screening tests and prevalence of fetal aneuploidies in a tertiary hospital in Thailand

Economic evaluation of prenatal screening for fetal aneuploidies in Thailand

Contact Info

Product

Resources

About