Strong impact of ethnicity on effectiveness of the first trimester maternal serum screen of fetal Down syndrome

Lerthiranwong, Thitikarn; Wanapirak, Chanane; Sirichotiyakul, Supatra; Tongprasert, Fuanglada; Srisupundit, Kasemsri; Luewan, Suchaya; Tongsong, Theera

doi:10.1080/14767058.2017.1358264

Cited by 6 publications

(5 citation statements)

References 15 publications

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“…Actually, several reports on the effectiveness of quad test in developing countries have been published, but most involved a small sample size, including a small number of fetuses with DS (6, 7). Additionally, as already known, ethnicity has a great impact on serum biomarker levels and accuracy of tests, and it cannot completely be corrected by ethnic factors, either in the first trimester or second trimester (8)(9)(10)(11). Accordingly, our research team took advantage of this routine practice to evaluate the effectiveness of the strategy under the service settings of a large-scale unselected population and, also, to compare the diagnostic performance of Quad test based on Western reference models (WM) with ethnic correction and that based on Thai-specific reference models (TM).…”

Section: Introductionmentioning

confidence: 99%

Performance of Serum Quad Test in Screening for Fetal Down Syndrome in a Large-Scale Unselected Population in a Developing Country

Chaipongpun¹,

Wanapirak²,

Sirichotiyakul³

et al. 2023

Int J Public Health

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Objective: To assess the effectiveness of Quad test in the detection of Down syndrome (DS) in routine practice among a large-scale population and to compare the effectiveness of Quad test based on the Western reference model (WM) and that based on Thai reference model (TM).Methods: Quad test was performed on 42,769 pregnancies at 14–21 weeks. The fetal risk of DS derived from Quad test was automatically computed based on WM and used in evaluating the effectiveness. Also, the fetal risk was calculated based on the TM.Results: Of 39,740 women with complete follow-ups including 74 fetuses with DS, with WM, the detection and false positive rates were 81.1% and 7.2%, respectively, whereas the detection and false positive rates with TM were 87.8%, and 6.8%, respectively. According to ROC curves, the performance of Quad test based on TM was slightly but significantly better than that based on WM (AUC of 0.959 vs. 0.940, p = 0.001).Conclusion: Quad test is highly effective in service settings and suitable for developing countries and the effectiveness is even higher when based on ethnicity-specific reference model.

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Section: Introductionmentioning

confidence: 99%

Performance of Serum Quad Test in Screening for Fetal Down Syndrome in a Large-Scale Unselected Population in a Developing Country

Chaipongpun¹,

Wanapirak²,

Sirichotiyakul³

et al. 2023

Int J Public Health

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“…In actual practice, the serum screening applied in the Asian population is based on Caucasian normative models with weight correction and ethnic factor correction, which is different for each biomarker. However, even with the use of ethnic factor correction, the conventional method (Caucasian normative model with ethnic correction) is not as effective as the methods using the models developed from the specific population under consideration [ 7 ]. Accordingly, to be more effective in screening, the normative references of median concentrations of the serum biomarkers in normal pregnancy specific to the population under consideration must be firstly developed.…”

Section: Introductionmentioning

confidence: 99%

Ethnicity-Specific Normative Models of Quadruple Test as a Screening Test for Down Syndrome

et al. 2021

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Background and Objectives: To establish normative models for median levels of serum biomarkers of the second trimester quad test (alpha-fetoprotein: AFP; free beta-human gonadotropins: hCG; inhibin-A; and unconjugated estriol: uE3) specific to Thai women and to compare multiples of the median (MoMs) derived from ethnicity-specific models and those derived from Caucasian models with ethnic correction. Materials and Methods: A cross-sectional study was undertaken in a tertiary, medical teaching center among low-risk pregnant Thai women between 14 and 21 weeks of gestation to measure the levels of the four serum biomarkers. The measured values of each biomarker were analyzed using the multivariable factorial polynomial technique for quantile regression as a function of gestational age and maternal weight. Results: The Thai-specific normative models for the four biomarkers were generated and available for use. The MoMs of all individuals generated from our models were significantly different from conventional (Caucasian) models with ethnic correction (Wilcoxon signed-rank test; p < 0.0001 for all biomarkers). The MoMs of AFP and hCG from both methods were in agreement, but those from Thai-specific models were significantly higher. However, those of inhibin-A and uE3 were markedly different and ethnic correction was unlikely to be useful. Conclusions: The Thai-specific normative models of the quad test as a function of gestational age and maternal weight were constructed using multivariable factorial polynomial models, better than simple quantile regression or log-linear regression used in earlier decades. The analysis of MoMs supports the use of ethnicity-specific models instead of Caucasian models with ethnic correction.

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“…Several studies demonstrated an association between individual marker levels and rate of SGA, but most of them had only a limited number of women, and it is difficult to implement these findings in actual practice. Moreover, it is well established that racial factors strongly impact on serum marker levels [9][10][11][12][13], and the normative data of serum biomarkers derived from Caucasian women cannot accurately be interpreted when used in other parts of the world. Though several studies have linked abnormal serum marker levels to higher rate of SGA, no study provides objective methods or models derived from individual serum markers that can be clinically used to determine the probability of SGA.…”

Section: Introductionmentioning

confidence: 99%

Quad test for fetal aneuploidy screening as a predictor of small-for-gestational age fetuses: a population-based study

Boonpiam

Wanapirak

Sirichotiyakul

et al. 2020

BMC Pregnancy Childbirth

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Background To identify the relationship between quadruple test for aneuploidy screening (alpha-fetoprotein: AFP; free beta-human chorionic gonadotropin: b-hCG; unconjugated estriol: uE3 and inhibin-A: IHA) and fetal growth restriction and to construct predictive models for small-for-gestational-age (SGA) fetuses. Methods Women who underwent quadruple test for aneuploidy were followed-up for final outcomes. The multiples of the median (MoMs) of the four biochemical markers for the SGA group and those of normal fetuses were compared. The models for predicting SGA by the individual biomarkers and their combination were constructed using binary logistic regression analysis, and their diagnostic performances in predicting SGA were determined. Results Of 10,155 eligible pregnant women, 578 (5.7%) and 9577 (94.3%) had SGA and normal growth, respectively. High levels of AFP, b-hCG and IHA but low levels of uE3 significantly increased the risk of SGA. The constructed predictive equations had predictive performance for SGA, with areas under the receiver-operated characteristic curve of 0.724, 0.655, 0.597, 0.664 and 0.754 for AFP, b-hCG, uE3, IHA, and the combination, respectively. Conclusion The quad test for aneuploidy screening could also be used as a predictor of SGA, without extra-effort and extra-cost.

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Strong impact of ethnicity on effectiveness of the first trimester maternal serum screen of fetal Down syndrome

Cited by 6 publications

References 15 publications

Performance of Serum Quad Test in Screening for Fetal Down Syndrome in a Large-Scale Unselected Population in a Developing Country

Performance of Serum Quad Test in Screening for Fetal Down Syndrome in a Large-Scale Unselected Population in a Developing Country

Ethnicity-Specific Normative Models of Quadruple Test as a Screening Test for Down Syndrome

Quad test for fetal aneuploidy screening as a predictor of small-for-gestational age fetuses: a population-based study

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