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Non‐invasive prenatal testing in the management of twin pregnancies

Twin pregnancies are common and associated with pregnancy complications and adverse outcomes. Prenatal clinical management is intensive and has been hampered by inferior screening and less acceptable invasive testing. For aneuploidy screening, meta‐analyses show that non‐invasive prenatal testing (N...

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Autores principales: Benn, Peter, Rebarber, Andrei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8518532/
https://www.ncbi.nlm.nih.gov/pubmed/34170028
http://dx.doi.org/10.1002/pd.5989
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author Benn, Peter
Rebarber, Andrei
author_facet Benn, Peter
Rebarber, Andrei
author_sort Benn, Peter
collection PubMed
description Twin pregnancies are common and associated with pregnancy complications and adverse outcomes. Prenatal clinical management is intensive and has been hampered by inferior screening and less acceptable invasive testing. For aneuploidy screening, meta‐analyses show that non‐invasive prenatal testing (NIPT) through analysis of cell‐free DNA (cf‐DNA) is superior to serum and ultrasound‐based tests. The positive predictive value for NIPT is driven strongly by the discriminatory power of the assay and only secondarily by the prior risk. Uncertainties in a priori risks for aneuploidies in twin pregnancies are therefore of lesser importance with NIPT. Additional information on zygosity can be obtained using NIPT. Establishing zygosity can be helpful when chorionicity was not reliably established early in pregnancy or where the there is a concern for one versus two affected fetuses. In dizygotic twin pregnancies, individual fetal fractions can be measured to ensure that both values are satisfactory. Vanishing twins can be identified by NIPT. Although clinical utility of routinely detecting vanishing twins has not yet been demonstrated, there are individual cases where cf‐DNA analysis could be helpful in explaining unusual clinical or laboratory observations. We conclude that cf‐DNA analysis and ultrasound have synergistic roles in the management of multiple gestational pregnancies.
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spelling pubmed-85185322021-10-21 Non‐invasive prenatal testing in the management of twin pregnancies Benn, Peter Rebarber, Andrei Prenat Diagn Review Twin pregnancies are common and associated with pregnancy complications and adverse outcomes. Prenatal clinical management is intensive and has been hampered by inferior screening and less acceptable invasive testing. For aneuploidy screening, meta‐analyses show that non‐invasive prenatal testing (NIPT) through analysis of cell‐free DNA (cf‐DNA) is superior to serum and ultrasound‐based tests. The positive predictive value for NIPT is driven strongly by the discriminatory power of the assay and only secondarily by the prior risk. Uncertainties in a priori risks for aneuploidies in twin pregnancies are therefore of lesser importance with NIPT. Additional information on zygosity can be obtained using NIPT. Establishing zygosity can be helpful when chorionicity was not reliably established early in pregnancy or where the there is a concern for one versus two affected fetuses. In dizygotic twin pregnancies, individual fetal fractions can be measured to ensure that both values are satisfactory. Vanishing twins can be identified by NIPT. Although clinical utility of routinely detecting vanishing twins has not yet been demonstrated, there are individual cases where cf‐DNA analysis could be helpful in explaining unusual clinical or laboratory observations. We conclude that cf‐DNA analysis and ultrasound have synergistic roles in the management of multiple gestational pregnancies. John Wiley and Sons Inc. 2021-06-25 2021-09 /pmc/articles/PMC8518532/ /pubmed/34170028 http://dx.doi.org/10.1002/pd.5989 Text en © 2021 The Authors. Prenatal Diagnosis published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review
Benn, Peter
Rebarber, Andrei
Non‐invasive prenatal testing in the management of twin pregnancies
title Non‐invasive prenatal testing in the management of twin pregnancies
title_full Non‐invasive prenatal testing in the management of twin pregnancies
title_fullStr Non‐invasive prenatal testing in the management of twin pregnancies
title_full_unstemmed Non‐invasive prenatal testing in the management of twin pregnancies
title_short Non‐invasive prenatal testing in the management of twin pregnancies
title_sort non‐invasive prenatal testing in the management of twin pregnancies
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8518532/
https://www.ncbi.nlm.nih.gov/pubmed/34170028
http://dx.doi.org/10.1002/pd.5989
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