Clinical trial NCT04077060: First Trimester Risk Assessment Based on Ultrasound and Cell-free DNA vs Combined Screening
Official title: First Trimester Risk Assessment Based on Ultrasound and Cell-free DNA vs Combined Screening: Women's Experience
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Aneuploidy
Lead sponsor: Federico II University
Sponsor class: OTHER
First posted: 2019-09-04
Enrollment: 40
Sex: FEMALE
Minimum age (years): 18
Maximum age (years): 45
Standard ages: ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: OTHER

Brief summary: There is an ongoing debate regarding how cell-free DNA (cfDNA) screening can best be incorporated into current prenatal screening algorithms for chromosomal abnormalities.

Test performance of cfDNA has been shown to be better that first-trimester combined screening (FTCS). However, the cost of the cfDNA testing is considered too high to adopt as first line screening. Moreover, FTCS includes a detailed ultrasound examination of the fetus with nuchal translucency (NT) measurement that allows for early detection of fetal abnormalities.

An approach in which every woman are offered an early anatomy scan along with cfDNA may also be a reasonable option. Recently a randomized controlled trial, including 1,518 women with singleton pregnancy undergoing first-trimester screening, compared the screening performance of FTCS with an approach that uses the combination of a detailed ultrasound examination and cfDNA analysis. The trial showed that first-trimester risk assessment for trisomy 21 that includes a detailed ultrasound examination along cfDNA was associated with a significant reduction in the false-positive rate compared with FTCS. This approach obviates the need for maternal serum free beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A in screening for fetal aneuploidy.

Despite robust evidence on the very high detection rate of cfDNA in detecting trisomy 21, literature is lacking on data regarding women's experience and emotional well-being and satisfaction after test-results of women offered cfDNA compared to those offered FTCS.


Eligibility criteria: Inclusion Criteria:

* Pregnant women with singleton gestations
* ≤12 6/7 weeks of gestation
* Normal ultrasound examination at the time of randomization
* \>18 \<45 years
* Crown-rump length (CRL) \<84 mm at the time of randomization

Exclusion Criteria:

* Multiple gestations, including vanishing twins
* \>12 6/7 weeks of gestation
* Ectopic pregnancy
* Abnormal ultrasound examination at the time of first prenatal visit
* Women who are unconscious, severly ill, mentally handicapped, or under the age of 18 years.
* Women who have already planned for invasive prenatal testing, e.g. for a history of prior child or pregnancy with chromosomal or genetic abnormalities
* CRL \>84mm at the time of randomization

Primary outcomes:
measure: reassurance
timeFrame: at the time of screening test
measure: Anxiety
timeFrame: at the time of screening test
measure: Satisfaction of the pregnant women
timeFrame: 11-13 weeks of gestation
measure: False positive rate
timeFrame: 1 week after test
measure: Anxiety
timeFrame: at the time of screening test
Secondary outcomes:
Other outcomes:
Locations:
city: Napoli
country: Italy
facility: Gabriele Saccone
Study officials:
References:
citation: Migliorini S, Saccone G, Silvestro F, Massaro G, Arduino B, D'Alessandro P, Petti MT, Paino JAC, Guida M, Locci M, Zullo F. First-trimester screening based on cell-free DNA vs combined screening: A randomized clinical trial on women's experience. Prenat Diagn. 2020 Oct;40(11):1482-1488. doi: 10.1002/pd.5800. Epub 2020 Aug 13.