Efficacy of screening for fetal Down syndrome in the United States from 1974 to 1997
Efficacy of screening for fetal Down syndrome in the United States from 1974 to 1997
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DOI：
10.1016/s0029-7844(00)01044-9
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发表时间：
2000-12-01
影响因子：
7.2
通讯作者：
Vintzileos, AM
中科院分区：
文献类型：
--
作者：
Egan, JFX;Benn, P;Vintzileos, AM
目的：估计1974年至1997年美国唐氏综合征的16周患病率，并确定母亲年龄截止值和产前三重筛查检测唐氏综合征的有效性。使用1974年至1997年美国13-49岁妇女按母亲年龄分列的活产婴儿的出生率统计数据，我们评估高龄产妇（分娩时35-49岁）和三联血清试验（母体血清甲胎蛋白、hCG和未结合雌三醇）作为唐氏综合征的筛查试验。使用敏感性，假阳性率，阳性预测值和似然比（似然比=敏感性/假阳性率）进行评估的有效性：在1974年，估计中期妊娠唐氏综合征的患病率为740分之一，但到1997年，已增加到504分之一。在35-49岁的妇女中，妊娠16周的唐氏综合症胎儿的比例从1974年的28.5%增加到1997年的47.3%。然而，35-49岁妇女的活产率增长更快，从1974年的4.7%增至1997年的12.6%。母亲的年龄，以确定一个受影响的怀孕的似然比下降，在研究期间，大大低于使用血清test.Conclusion：母亲的年龄截止35岁，在20世纪90年代导致高假阳性率，是有效的基础上的似然比和阳性预测值。对所有孕妇进行血清检测将减少子宫颈穿刺术的次数，并减少与手术有关的损失。（《妇产科》2000年;96：979-85。(C)2000年由美国妇产科医师学会。
Objective: To estimate the 16-week prevalence of Down syndrome in the United States from 1974 to 1997 and to determine the efficacy of maternal age cutoffs and triple screens for detecting it antenatally.Methods: Using natality statistics for the United States from 1974 to 1997 of maternal-age-specific live births to women 13-49 years old, we evaluated advanced maternal age (35-49 years at delivery) and the triple serum test (maternal serum alpha-fetoprotein, hCG, and unconjugated estriol) as screening tests for Down syndrome. Efficacy was evaluated using sensitivity, false-positive rate, positive predictive value, and likelihood ratio (likelihood ratio = sensitivity/false-positive rate).Results: In 1974, the estimated second-trimester prevalence of Down syndrome was one in 740, but by 1997 that had increased to one in 504. The proportion of Down syndrome fetuses at 16 weeks' gestation in women 35-49 years old increased from 28.5% in 1974 to 47.3% in 1997. However, live births to women 35-49 years old increased more rapidly from 4.7% in 1974 to 12.6% in 1997. The likelihood ratio for maternal age to identify an affected pregnancy decreased during the study period and was substantially lower than that using the serum test.Conclusion: A maternal age cutoff of 35 years in the 1990s resulted in high false-positive rates and was less efficacious based on likelihood ratio and positive predictive value. Serum testing of all pregnant women would reduce the number of amniocenteses and decrease procedure-related losses. (Obstet Gynecol 2000;96:979-85. (C) 2000 by The American College of Obstetricians and Gynecologists.).