Evolution of the indications for genetic amniocentesis after the introduction of the Prenatal Screening Program by the National Health Insurance in Poland

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P R A C E O R Y G I N A L N E

położnictwo Ginekol Pol. 2013, 84, 418-421

Evolution of the indications for genetic

amniocentesis after the introduction of the Prenatal Screening Program by the National Health Insurance in Poland

Zmiana wskazań do amniopunkcji genetycznej po wprowadzeniu Programu badań prenatalnych przez Narodowy Fundusz Zdrowia w Polsce

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Department of Obstetrics, Medical University of Gdansk, Poland

Abstract

Objective: In 2008, the Prenatal Screening Program was introduced by the National Health Insurance in the Pomeranian region of Poland. As of then, biochemical and ultrasound screening was offered to women eligible for amniocentesis according to the earlier policy. The aim of the study was to investigate the evolution of the indications for amniocentesis after the introduction of the Program.

Material and Methods: In total, 2579 women referred for amniocentesis to the Department of Obstetrics, Medical University of Gdansk, were included in the study. They were divided into two groups: 1705 women referred between 1996 and 2007 (group A) and 874 women referred between 2008 and 2010 (group B). Indications for amniocen- tesis were compared between the groups.

Results: A significant difference in the indications for amniocentesis was found between the groups (Kruskal-Wal- lis test; p<0.001). Maternal age, fetal malformation in the previous pregnancy, and anxiety were less frequent in group B (p<0.0001, p=0.0008 and p=0.0156, respectively). In contrast, a higher frequency of positive biochemical screening and abnormal ultrasound results as indications for amniocentesis was found in group B (p<0.0001 and p=0.0008, respectively).

Conclusions: The introduction of the Prenatal Screening Program by the National Health Insurance shifted the proportion of indications for amniocentesis from maternal age to positive results in biochemical and ultrasound screenings, and increased the number of invasive testing. Further observation of the trend and its influence on the detection rate is imperative to confirm that the proposed Program is adequate and does not require adjustments.

Key words:

amniocentesis / indication / maternal age / biochemical screening / / XltrasoXnd screening / foetal malformation / chromosomal abnormality /

Otrzymano: 18.12.2012

Zaakceptowano do druku: 15.05.2013 Corresponding address:

Katarzyna Ciach

Department of Obstetrics, Medical University of Gdansk Poland, 80-402 Gdansk, Kliniczna 1a

fax: +48 58 349 3416, ph.:+48 502 115 942 e-mail: kciach@wp.pl

© P o l s k i e T o w a r z y s t w o G i n e k o l o g i c z n e

Nr 06/2013

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P R A C E O R Y G I N A L N E położnictwo Katarzyna Ciach et al. Evolution of the indications for genetic amniocentesis after the introduction of the Prenatal Screening Program...

Ginekol Pol. 2013, 84, 418-421

Introduction

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Aim of the study

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Material and methods

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Cel: W 2008 roku Narodowy Fundusz Zdrowia wprowadził Program badań prenatalnych w województwie po- morskim. Od tego momentu badanie biochemiczne i przesiewowe USG genetyczne oferowane było kobietom kwalifikującym się do amniopunkcji według wcześniejszych wskazań. Celem niniejszej pracy było zbadanie ewolucji wskazań do amniopunkcji po wprowadzeniu Programu.

Materiały i metody: Materiał kliniczny obejmował 2579 ciężarnych, u których w latach 1996-2010 wykonano amniopunkcję genetyczną w Klinice Położnictwa GUMed. Pacjentki zostały podzielone na 2 grupy: grupa A - 1705 ciężarnych, u których wykonano amniopunkcję w latach 1996-2007, grupa B - 874 ciężarnych, u których wykonano amniopunkcję w latach 2008-2010. Dokonano porównania wskazań do amniopunkcji w obu grupach.

Wyniki: Statystycznie znamienne różnice stwierdzono porównując obie grupy (Kruskal-Wallis test; p<0,001). Wiek matki, wady płodu w poprzedniej ciąży, lęk, występowały statystycznie znamiennie rzadziej w grupie B (p<0,0001, p=0,0008 oraz p=0,0156). Nieprawidłowy wynik USG oraz badania biochemicznego był znacząco częstszym wskazaniem do amniopunkcji w grupie B (p<0,0001, p=0,0008).

Wnioski: Wprowadzenie Programu badań prenatalnych przez NFZ zmieniło wcześniejsze proporcje wskazań do amniopunkcji ze względu na wiek matki na rzecz nieprawidłowego wyniku testu biochemicznego i USG genetycz- nego. Dalsza obserwacja tego trendu i jego wpływu na wykrywalność nieprawidłowości jest niezbędna w celu potwierdzenia, że proponowany program jest odpowiedni i nie wymaga zmian.

Słowa kluczowe:

amnioSXnNcMa / wskazania / wiek matki / skrining biochemiczny /

/ skrining Xltrasonogra¿czny / wady SáodX / aberracje chromosomowe /

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P R A C E O R Y G I N A L N E położnictwo

Katarzyna Ciach et al. Evolution of the indications for genetic amniocentesis after the introduction of the Prenatal Screening Program...

Ginekol Pol. 2013, 84, 418-421

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Discussion

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Table I. Indications for amniocentesis in 1996-2007 (group A) and 2008-2010 (group B).

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Nr 06/2013

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P R A C E O R Y G I N A L N E położnictwo Katarzyna Ciach et al. Evolution of the indications for genetic amniocentesis after the introduction of the Prenatal Screening Program...

Ginekol Pol. 2013, 84, 418-421

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References

1. http://www.nfz-gdansk.pl/swiadczeniodawcy/konkursy/2007/materialy/2006_z53/

z53_20060825_z5.pdf

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2011, 157, 156-160.

3. Tabor A, Alfirevic Z Update on procedure-related risks for prenatal diagnosis techniques. Fetal Diagn Ther. 2010, 27, 1-7.

4. Kowalczyk D, Wiecek J, Guzikowski W, Ośko A. Analysis of the course of pregnancy and labor after genetic amniocenthesis in women after 35 years of age. Ginekol Pol. 2011, 82, 738-742.

5. Baird P, Sadovnick A, Yee I. Maternal age and birth defects: a population study. Lancet. 1991, 337, 527-530.

6. Nicolaides K. Screening for chromosomal defects. Ultrasound Obstet Gynecol. 2003, 21, 313- 321.

7. Callaway L, Lust K, McIntyre H. Pregnancy outcomes in women of very advanced maternal age.

Aust N Z J Obstet Gynaecol. 2005, 45, 12-16.

8. Paszkowski T, Woźniakowska E. Progesteron w profilaktyce porodu przedwczesnego. Ginekol po Dypl. 2005,7, 33-38.

9. Nicolaides K, Chervenak F, McCullough L, [et al.]. Evidence-based obstetric ethics and informed decision-making by pregnant women about invasive diagnosis after first-trimester assessment of risk for trisomy 21. Am J Obstet Gynecol. 2005, 193, 322–326.

10. Karaoguz M, Bal F, Yakut T, [et al.]. Cytogenetic results of amniocentesis materials: incidence of abnormal karyotypes in the Turkish collaborative study. Genet Couns. 2006, 17, 219-230.

11. Tseng J, Chou M, Lo F, [et al.]. Detection of chromosome aberrations in the second trimester using genetic amniocentesis: experience during 1995-2004. Taiwan J Obstet Gynecol. 2006, 45, 39-41.

Figure 1. Indications (1-7) for amniocentesis in 1996-2007 (group A) and 2008-2010 (group B).