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• W4247776992 abstract "We thank the authors for their comments. Although cell-free DNA (cfDNA) testing has the highest detection rate among aneuploidy screening modalities, we agree that the reportedly high screening failure rates in women with obesity affects its use in this population. We also agree that the optimal aneuploidy screening option depends on the patient and her preferences. Our study sought to determine the screening failure rate in women with obesity cases with an initial screen failure and to assess the increase in the fetal cfDNA fraction over time in the most obese women. We concluded that more than 80% of women weighing >400 lb received results between 9 and 12 weeks’ gestation and that approximately 94% of women weighing >400 lb received results between 13 and 18 weeks’ gestation. The no-call result rate owing to low fetal fraction is lower than previously reported, indicating that cfDNA screening is appropriate in women who desire aneuploidy screening with the highest detection rate and lower false-positive rates. The authors’ screening algorithm does not address the limitations of other forms of aneuploidy screening in women with obesity. In particular, there may be a higher rate of unobtainable nuchal translucency and greater scanning time required for women with obesity.1Thornburg L.L. Mulconry M. Post A. Carpenter A. Grace D. Pressman E.K. Fetal nuchal translucency thickness evaluation in the overweight and obese gravida.Ultrasound Obstet Gynecol. 2009; 33: 665-669Crossref PubMed Scopus (33) Google Scholar,2Aagaard-Tillery K.M. Flint Porter T. Malone F.D. et al.Influence of maternal BMI on genetic sonography in the FaSTER trial.Prenat Diagn. 2010; 30: 14-22Crossref PubMed Scopus (85) Google Scholar Studies have shown that targeted and standard sonography have higher failure rates and lower detection rates for soft aneuploidy markers in women with obesity.3Gandhi M. Fox N.S. Russo-Stieglitz K. Hanley M.E. Matthews G. Rebarber A. Effect of increased body mass index on first-trimester ultrasound examination for aneuploidy risk assessment.Obstet Gynecol. 2009; 114: 856-859Crossref PubMed Scopus (25) Google Scholar,4Dashe J.S. McIntire D.D. Twickler D.M. Effect of maternal obesity on the ultrasound detection of anomalous fetuses.Obstet Gynecol. 2009; 113: 1001-1007Crossref PubMed Scopus (126) Google Scholar In addition, the higher false-positive rate in screening with ultrasound or serum analyte screening may lead to increased invasive testing, which can be technically more challenging in the most obese women. Therefore, we believe that cfDNA screening offers a viable aneuploidy screening option for patients with obesity with the appropriate pretest counseling. Is there an optimal gestational age for cell-free DNA testing in maternal obesity?American Journal of Obstetrics & GynecologyVol. 225Issue 3PreviewCell-free DNA (cfDNA) sequencing technology is currently the most accurate screening test for common trisomies and is superior to the traditional screening tests such as first trimester screening, quad screen, and so on. However, it may not be suitable for all pregnant women. For example, multiple studies have found that mothers with obesity have higher screen failures or no-call results owing to a low fetal cfDNA fraction especially during very early gestation.1,2 Nevertheless, no guidelines from scientific societies recommend an optimal gestational age for cfDNA sampling in cases with maternal obesity. Full-Text PDF" @default.
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• W4247776992 date "2021-09-01" @default.
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• W4247776992 title "Obesity and no-call results: optimal timing of cell-free DNA testing and redraw" @default.
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• W4247776992 doi "https://doi.org/10.1016/j.ajog.2021.05.027" @default.
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