(268) Antenatal testing surveillance and perinatal outcomes in pregnancies with trisomy 21

Thursday, February 9, 2023

10:30 AM – 12:00 PM

Objective: There are no antenatal testing guidelines for fetuses with trisomy 21 (T21) and strategies vary by provider. We compared perinatal outcomes in pregnancies with T21 fetuses who did versus did not receive antenatal testing.

Study Design: Retrospective cohort of patients with fetal T21 that delivered at our institution, 11/2010-6/2022. Patients who underwent termination of pregnancy (TOP) or had a fetal demise (IUFD) < 32 weeks were excluded. We compared patients who had antenatal testing with biophysical profile (BPP) to those who did not. The primary outcome was an adverse perinatal composite (fetal or neonatal death, abnormal arterial cord gas, RDS or BPD). Secondary outcomes included number of ultrasounds and office visits. Characteristics and outcomes were compared between groups. Multivariable logistic regression was used to adjust for key covariates. Tests of heterogeneity were used to evaluate for effect modification by indication for BPP (T21 alone, fetal growth restriction [FGR], maternal comorbidities [DM, HTN], polyhydramnios, oligohydramnios, PROM).

Results: Of 183 patients with fetal T21, 16 were excluded (14 TOPs, 2 IUFD). Eighty-two (49%) had antenatal testing beginning at 33 ± 2 weeks with 72 (88%) performed weekly. Indications for antenatal testing included T21 (31%), FGR (21%), and other (48%) (Table 1). Patients with antenatal testing were older, more likely to have had positive cfDNA testing, have DM, and FGR (Table 1). There were no differences in the composite perinatal outcome (18% vs 21%, aOR 0.88 [0.39-1.08]) or its components (Table 2). Antenatal testing was significantly associated with 2.94 (1.87-4.00) more ultrasounds and 2.10 (0.26-3.93) more office visits. The association between antenatal testing and the primary outcome did not vary by indication for testing (p=0.76).

Conclusion: There was no difference in perinatal outcomes based on whether antenatal testing was used in pregnancies with fetal T21. Given the increased resource utilization, larger studies should evaluate if there is a measurable benefit to antenatal testing for fetal T21.

Primary & Presenting Author(s)

Margaret Page, MD
University of Alabama at Birmingham
Birmingham, Alabama, United States

Coauthor(s)

CB
Christina T. Blanchard, MS
Statistician
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
Angela R. Seasely, MD, MS (she/her/hers)
Fellow
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
VJ
Victoria C. Jauk, RN
Statistician
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
FM
Fady Mikhail, MD, PhD
Department of Genetics, University of Alabama at Birmingham
Brimingham, Alabama, United States
JO
John Owen, MD,MSPH
Professor
Center for Women's Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States
Ashley N. Battarbee, MD,MSCR
Assistant Professor
University of Alabama at Birmingham
Birmingham, Alabama, United States
Akila Subramaniam, MD,MPH
Associate Professor
Center for Women’s Reproductive Health, University of Alabama at Birmingham
Birmingham, Alabama, United States