Influence of maternal BMI on genetic sonography in the FaSTER trial

Kjersti M. Aagaard-Tillery, T. Flint Porter, Fergal D. Malone, David A. Nyberg, Jamie Collins, Christine H. Comstock, Gary Hankins, Keith Eddleman, Lorraine Dugoff, Honor M. Wolfe, Mary E. D'Alton

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Objective: We sought to evaluate the influence of maternal body mass index (BMI) on sonographic detection employing data from the FaSTER trial. Method: Unselected singleton pregnancies underwent detailed genetic sonogram to evaluate for structural fetal anomalies and soft markers for aneuploidy. BMI (kg/m 2) were calculated from reported initial visit values. Sensitivity, specificity, false positive and false negative rates (FPR and FNR), likelihood ratio, detection rates, and a missed diagnosis rate (MDR: FNR + marker recorded as 'missing'/N) were calculated. Results: Eight thousand five hundred and fifty-five patients with complete BMI information had detailed genetic sonography. A lower sensitivity with an elevated FNR and MDR was observed in obese women for multiple aneuploid markers (e.g. ≥2 markers 32% sensitivity with 68% FNR among BMI <25 vs 22% and 78% among BMI >30). Similarly, the detection rate for cardiac anomalies among women at BMI <25 was higher (21.6%) at a significantly lower FPR (78.4%; 95% CI 77.3-79.5%) in comparison to obese women (8.3% with FPR 91.7%; 95% CI 90.1-93.2%). In a logistic regression model, maternal obesity significantly decreased the likelihood of sonographic detection of common anomalies (adjusted OR 0.7; 95% CI 0.6-0.9; p = 0.001). Conclusion: The performance of second trimester genetic sonography is influenced by obesity, with a significantly higher MDR for multiple minor markers and lower likelihood for detecting common anomalies.

Original languageEnglish (US)
Pages (from-to)14-22
Number of pages9
JournalPrenatal Diagnosis
Volume30
Issue number1
DOIs
StatePublished - Jan 2010

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Ultrasonography
Body Mass Index
Mothers
Aneuploidy
Obesity
Logistic Models
Second Pregnancy Trimester
Sensitivity and Specificity
Pregnancy

Keywords

  • Detection of fetal aneuploidy
  • Fetal Down syndrome markers
  • Fetal genetic sonogram
  • Nuchal translucency
  • Obesity
  • Prenatal sonography
  • Trisomy 21 detection

ASJC Scopus subject areas

  • Genetics(clinical)
  • Obstetrics and Gynecology

Cite this

Aagaard-Tillery, K. M., Flint Porter, T., Malone, F. D., Nyberg, D. A., Collins, J., Comstock, C. H., ... D'Alton, M. E. (2010). Influence of maternal BMI on genetic sonography in the FaSTER trial. Prenatal Diagnosis, 30(1), 14-22. https://doi.org/10.1002/pd.2399

Influence of maternal BMI on genetic sonography in the FaSTER trial. / Aagaard-Tillery, Kjersti M.; Flint Porter, T.; Malone, Fergal D.; Nyberg, David A.; Collins, Jamie; Comstock, Christine H.; Hankins, Gary; Eddleman, Keith; Dugoff, Lorraine; Wolfe, Honor M.; D'Alton, Mary E.

In: Prenatal Diagnosis, Vol. 30, No. 1, 01.2010, p. 14-22.

Research output: Contribution to journalArticle

Aagaard-Tillery, KM, Flint Porter, T, Malone, FD, Nyberg, DA, Collins, J, Comstock, CH, Hankins, G, Eddleman, K, Dugoff, L, Wolfe, HM & D'Alton, ME 2010, 'Influence of maternal BMI on genetic sonography in the FaSTER trial', Prenatal Diagnosis, vol. 30, no. 1, pp. 14-22. https://doi.org/10.1002/pd.2399
Aagaard-Tillery KM, Flint Porter T, Malone FD, Nyberg DA, Collins J, Comstock CH et al. Influence of maternal BMI on genetic sonography in the FaSTER trial. Prenatal Diagnosis. 2010 Jan;30(1):14-22. https://doi.org/10.1002/pd.2399
Aagaard-Tillery, Kjersti M. ; Flint Porter, T. ; Malone, Fergal D. ; Nyberg, David A. ; Collins, Jamie ; Comstock, Christine H. ; Hankins, Gary ; Eddleman, Keith ; Dugoff, Lorraine ; Wolfe, Honor M. ; D'Alton, Mary E. / Influence of maternal BMI on genetic sonography in the FaSTER trial. In: Prenatal Diagnosis. 2010 ; Vol. 30, No. 1. pp. 14-22.
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abstract = "Objective: We sought to evaluate the influence of maternal body mass index (BMI) on sonographic detection employing data from the FaSTER trial. Method: Unselected singleton pregnancies underwent detailed genetic sonogram to evaluate for structural fetal anomalies and soft markers for aneuploidy. BMI (kg/m 2) were calculated from reported initial visit values. Sensitivity, specificity, false positive and false negative rates (FPR and FNR), likelihood ratio, detection rates, and a missed diagnosis rate (MDR: FNR + marker recorded as 'missing'/N) were calculated. Results: Eight thousand five hundred and fifty-five patients with complete BMI information had detailed genetic sonography. A lower sensitivity with an elevated FNR and MDR was observed in obese women for multiple aneuploid markers (e.g. ≥2 markers 32{\%} sensitivity with 68{\%} FNR among BMI <25 vs 22{\%} and 78{\%} among BMI >30). Similarly, the detection rate for cardiac anomalies among women at BMI <25 was higher (21.6{\%}) at a significantly lower FPR (78.4{\%}; 95{\%} CI 77.3-79.5{\%}) in comparison to obese women (8.3{\%} with FPR 91.7{\%}; 95{\%} CI 90.1-93.2{\%}). In a logistic regression model, maternal obesity significantly decreased the likelihood of sonographic detection of common anomalies (adjusted OR 0.7; 95{\%} CI 0.6-0.9; p = 0.001). Conclusion: The performance of second trimester genetic sonography is influenced by obesity, with a significantly higher MDR for multiple minor markers and lower likelihood for detecting common anomalies.",
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AU - Collins, Jamie

AU - Comstock, Christine H.

AU - Hankins, Gary

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AU - D'Alton, Mary E.

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N2 - Objective: We sought to evaluate the influence of maternal body mass index (BMI) on sonographic detection employing data from the FaSTER trial. Method: Unselected singleton pregnancies underwent detailed genetic sonogram to evaluate for structural fetal anomalies and soft markers for aneuploidy. BMI (kg/m 2) were calculated from reported initial visit values. Sensitivity, specificity, false positive and false negative rates (FPR and FNR), likelihood ratio, detection rates, and a missed diagnosis rate (MDR: FNR + marker recorded as 'missing'/N) were calculated. Results: Eight thousand five hundred and fifty-five patients with complete BMI information had detailed genetic sonography. A lower sensitivity with an elevated FNR and MDR was observed in obese women for multiple aneuploid markers (e.g. ≥2 markers 32% sensitivity with 68% FNR among BMI <25 vs 22% and 78% among BMI >30). Similarly, the detection rate for cardiac anomalies among women at BMI <25 was higher (21.6%) at a significantly lower FPR (78.4%; 95% CI 77.3-79.5%) in comparison to obese women (8.3% with FPR 91.7%; 95% CI 90.1-93.2%). In a logistic regression model, maternal obesity significantly decreased the likelihood of sonographic detection of common anomalies (adjusted OR 0.7; 95% CI 0.6-0.9; p = 0.001). Conclusion: The performance of second trimester genetic sonography is influenced by obesity, with a significantly higher MDR for multiple minor markers and lower likelihood for detecting common anomalies.

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KW - Prenatal sonography

KW - Trisomy 21 detection

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