The University of Southampton
University of Southampton Institutional Repository

Fetal hydrops and the Incremental yield of Next generation sequencing over standard prenatal Diagnostic testing ( FIND) study: prospective cohort study and meta‐analysis

Fetal hydrops and the Incremental yield of Next generation sequencing over standard prenatal Diagnostic testing ( FIND) study: prospective cohort study and meta‐analysis
Fetal hydrops and the Incremental yield of Next generation sequencing over standard prenatal Diagnostic testing ( FIND) study: prospective cohort study and meta‐analysis

Objective: To determine the incremental yield of exome sequencing (ES) over chromosomal microarray analysis (CMA) or karyotyping in prenatally diagnosed non-immune hydrops fetalis (NIHF). Methods: A prospective cohort study (comprising an extended group of the Prenatal Assessment of Genomes and Exomes (PAGE) study) was performed which included 28 cases of prenatally diagnosed NIHF undergoing trio ES following negative CMA or karyotyping. These cases were combined with data from a systematic review of the literature. MEDLINE, EMBASE, CINAHL and ClinicalTrials.gov databases were searched electronically (January 2000 to October 2020) for studies reporting on the incremental yield of ES over CMA or karyotyping in fetuses with prenatally detected NIHF. Inclusion criteria for the systematic review were: (i) at least two cases of NIHF undergoing sequencing; (ii) testing initiated based on prenatal ultrasound-based phenotype; and (iii) negative CMA or karyotyping result. The incremental diagnostic yield of ES was assessed in: (i) all cases of NIHF; (ii) isolated NIHF; (iii) NIHF associated with an additional fetal structural anomaly; and (iv) NIHF according to severity (i.e. two vs three or more cavities affected). Results: In the extended PAGE study cohort, the additional diagnostic yield of ES over CMA or karyotyping was 25.0% (7/28) in all NIHF cases, 21.4% (3/14) in those with isolated NIHF and 28.6% (4/14) in those with non-isolated NIHF. In the meta-analysis, the pooled incremental yield based on 21 studies (306 cases) was 29% (95% CI, 24–34%; P < 0.00001; I 2 = 0%) in all NIHF, 21% (95% CI, 13–30%; P < 0.00001; I 2 = 0%) in isolated NIHF and 39% (95% CI, 30–49%; P < 0.00001; I 2 = 1%) in NIHF associated with an additional fetal structural anomaly. In the latter group, congenital limb contractures were the most prevalent additional structural anomaly associated with a causative pathogenic variant, occurring in 17.3% (19/110) of cases. The incremental yield did not differ significantly according to hydrops severity. The most common genetic disorders identified were RASopathies, occurring in 30.3% (27/89) of cases with a causative pathogenic variant, most frequently due to a PTPN11 variant (44.4%; 12/27). The predominant inheritance pattern in causative pathogenic variants was autosomal dominant in monoallelic disease genes (57.3%; 51/89), with most being de novo (86.3%; 44/51). Conclusions: Use of prenatal next-generation sequencing in both isolated and non-isolated NIHF should be considered in the development of clinical pathways. Given the wide range of potential syndromic diagnoses and heterogeneity in the prenatal phenotype of NIHF, exome or whole-genome sequencing may prove to be a more appropriate testing approach than a targeted gene panel testing strategy.

exome sequencing, fetus, hydrops, next-generation sequencing, non-immune hydrops fetalis, prenatal diagnosis
0960-7692
509-518
Mone, F.
49745004-d6b1-4148-a590-b59c0d8391b3
Eberhardt, R. Y.
e37e84f9-2995-4c17-9a7a-95bdb728dee9
Hurles, M. E.
2994beb2-99f7-4e38-bf23-3a1ee3f64680
Mcmullan, D. J.
587a5c48-6111-46f2-8b0c-4f7106371885
Maher, E. R.
8e53ca29-51dc-47fd-b666-746ea2d06cc5
Lord, Jenny
e1909780-36cd-4705-b21e-4580038d4ec6
Chitty, L. S.
8bf54b06-f21f-4bf1-b7ed-8d61cce9ebbc
Dempsey, E.
c8a50d69-eb43-403a-9eca-533d0c11f681
Homfray, T.
3db2bf84-e841-4d95-b318-de5f68a7653f
Giordano, J. L.
35fc9c1b-c8e6-47f9-877d-4704f04d00ce
Wapner, R. J.
9e18edb7-6c0f-4fec-a678-7cbdf195c9ef
Sun, L.
f11eeb8b-51de-4c11-82ad-8811880dfd70
Sparks, T. N.
27b8e27e-75e4-4056-8bd3-03924816f6e6
Norton, M E
e2dcd6ff-bc12-47cf-8b99-6fafd15a438c
Kilby, M. D.
dc85a6f2-acb0-4a0b-afbc-2aed41cb9ad5
Mone, F.
49745004-d6b1-4148-a590-b59c0d8391b3
Eberhardt, R. Y.
e37e84f9-2995-4c17-9a7a-95bdb728dee9
Hurles, M. E.
2994beb2-99f7-4e38-bf23-3a1ee3f64680
Mcmullan, D. J.
587a5c48-6111-46f2-8b0c-4f7106371885
Maher, E. R.
8e53ca29-51dc-47fd-b666-746ea2d06cc5
Lord, Jenny
e1909780-36cd-4705-b21e-4580038d4ec6
Chitty, L. S.
8bf54b06-f21f-4bf1-b7ed-8d61cce9ebbc
Dempsey, E.
c8a50d69-eb43-403a-9eca-533d0c11f681
Homfray, T.
3db2bf84-e841-4d95-b318-de5f68a7653f
Giordano, J. L.
35fc9c1b-c8e6-47f9-877d-4704f04d00ce
Wapner, R. J.
9e18edb7-6c0f-4fec-a678-7cbdf195c9ef
Sun, L.
f11eeb8b-51de-4c11-82ad-8811880dfd70
Sparks, T. N.
27b8e27e-75e4-4056-8bd3-03924816f6e6
Norton, M E
e2dcd6ff-bc12-47cf-8b99-6fafd15a438c
Kilby, M. D.
dc85a6f2-acb0-4a0b-afbc-2aed41cb9ad5

Mone, F., Eberhardt, R. Y., Hurles, M. E., Mcmullan, D. J., Maher, E. R., Lord, Jenny, Chitty, L. S., Dempsey, E., Homfray, T., Giordano, J. L., Wapner, R. J., Sun, L., Sparks, T. N., Norton, M E and Kilby, M. D. (2021) Fetal hydrops and the Incremental yield of Next generation sequencing over standard prenatal Diagnostic testing ( FIND) study: prospective cohort study and meta‐analysis. Ultrasound in Obstetrics & Gynecology, 58 (4), 509-518. (doi:10.1002/uog.23652).

Record type: Review

Abstract

Objective: To determine the incremental yield of exome sequencing (ES) over chromosomal microarray analysis (CMA) or karyotyping in prenatally diagnosed non-immune hydrops fetalis (NIHF). Methods: A prospective cohort study (comprising an extended group of the Prenatal Assessment of Genomes and Exomes (PAGE) study) was performed which included 28 cases of prenatally diagnosed NIHF undergoing trio ES following negative CMA or karyotyping. These cases were combined with data from a systematic review of the literature. MEDLINE, EMBASE, CINAHL and ClinicalTrials.gov databases were searched electronically (January 2000 to October 2020) for studies reporting on the incremental yield of ES over CMA or karyotyping in fetuses with prenatally detected NIHF. Inclusion criteria for the systematic review were: (i) at least two cases of NIHF undergoing sequencing; (ii) testing initiated based on prenatal ultrasound-based phenotype; and (iii) negative CMA or karyotyping result. The incremental diagnostic yield of ES was assessed in: (i) all cases of NIHF; (ii) isolated NIHF; (iii) NIHF associated with an additional fetal structural anomaly; and (iv) NIHF according to severity (i.e. two vs three or more cavities affected). Results: In the extended PAGE study cohort, the additional diagnostic yield of ES over CMA or karyotyping was 25.0% (7/28) in all NIHF cases, 21.4% (3/14) in those with isolated NIHF and 28.6% (4/14) in those with non-isolated NIHF. In the meta-analysis, the pooled incremental yield based on 21 studies (306 cases) was 29% (95% CI, 24–34%; P < 0.00001; I 2 = 0%) in all NIHF, 21% (95% CI, 13–30%; P < 0.00001; I 2 = 0%) in isolated NIHF and 39% (95% CI, 30–49%; P < 0.00001; I 2 = 1%) in NIHF associated with an additional fetal structural anomaly. In the latter group, congenital limb contractures were the most prevalent additional structural anomaly associated with a causative pathogenic variant, occurring in 17.3% (19/110) of cases. The incremental yield did not differ significantly according to hydrops severity. The most common genetic disorders identified were RASopathies, occurring in 30.3% (27/89) of cases with a causative pathogenic variant, most frequently due to a PTPN11 variant (44.4%; 12/27). The predominant inheritance pattern in causative pathogenic variants was autosomal dominant in monoallelic disease genes (57.3%; 51/89), with most being de novo (86.3%; 44/51). Conclusions: Use of prenatal next-generation sequencing in both isolated and non-isolated NIHF should be considered in the development of clinical pathways. Given the wide range of potential syndromic diagnoses and heterogeneity in the prenatal phenotype of NIHF, exome or whole-genome sequencing may prove to be a more appropriate testing approach than a targeted gene panel testing strategy.

Text
uog.23652 - Accepted Manuscript
Download (2MB)

More information

Accepted/In Press date: 29 March 2021
e-pub ahead of print date: 13 April 2021
Published date: October 2021
Additional Information: Funding Information: R.Y.E. and J.L. report grants from the Health Innovation Challenge Fund during the conduct of the PAGE study. D.J.M. reports grants for travel expenses from Congenica to attend educational symposia during the conduct of the PAGE study. M.E.H. reports grants from the Wellcome Trust and the UK Government Department of Health during the conduct of the study and personal fees from Congenica, outside of the submitted work. M.D.K. is a member of Illumina's International Perinatal Advisory Group (but receives no payment for this) and is the Fetal Medicine Representative for the Central and South GLH. He is also the Royal College of Obstetricians and Gynaecologists' (RCOG) representative on the Joint Colleges Committee of Genomic and Genetic Medicine and the RCOG Genomic Taskforce. E.R.M. has received travel expenses, accommodation and consultant fees for participating in an Illumina International Advisory Group after completion of the PAGE study. M.D.K. is funded through the Department of Health, Wellcome Trust and Health Innovation Challenge Fund (award number HICF‐R7‐396) for the PAGE and PAGE2 research studies completed in August 2019. L.S.C. was funded partially by the same group in relation to the PAGE study. R.J.W. receives funding from Illumina and NIH for research. M.E.N. has been funded from Ultragenyx and the NIH for research relevant to included cases. Funding Information: The PAGE study was supported by a Health Innovation Challenge from the UK Department of Health and Wellcome Trust (no. HICF-R7-396). We are grateful to Jane Fisher from?Antenatal Results and Choices and to Michael Parker of The Ethox Centre, Nuffield Department of Population Health and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK, for their valuable input to the study. We are also grateful to the members of the PAGE study clinical review panel. L.S.C., a NIHR Senior Investigator, is funded partially by the National Institute for Health Research (NIHR) Biomedical Research Centre at Great Ormond Street Hospital, London, UK. E.R.M. acknowledges support from NIHR Cambridge Biomedical Research Centre, Cambridge, UK (NIHR Senior Investigator Award). The University of Cambridge, Cambridge, UK, has received salary support with regard to E.R.M. from the UK National Health Service (NHS) in the East of England through the Clinical Academic Reserve. The views expressed herein are those of the authors and not necessarily those of the NIHR, NHS or Department of Health. R.Y.E. and J.L. report grants from the Health Innovation Challenge Fund during the conduct of the PAGE study. D.J.M. reports grants for travel expenses from Congenica to attend educational symposia during the conduct of the PAGE study. M.E.H. reports grants from the Wellcome Trust and the UK Government Department of Health during the conduct of the study and personal fees from Congenica, outside of the submitted work. M.D.K. is a member of Illumina's International Perinatal Advisory Group (but receives no payment for this) and is the Fetal Medicine Representative for the Central and South GLH. He is also the Royal College of Obstetricians and Gynaecologists' (RCOG) representative on the Joint Colleges Committee of Genomic and Genetic Medicine and the RCOG Genomic Taskforce. E.R.M. has received travel expenses, accommodation and consultant fees for participating in an Illumina International Advisory Group after completion of the PAGE study. M.D.K. is funded through the Department of Health, Wellcome Trust and Health Innovation Challenge Fund (award number HICF-R7-396) for the PAGE and PAGE2 research studies completed in August 2019. L.S.C. was funded partially by the same group in relation to the PAGE study. R.J.W. receives funding from Illumina and NIH for research. M.E.N. has been funded from Ultragenyx and the NIH for research relevant to included cases. Funding Information: The PAGE study was supported by a Health Innovation Challenge from the UK Department of Health and Wellcome Trust (no. HICF‐R7‐396). We are grateful to Jane Fisher from Antenatal Results and Choices and to Michael Parker of The Ethox Centre, Nuffield Department of Population Health and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK, for their valuable input to the study. We are also grateful to the members of the PAGE study clinical review panel. L.S.C., a NIHR Senior Investigator, is funded partially by the National Institute for Health Research (NIHR) Biomedical Research Centre at Great Ormond Street Hospital, London, UK. E.R.M. acknowledges support from NIHR Cambridge Biomedical Research Centre, Cambridge, UK (NIHR Senior Investigator Award). The University of Cambridge, Cambridge, UK, has received salary support with regard to E.R.M. from the UK National Health Service (NHS) in the East of England through the Clinical Academic Reserve. The views expressed herein are those of the authors and not necessarily those of the NIHR, NHS or Department of Health. Publisher Copyright: © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Keywords: exome sequencing, fetus, hydrops, next-generation sequencing, non-immune hydrops fetalis, prenatal diagnosis

Identifiers

Local EPrints ID: 449248
URI: http://eprints.soton.ac.uk/id/eprint/449248
ISSN: 0960-7692
PURE UUID: ef3e8dbe-dd37-4651-9bbd-0bab3398606c
ORCID for Jenny Lord: ORCID iD orcid.org/0000-0002-0539-9343

Catalogue record

Date deposited: 20 May 2021 16:32
Last modified: 17 Mar 2024 06:34

Export record

Altmetrics

Contributors

Author: F. Mone
Author: R. Y. Eberhardt
Author: M. E. Hurles
Author: D. J. Mcmullan
Author: E. R. Maher
Author: Jenny Lord ORCID iD
Author: L. S. Chitty
Author: E. Dempsey
Author: T. Homfray
Author: J. L. Giordano
Author: R. J. Wapner
Author: L. Sun
Author: T. N. Sparks
Author: M E Norton
Author: M. D. Kilby

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×