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Objective To identify and determine the optimal method to screening for fetal Down’s syndrome (DS). Methods Three large cohorts with 17 118, 39 903, 16 646 subjects were enrolled for the first trimester double marker (pregnancy-associated plasma protein A and free β-human chorionic gonadotropin) screening (FTDMS), second trimester double marker (α-fetoprotein and free β-human chorionic gonadotropin) screening (STDMS), and second trimester triple marker (α-fetoprotein, free β-human chorionic gonadotropin and unconjugated estriol 3) screening (STTMS), respectively. The sensitivity, specificity, false positive rate (FPR), false negative rate (FNR) and the areas under ROC curves (AUCs) were estimated in order to determine the optimal screening method in women under or above 35 years old. Results For women under 35 years old, STTMS was the best method with a detection rate of 68.8% and FPR of 4.3% followed by the STDMS with a detection rate (sensitivity) of 66.7% and FPR of 4.9%. The FTDMS had a lower detection rate of 61.1% and FPR of 6.3%. For women above 35 years old, the detection rate of all the methods was similar, but STTMS method had a lowest FPR of 15.9%. For women under 35 years old AUCs were 0.77 (95% CI, 0.64 to 0.91), 0.81 (95% CI, 0.71 to 0.91), and 0.82 (95% CI, 0.69 to 0.96) for FTDMS, STDMS, and STTMS methods, respectively; for those above 35 years old, AUCs were 0.70 (95% CI, 0.56 to 0.83), 0.70 (95% CI, 0.59 to 0.82), 0.78 (95% CI, 0.58 to 0.97) for FTDMS, STDMS and STTMS , respectively. Conclusion Findings from our study revealed that STDMS is optimal for the detection of fetal DS in pregnant women aged under 35. For individual women, if economic condition permits, STTMS is the best choice, while for women aged above 35, STTMS is the best choice in this regard.
Objective To identify and determine the optimal method to screening for fetal Down’s syndrome (DS). Methods Three large cohorts with 17 118, 39 903, 16 646 subjects were enrolled for the first trimester double marker (pregnancy-associated plasma protein A and free β -human chorionic gonadotropin screening (FTDMS), second trimester double marker (STDMS), and second trimester triple marker (α-fetoprotein, free β-human chorionic gonadotropin and unconjugated estriol The sensitivity, specificity, false positive rate (FNR) and the areas under ROC curves (AUCs) were estimated in order to determine the optimal screening method in women under or above 35 years old. Results For women under 35 years old, STTMS was the best method with a detection rate of 68.8% and FPR of 4.3% followed by the STDMS with a detection rate (sensitivity) of 66.7% and FPR of 4.9%. The F TDMS had a lower detection rate of 61.1% and an FPR of 6.3%. For women above 35 years old, the detection rate of all the methods was similar, but STTMS method had a lowest FPR of 15.9%. For women under 35 years old AUCs were 0.77 (95% CI, 0.64 to 0.91), 0.81 (95% CI 0.71 to 0.91), and 0.82 (95% CI 0.69 to 0.96) for FTDMS, STDMS, and STTMS methods, respectively; old, AUCs were 0.70 (95% CI 0.56 to 0.83), 0.70 (95% CI 0.59 to 0.82), 0.78 (95% CI 0.58 to 0.97) for FTDMS, STDMS and STTMS, respectively. revealed that STDMS is optimal for the detection of fetal DS in pregnant women aged under 35. For individual women, if economic condition permits, STTMS is the best choice while while for women aged 35, STTMS is the best choice in this regard.