BACKGROUND
Technological advances in the analysis of cell-free DNA in maternal serum have allowed
expanded prenatal screening possibilities for fetal aneuploidies. The sensitivity
and positive predictive value of the assay are partly dependent on the amount of cell-free
DNA present in maternal circulation. Thus, it is important to know what fetal and
maternal factors influence the level of cell-free DNA in maternal circulation. Maternal
heparin use has been associated with an increase in nonreportable cell-free DNA results
because of a low fetal fraction in some, but not all, previous studies. In addition,
there are likely additional factors that affect cell-free DNA that remain uncharacterized.
OBJECTIVE
This study aimed to determine whether heparins, low-dose aspirin, and maternal clinical
factors affect the rate of nonreportable cell-free DNA testing results.
STUDY DESIGN
A retrospective cohort study was conducted using pregnant people receiving cell-free
fetal DNA testing from January 1, 2014, to June 30, 2018. Data were collected on patient
demographics, medical comorbidities, medication use, and cell-free DNA test results.
Univariate and multivariate analyses were performed to determine which factors were
independently associated with the rate of nonreportable results.
RESULTS
From an original sample of 1117 pregnant people, 743 met the inclusion criteria. Maternal
weight (odds ratio, 1.02), heparin use (odds ratio, 12.06), aspirin use (odds ratio,
4.70), chronic hypertension (odds ratio, 5.26), pregestational diabetes mellitus (odds
ratio, 2.46), and autoimmune disease (odds ratio, 3.59) were significantly associated
with an increased rate of nonreportable results in the univariate analysis. Moreover,
the association was present for maternal weight (odds ratio, 1.02), heparin use (odds
ratio, 21.87),and aspirin use (odds ratio, 2.85) in the multivariate analysis.
CONCLUSION
The previously seen association between maternal heparin use and an increase in nonreportable
cell-free DNA results was confirmed. Furthermore, there seems to be an increase in
nonreportable results in pregnant people taking low-dose aspirin. Providers should
consider the effect of these medications when counseling patients on prenatal genetic
screening options.
Key words
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Article info
Publication history
Published online: December 22, 2022
Accepted:
December 20,
2022
Received in revised form:
December 2,
2022
Received:
September 30,
2022
Footnotes
The authors report no conflict of interest.
Data from this manuscript was presented as an oral abstract at the 2019 American College of Obstetricians and Gynecologists Annual Clinical and Scientific Meeting, Nashville, TN, May 5, 2019.
Cite this article as: Nitsche JF, Lovell D, Stephens N, et al. The effects of heparin, aspirin, and maternal clinical factors on the rate of nonreportable cell-free DNA results: a retrospective cohort study. Am J Obstet Gynecol MFM 2022;XX:x.ex–x.ex.
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