Implementation of maternal blood cell-free DNA testing in early screening for aneuploidies.

Several externally blinded validation and implementation studies in the last 9 years have shown that it is now possible, through analysis of cell-free (cf) DNA in maternal blood, to effectively detect a high proportion of fetuses affected by trisomies 21, 18, and 13 at a much lower false-positive rate (FPR) than all other existing screening methods. This article is aimed at reviewing technical and clinical considerations for implementing cfDNA testing in routine practice, including methods of analysis, performance of the test, models for clinical implementation, and interpretation of results.post-print305 K

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The Fetal Growth Restriction at Term Managed by Angiogenic Factors Versus Feto-Maternal Doppler (GRAFD) Trial to Avoid Adverse Perinatal Outcomes: Protocol for a Multicenter, Open-Label, Randomized Controlled Trial.

Background: Fetal smallness affects 10% of pregnancies. Small fetuses are at a higher risk of adverse outcomes. Their management using estimated fetal weight and feto-maternal Doppler has a high sensitivity for adverse outcomes; however, more than 60% of fetuses are electively delivered at 37 to 38 weeks. On the other hand, classification using angiogenic factors seems to have a lower false-positive rate. Here, we present a protocol for the Fetal Growth Restriction at Term Managed by Angiogenic Factors Versus Feto-Maternal Doppler (GRAFD) trial, which compares the use of angiogenic factors and Doppler to manage small fetuses at term. Objective: The primary objective is to demonstrate that classification based on angiogenic factors is not inferior to estimated fetal weight and Doppler at detecting fetuses at risk of adverse perinatal outcomes. Methods: This is a multicenter, open-label, randomized controlled trial conducted in 20 hospitals across Spain. A total of 1030 singleton pregnancies with an estimated fetal weight ≤10th percentile at 36+0 to 37+6 weeks+days will be recruited and randomly allocated to either the control or the intervention group. In the control group, standard Doppler-based management will be used. In the intervention group, cases with a soluble fms-like tyrosine kinase to placental growth factor ratio ≥38 will be classified as having fetal growth restriction; otherwise, they will be classified as being small for gestational age. In both arms, the fetal growth restriction group will be delivered at ≥37 weeks and the small for gestational age group at ≥40 weeks. We will assess differences between the groups by calculating the relative risk, the absolute difference between incidences, and their 95% CIs. Results: Recruitment for this study started on September 28, 2020. The study results are expected to be published in peer-reviewed journals and disseminated at international conferences in early 2023. Conclusions: The angiogenic factor–based protocol may reduce the number of pregnancies classified as having fetal growth restriction without worsening perinatal outcomes. Moreover, reducing the number of unnecessary labor inductions would reduce costs and the risks derived from possible iatrogenic complications. Additionally, fewer inductions would lower the rate of early-term neonates, thus improving neonatal outcomes and potentially reducing long-term infant morbidities.post-print467 K

The roll of placental growth in the prediction of preeclampsia in asymptomatic women:systematic review of the literature and meta-analysis. Hierarchical models for meta-analysis of diagnostic test accuracy

Depto. de Estadística y Ciencia de los DatosFac. de Estudios EstadísticosFALSEsubmitte

Genome-Wide Cell-Free DNA Test for Fetal Chromosomal Abnormalities and Variants: Unrestricted Versus Restricted Reporting.

This study aimed to compare the screening performance of genome-wide cfDNA testing for chromosomal abnormalities between two periods where additional findings were reported and not reported. Data were obtained from consecutive pregnant women with a singleton pregnancy at ≥10 weeks who requested cfDNA testing during 2015–2019. The performance of screening of the cfDNA test was determined by calculating the concordance rate, detection rate, and false-positive rate. Data from 3981 women were included. The no-result rates were similar between the two reporting periods (2.04% vs. 2.08%). Concordance rates for trisomy 21 and 18 were 100% and 100%, respectively. There were two cases tested high risk for trisomy 13, with a concordance rate of 0%. In total, 12 cases were high risk for any sex chromosome aneuploidy with an overall concordance of 75%, and 15 cases tested high risk for any rare autosomal trisomy, with a 13.3% concordance rate. The detection rates for trisomy 21 and 18 were 100% and 100%, respectively. For any SCA, the detection rate was 90%. For the two reporting periods, the combined false-positive rates were 0.93% and 0.17%, which were significantly different (p = 0.002). Restricting the reporting of additional findings from genome-wide cfDNA analysis has reduced the false-positive rate but without a reduction in the no-result rate.post-print474 K

Valoración por parte de los estudiantes de la utilización de material audio-visual docente

V Jornada Nacional sobre estudios universitarios y I Taller de Innovación EducativaEs fundamental la investigación relacionada con la búsqueda de herramientas que faciliten el aprendizaje de los estudiantes y la puesta en práctica de los conocimientos adquiridos. En este sentido, nos pueden resultar de ayuda las Tecnologías de la Información y la Comunicación (tic) como el uso de material audio-visual. En el ámbito de la Psicología Clínica, con este material audio-visual se puede fomentar el aprendizaje vicario de las técnicas de intervención a partir de la observación de la aplicación de las mismas en casos reales. En el marco de un proyecto de mejora educativa se ha desarrollado material especializado para el apoyo a la docencia fortaleciendo el uso de la tecnología en el proceso de enseñanza-aprendizaje en la formación profesional del psicólogo. El objetivo del presente trabajo es presentar la valoración por parte de los estudiantes de material audiovisual en lengua inglesa utilizado en los seminarios de casos incluidos en la asignatura PS1034 Evaluación e Intervención Clínica del Grado en Psicología de la Universitat Jaume I. El material consiste en un video demostrativo en lengua inglesa en el que mediante un role playing se ejemplifican distintas técnicas terapéuticas aplicadas a un caso real de Trastorno Obsesivo Compulsivo (toc). Participaron un total de 59 alumnos (51 de ellos mujeres y 8 hombres) con una media de edad de 24,89 años (DT= 8.29) de 4º curso del Grado de Psicología. Después de visionar el vídeo, contestaron a la Escala de valoración del material audio-visual en lengua inglesa desarrollada para el presente estudio. Los alumnos valoraron en dicha escala, de 0 a 10, su opinión acerca de: Aprendizaje a través de materiales audio-visuales; Atractivo del material; Calidad del material; Contenido; Interés y motivación; Utilidad; Grado en que les había ayudado a conocer el tratamiento del toc; Dificultad; Ayuda proporcionada; Grado de ayuda en el aprendizaje del inglés y Satisfacción global. La media de puntuaciones en cada uno de los aspectos valorados superó los 7 puntos, siendo la satisfacción global de la actividad de 8,15. Además, se observaron correlaciones positivas y significativas entre la motivación e interés de los alumnos y la utilidad percibida del material a la hora de transmitirles conocimientos sobre el tratamiento del toc (r=0,64). También, entre la calidad percibida de material audio-visual y el atractivo que tuvo para ellos aprender a través de esta herramienta (r=0,61). Las puntuaciones muestran que la opinión de los alumnos en relación al material audio-visual en lengua inglesa utilizado fue muy buena. Esto apoya las acciones de fomentar la utilización de las tics en la impartición de las clases. Además, los resultados muestran que cuanto más motivados e interesados estaban percibían que les había sido más útil, lo que pone de manifiesto la importancia de trabajar la motivación a la hora de realizar este tipo de actividades. Por último, la relación entre la calidad del material y el atractivo que tiene para ellos a la hora de aprender muestra la importancia de utilizar buenos materiales

First-trimester screening for trisomies by cfDNA testing of maternal blood in singleton and twin pregnancies: factors affecting test failure.

Objectives: To examine factors affecting the failure rate to obtain a result from (cf) DNA testing of maternal blood for fetal trisomies 21, 18 and 13 in singleton and twin pregnancies in the first trimester of pregnancy. Methods: This was a prospective study in 23,495 singleton and 928 twin pregnancies undergoing screening for fetal trisomies by targeted cfDNA testing at 10+0-14+1 weeks’ gestation. Multivariate regression analysis was used to determine significant predictors of failure to obtain a result after first sampling. Results: There was no result from cfDNA testing after first sampling in 3.4% (798/23,495) of singletons, 11.3% (91/806) of DC twins and in 4.9% (6/122) of MC twins. Multivariate logistic regression analysis demonstrated that the risk of test failure first, increased with increasing maternal age (odds ratio (OR) 1.02; 95% confidence interval (CI) 1.01, 1.04) and weight (OR 1.05; 95% CI 1.04, 1.05), decreasing gestational age (OR 0.85; 95% CI 0.79, 0.91) and serum PAPP-A (OR 0.56; 95% CI 0.49, 0.64) and free ß-hCG (OR 0.67; 95% CI 0.60, 0.74), second, was higher in women of Black (OR 1.72; 95% CI 1.33, 2.20) and South Asian (OR 1.99; 95% CI 1.56, 2.52) than White racial origin, in dichorionic twin (OR 1.75; 95% CI 1.34, 2.25) than singleton pregnancy and in in vitro fertilization (OR 3.82; 95% CI 3.19, 4.55) than natural conception and third, was lower in parous (OR 0.63; 95% CI 0.55, 0.74) than nulliparous women. Conclusions: Maternal age, weight, racial origin and parity, gestational age, dichorionicity, method of conception and serum levels of free ß-hCG and PAPP-A are independent predictors of cfDNA test failure. The risk of test failure is higher in dichorionic twin than in singleton pregnancies, mainly because a higher proportion of twins are conceived by in vitro fertilization and more of the women are nulliparous.pre-print429 K

Valoración por parte de los estudiantes universitarios de la utilización de material audiovisual en lengua inglesa en el aula.

V Jornada Nacional sobre estudios universitarios y I Taller de Innovación Educativa.Cada vez más el multilingüismo entre estudiantes y docentes en la universidad española cobra mayor importancia. En la actualidad, en la Universitat Jaume I existen algunas medidas que fomentan el uso de lenguas extranjeras entre la comunidad universitaria, todas ellas comprendidas en el Plan Plurianual de Multilingüismo de dicha universidad. Además, cada vez más se percibe el inglés como un instrumento necesario para la comunicación y empleabilidad. Como indica Alcón (2011), hay que ir un paso más allá de la utilización del inglés para la difusión de la investigación. En este sentido, una asignatura pendiente en las universidades españolas es el uso de las lenguas, especialmente el inglés, en la docencia. Es de vital importancia el desarrollo y uso en el aula de materiales docentes en lengua inglesa. Por otra parte, la utilización de material audiovisual ofrece grandes posibilidades a la hora de transmitir y adquirir conocimientos. El objetivo de este trabajo es analizar la opinión de los estudiantes universitarios acerca del uso de material audiovisual docente desarrollado en lengua inglesa. Además, se estudiará la relación entre el interés que suscitó el contenido del material mostrado en versión original y la satisfacción global que los participantes manifestaron en la actividad. Formaron parte del estudio un total de 77 participantes (76,6% mujeres y 19,5% hombres), todos ellos estudiantes de 4º de Grado en Psicología que cursaban la asignatura PS1034 Evaluación e Intervención Clínica. La media de edad fue de 23,77 (DT=6,44). Los estudiantes visionaron un video en versión original (inglés) de 45 min de duración. Posteriormente, los participantes contestaron la “Escala de Valoración de Material Audiovisual en lengua inglesa” desarrollada para este estudio y formada por 11 ítems que valoraban aspectos relacionados con el material presentado en el aula, así como la satisfacción global, en escalas de 0 a 10. En general, la media de las puntuaciones obtenidas para los diferentes ítems fue superior a 7. Se observaron correlaciones positivas significativas entre el interés y motivación suscitado por el material presentado y la valoración de la satisfacción global con la actividad (r=.54). Finalmente, con este trabajo se pretende contribuir al desarrollo de material especializado para el apoyo a la docencia en lengua inglesa y, de esta forma, fomentar la incorporación de esta lengua en el proceso enseñanza-aprendizaje beneficiando tanto a los alumnos como a los docentes

Protocol for a sequential, prospective metaanalysis to describe coronavirus disease 2019 (COVID-19) in the pregnancy and postpartum periods.

We urgently need answers to basic epidemiological questions regarding SARS-CoV-2 infection in pregnant and postpartum women and its effect on their newborns. While many national registries, health facilities, and research groups are collecting relevant data, we need a collaborative and methodologically rigorous approach to better combine these data and address knowledge gaps, especially those related to rare outcomes. We propose that using a sequential, prospective meta-analysis (PMA) is the best approach to generate data for policy- and practice-oriented guidelines. As the pandemic evolves, additional studies identified retrospectively by the steering committee or through living systematic reviews will be invited to participate in this PMA. Investigators can contribute to the PMA by either submitting individual patient data or running standardized code to generate aggregate data estimates. For the primary analysis, we will pool data using two-stage meta-analysis methods. The meta-analyses will be updated as additional data accrue in each contributing study and as additional studies meet study-specific time or data accrual thresholds for sharing. At the time of publication, investigators of 25 studies, including more than 76,000 pregnancies, in 41 countries had agreed to share data for this analysis. Among the included studies, 12 have a contemporaneous comparison group of pregnancies without COVID-19, and four studies include a comparison group of non-pregnant women of reproductive age with COVID-19. Protocols and updates will be maintained publicly. Results will be shared with key stakeholders, including the World Health Organization (WHO) Maternal, Newborn, Child, and Adolescent Health (MNCAH) Research Working Group. Data contributors will share results with local stakeholders. Scientific publications will be published in open-access journals on an ongoing basis.post-print641 K

Web-based, self-help intervention for Adjustment Disorders: acceptance and usability

Despite having proved their efficacy, Internet-based interventions (IBI) have not yet been implemented in health care settings. The acceptability of these interventions may be one key barrier. The present work aims to assess the acceptability and usability of a Web-based self-help intervention (TAO) for Adjustment disorders (AD) among 7 patients with AD and 15 clinicians. The intervention was well accepted and described as user-friendly by both samples. Furthermore, results of this work suggest that certain aspects should be considered during the development of IBI in order to promote adherence and achieve the desired changes. To our knowledge, this is the first work to explore specific features of an IBI that might impact users' satisfaction and adherence