{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T17:08:38Z","timestamp":1771002518273,"version":"3.50.1"},"reference-count":20,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2006,7,5]],"date-time":"2006-07-05T00:00:00Z","timestamp":1152057600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Prenatal Diagnosis"],"published-print":{"date-parts":[[2006,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To compare the Integrated test in three policies for prenatal Down syndrome screening: Integrated screening for all women, sequential screening (first\u2010trimester tests allowing early completion of screening for high\u2010risk pregnancies), and Contingent screening (early completion of screening for high\u2010 and low\u2010risk pregnancies).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and Methods<\/jats:title><jats:p>Estimation of detection rates (DRs) and false\u2010positive rates (FPRs) using Monte Carlo simulation and cost effectiveness for each method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting and Population<\/jats:title><jats:p>Down syndrome affected and unaffected pregnancies studied in the Serum Urine and Ultrasound Screening Study (SURUSS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results and Main Outcomes<\/jats:title><jats:p>Integrated screening has the best screening performance. The performance of the other two policies approached that of Integrated screening as the first\u2010trimester test FPR decreased. If the first\u2010trimester FPR is set to 0.5% (risk \u2265 1 in 30) with an overall DR of 90%, sequential and contingent screening yield overall FPRs of 2.25% and 2.42%, respectively, and 66% of the affected pregnancies are detected by the first\u2010trimester test. The Integrated test on all women yields an FPR of 2.15%. With sequential screening, 99.5% of women would proceed to an Integrated test, or 30% with contingent screening if those with first\u2010trimester test risks of \u22641 in 2000 are classified screen\u2010negative and receive no further testing. About 20% of affected pregnancies identified in the first trimester using sequential or contingent screening would have unnecessary terminations (they would miscarry before the early second trimester). Contingent screening is the most cost\u2010effective if there is no alphafetoprotein screening for neural tube defects, otherwise Integrated screening is more cost\u2010effective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Integrated screening for all women is the simplest, most effective, and the safest policy. Contingent screening is the most complex with the lowest screening performance. Making an earlier diagnosis with sequential and contingent screening has adverse consequences that are sufficient to discourage their use. Copyright \u00a9 2006 John Wiley &amp; Sons, Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pd.1498","type":"journal-article","created":{"date-parts":[[2006,7,6]],"date-time":"2006-07-06T02:46:59Z","timestamp":1152154019000},"page":"769-777","source":"Crossref","is-referenced-by-count":53,"title":["Sequential and contingent prenatal screening for Down syndrome"],"prefix":"10.1002","volume":"26","author":[{"given":"Nicholas J","family":"Wald","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alicja R","family":"Rudnicka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan P","family":"Bestwick","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2006,7,5]]},"reference":[{"key":"e_1_2_1_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.1215"},{"key":"e_1_2_1_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001703-200104000-00013"},{"key":"e_1_2_1_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/acprof:oso\/9780192628268.003.0019"},{"key":"e_1_2_1_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.1305"},{"key":"e_1_2_1_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(94)90162-7"},{"key":"e_1_2_1_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0223(199902)19:2<142::AID-PD486>3.0.CO;2-7"},{"key":"e_1_2_1_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/jms.9.1.2"},{"key":"e_1_2_1_9_1","doi-asserted-by":"publisher","DOI":"10.1258\/096914105775220679"},{"key":"e_1_2_1_10_1","volume-title":"Why Mothers Die 1997\u20131999. The Fifth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom","author":"National Institute for Clinical Excellence","year":"2001"},{"key":"e_1_2_1_11_1","volume-title":"Birth Statistics. England and Wales; 1996; 1997;1998 (FMI, Nos 25\u201327)","author":"Office for National Statistics","year":"1998"},{"key":"e_1_2_1_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2005.05.010"},{"key":"e_1_2_1_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.1245"},{"key":"e_1_2_1_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/acprof:oso\/9780192628268.003.0002"},{"key":"e_1_2_1_15_1","volume-title":"Prenatal Medicine","author":"Wald NJ"},{"key":"e_1_2_1_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199908123410701"},{"key":"e_1_2_1_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2004.00193.x"},{"key":"e_1_2_1_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.840"},{"key":"e_1_2_1_19_1","doi-asserted-by":"publisher","DOI":"10.1258\/096914103321824133"},{"key":"e_1_2_1_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.297.6653.883"},{"key":"e_1_2_1_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.974"}],"container-title":["Prenatal Diagnosis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fpd.1498","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pd.1498","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,15]],"date-time":"2023-11-15T04:27:04Z","timestamp":1700022424000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/pd.1498"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,7,5]]},"references-count":20,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2006,9]]}},"alternative-id":["10.1002\/pd.1498"],"URL":"https:\/\/doi.org\/10.1002\/pd.1498","archive":["Portico"],"relation":{},"ISSN":["0197-3851","1097-0223"],"issn-type":[{"value":"0197-3851","type":"print"},{"value":"1097-0223","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,7,5]]}}}