{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:01:24Z","timestamp":1786118484401,"version":"build-2736575974"},"reference-count":83,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Prenatal Diagnosis"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Many systematic reviews (SRs) report the accuracy of prenatal Down syndrome screening, but their methodological quality has not been comprehensively evaluated. This umbrella review assessed the quality, compared non\u2010invasive prenatal testing (NIPT) with traditional screening, and evaluated the findings' robustness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We searched MEDLINE, Embase, and multiple other databases from inception to March 24, 2026, for SRs, including gray literature sources as specified in the methods. Methodological quality, risk of bias, and evidence certainty were assessed using AMSTAR 2, ROBIS, and GRADE. The study was registered with PROSPERO (CRD42024597291).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 42 included SRs, NIPT and combined screening were the most common. AMSTAR 2 ratings indicated that 88.1% (37\/42) of SRs were of low or critically low confidence; 66.7% SRs were judged to have a high risk of bias; and high\u2010quality evidence was scarce (9.6%). Despite this, NIPT's higher accuracy was maintained in sensitivity analyses, showing higher sensitivity (93.0%\u2013100.0%) and specificity (96.0%\u2013100.0%) than traditional methods, which showed wider performance variation (e.g.,\u00a0biochemical screening sensitivity: 28.0%\u201389.0%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The methodological quality of SRs evaluating Down syndrome screening is limited. Nevertheless, NIPT consistently shows higher accuracy than traditional screening. NIPT implementation should be prioritized where feasible, while future primary research requires large, prospective studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pd.70191","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T03:00:20Z","timestamp":1780455620000},"page":"1434-1446","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Quality of Evidence for Prenatal Down Syndrome Screening: An Umbrella Review"],"prefix":"10.1002","volume":"46","author":[{"given":"Yuehua","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Health Statistics College of Public Health Zhengzhou University  Zhengzhou Henan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingying","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Health Statistics College of Public Health Zhengzhou University  Zhengzhou Henan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinlong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Health Statistics College of Public Health Zhengzhou University  Zhengzhou Henan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0426-2414","authenticated-orcid":false,"given":"Ling","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Prenatal Diagnosis Center The Third Affiliated Hospital of Zhengzhou University  Zhengzhou Henan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3300-9453","authenticated-orcid":false,"given":"Kaijuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology Henan Children's Hospital Zhengzhou Children's Hospital, Children's Hospital Affiliated to Zhengzhou University  Zhengzhou Henan Province China"},{"name":"Key Laboratory of Tumor Epidemiology of Henan Province State Key Laboratory of Metabolic Dysregulation &amp; Prevention and Treatment of Esophageal Cancer Zhengzhou University  Zhengzhou Henan Province China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1706537"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012599"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012600"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.27698"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(23)02128\u20101"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjmed\u20102021\u2010000071"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj\u20102022\u2010070849"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011767.pub2"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j4008"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2015.06.005"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.ad"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1017\/rsm.2025.10047"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2026.112210"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2023.10.005"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj\u20102024\u2010083864"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1390"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1557"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643\u2010018\u20100768\u20108"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002\u20109378(95)90008\u2010X"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.8.1044"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006250\u2010200305000\u201000031"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.27698"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1159\/000358326"},{"issue":"16","key":"e_1_2_12_25_1","first-page":"2582","article-title":"Effectiveness Evaluation of Non\u2010Invasie Prenatal Genetic Test in Screening of Trisomy 21","volume":"24","author":"Geng J. S.","year":"2014","journal-title":"Maternal and\u00a0Child Health Care of China"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14791"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.13688\/j.cnki.chr.2016.15387"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.5118"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471\u20100528.14050"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11825\u2010019\u201000251\u2010w"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20284"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102015\u2010010002"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17484"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13047"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.5621"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.23648"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13842"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.4626"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011975"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tjog.2016.11.002"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471\u20100528.14009"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884\u2010024\u201006655\u20100"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1177\/8756479317702619"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0368\u20102315(05)82740\u20101"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD009925"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.5111"},{"key":"e_1_2_12_47_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13228"},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.4431"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.4238\/2015.September.9.1"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006254\u2010199806000\u201000022"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011984"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100040\u20101713785"},{"key":"e_1_2_12_53_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.12364"},{"key":"e_1_2_12_54_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep18866"},{"key":"e_1_2_12_55_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmt001"},{"key":"e_1_2_12_56_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006250\u2010199911001\u201000042"},{"key":"e_1_2_12_57_1","unstructured":"Institute of Health Economics \u201cFirst and Second Trimester Prenatal Screening for Trisomies 13 18 and 21 and Open Neural Tube Defects \u201d [Internet]. Edmont Alta Can Inst Health Econ IHE 2012 Sep Alta STE Rep No 2012\u201006 (2012)."},{"issue":"9","key":"e_1_2_12_58_1","first-page":"2165","article-title":"Value of Maternal Plasma Free Fetal DNA for Prenatal Screening of Trisomy 21 Syndrome: A Meta Analysis","volume":"34","author":"Gao Z. W.","year":"2019","journal-title":"Maternal and Child Health Care of China"},{"issue":"4","key":"e_1_2_12_59_1","first-page":"887","article-title":"Screening of Down\u2019s Syndrome Using Serum AFP and \u03b2\u2010hCG Indicators Among Pregnant Women During the Second Trimester of Pregnancy: A Meta Analysis","volume":"31","author":"Li L.","year":"2016","journal-title":"Maternal and Child Health Care of China"},{"issue":"9","key":"e_1_2_12_60_1","first-page":"2014","article-title":"Fetal Nuchal Translucency Detection During Early Pregnancy by Ultrasound Combined With Maternal Serum Indexes Detection in Screening of Down Syndrome: A\u00a0Meta Analysis","volume":"31","author":"Wang T. F.","year":"2016","journal-title":"Maternal and Child Health Care of China"},{"issue":"2","key":"e_1_2_12_61_1","first-page":"119","article-title":"Triple Serum Tests Screening for Down\u2019s Syndrome in Women at Second Trimester: A Meta Analysis","volume":"19","author":"Li L.","year":"2016","journal-title":"Chinese Journal of Preventive Medicine"},{"key":"e_1_2_12_62_1","doi-asserted-by":"publisher","DOI":"10.13404\/j.cnki.cjbhh.2015.06.004"},{"issue":"11","key":"e_1_2_12_63_1","first-page":"725","article-title":"A meta\u2010analysis of Screening Down\u2019s Syndrome With Maternal Pregnancy Associated Plasma Protein\u2010A Combined With Free Beta Human Chorionic Gonadotropin and Fetal Nuchal Translucency in the First Trimester","volume":"2","author":"Liu J. Z.","year":"2014","journal-title":"Chinese Journal of Family Planning"},{"key":"e_1_2_12_64_1","doi-asserted-by":"publisher","DOI":"10.3877\/cma.j.issn.1674\u20100785.2011.08.085"},{"issue":"13","key":"e_1_2_12_65_1","first-page":"1212","article-title":"Meta\u2010Analysis of Prenatal Screening for Trisomy 21 Using Nuchal Translucency Measurement With Serum Markers","volume":"30","author":"Yu Z. B.","year":"2009","journal-title":"Journal of the Fourth Military Medical University"},{"issue":"4","key":"e_1_2_12_66_1","first-page":"569","article-title":"Meta\u2010Analysis of Screening for\u00a0Chromosomal Abnormalities Using Elevated Nuchal Translucency in\u00a0First Trimester","volume":"29","author":"Yu Z. B.","year":"2009","journal-title":"Acta Universitatis Medicinalis Nanjing"},{"key":"e_1_2_12_67_1","doi-asserted-by":"publisher","DOI":"10.47895\/amp.vi0.9841"},{"key":"e_1_2_12_68_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gim.2022.03.019"},{"key":"e_1_2_12_69_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14082813"},{"key":"e_1_2_12_70_1","doi-asserted-by":"publisher","DOI":"10.1097\/GIM.0b013e3181bb267b"},{"key":"e_1_2_12_71_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa043693"},{"key":"e_1_2_12_72_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dml021"},{"key":"e_1_2_12_73_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpobgyn.2022.10.001"},{"key":"e_1_2_12_74_1","doi-asserted-by":"publisher","DOI":"10.1515\/labmed\u20102022\u20100023"},{"key":"e_1_2_12_75_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41431\u2010018\u20100271\u20107"},{"key":"e_1_2_12_76_1","doi-asserted-by":"publisher","DOI":"10.18773\/austprescr.2025.019"},{"key":"e_1_2_12_77_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1407349"},{"key":"e_1_2_12_78_1","doi-asserted-by":"publisher","DOI":"10.1002\/jgc4.1921"},{"key":"e_1_2_12_79_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13841"},{"key":"e_1_2_12_80_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph192416404"},{"key":"e_1_2_12_81_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2019.12.007"},{"key":"e_1_2_12_82_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.6278"},{"key":"e_1_2_12_83_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.26100"},{"key":"e_1_2_12_84_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010025\u201008592\u20100"}],"container-title":["Prenatal Diagnosis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pd.70191","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pd.70191","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pd.70191","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T15:55:06Z","timestamp":1786031706000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/pd.70191"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,2]]},"references-count":83,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1002\/pd.70191"],"URL":"https:\/\/doi.org\/10.1002\/pd.70191","archive":["Portico"],"relation":{},"ISSN":["0197-3851","1097-0223"],"issn-type":[{"value":"0197-3851","type":"print"},{"value":"1097-0223","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,2]]},"assertion":[{"value":"2025-11-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-02","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}