{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T07:29:05Z","timestamp":1792308545935,"version":"4.4.0"},"update-to":[{"DOI":"10.1371\/journal.pmed.1004790","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000}}],"reference-count":56,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T00:00:00Z","timestamp":1762300800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Evidence on the diagnostic yield of genome-wide non-invasive prenatal testing (GW-NIPT) is growing, but its comparative clinical and economic impact as a first-tier screening strategy for fetal chromosomal abnormalities remains unassessed. We compared GW-NIPT with targeted NIPT and first-trimester combined testing (FCT), in a Dutch setting where all pregnancies also undergo a routine second-trimester anomaly ultrasound scan (scan), to guide policymakers on optimal prenatal screening approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>We developed a decision-analytic model for a cohort of 175,000 pregnancies, reflecting the Dutch obstetric population. All strategies screened for common trisomies 21 (Down syndrome), 18 (Edwards syndrome), and 13 (Patau syndrome); GW-NIPT additionally considered rare autosomal trisomies and structural aberrations. Model inputs were based on the TRIDENT-2 study data and historical FCT data. Base-case unit costs were \u20ac166 (scan), \u20ac191 (FCT), and \u20ac350 (NIPT). Sensitivity analyses were conducted to account for uncertainties in model parameters and potential country-specific variations. Outcomes included total screening costs, number of fetal chromosomal abnormalities diagnosed, number of invasive procedures, and expected procedure-related euploid fetal losses. We summarized economic results as cost per diagnosed case and incremental cost per additional diagnosis across strategies. GW-NIPT yielded the highest number of diagnoses (545) versus targeted NIPT (514) and FCT (452), and the lowest cost per diagnosed case (\u20ac152,785), compared with targeted NIPT (\u20ac159,852) and FCT (\u20ac170,050). Invasive tests required per diagnosis were lower for GW-NIPT and targeted NIPT (both 6) than for FCT (13), implying a lower risk of procedure-related miscarriage (iatrogenic miscarriage). Sensitivity analyses indicated that test uptake and unit costs strongly influenced outcomes. GW-NIPT remained the most favorable in terms of cost per diagnosis for NIPT prices up to \u20ac467. Key limitations include the use of a decision-analytic model without quality-of-life outcomes and the lack of comparisons against explicit cost-effectiveness thresholds. Therefore, the results should be interpreted as relative clinical and economic comparisons rather than cost-effectiveness judgements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among the strategies evaluated, first-tier GW-NIPT had the greatest diagnostic yield and the lowest cost per diagnosis, improving detection rates and supporting reproductive autonomy at lower costs. Implementation decisions should also consider local pricing, laboratory capacity, and counseling resources. Future research that links screening outcomes to long-term health consequences (e.g., quality-adjusted life years or life-years), healthcare utilization, costs, and psychosocial outcomes will enable formal cost-effectiveness evaluations and support further refinement of prenatal screening policy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pmed.1004790","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T18:40:47Z","timestamp":1762368047000},"page":"e1004790","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Clinical and economic impact of genome-wide non-invasive prenatal testing (NIPT) as a first-tier screening method compared to targeted NIPT and first-trimester combined testing: A modeling study"],"prefix":"10.1371","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9971-8359","authenticated-orcid":true,"given":"Lisanne","family":"van Prooyen Schuurman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4682-3646","authenticated-orcid":true,"given":"Harry J.","family":"de Koning","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1779-2418","authenticated-orcid":true,"given":"Eva","family":"Meier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert-Jan H.","family":"Galjaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3531-466X","authenticated-orcid":true,"given":"Nicolien T.","family":"van Ravesteyn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,11,5]]},"reference":[{"issue":"4","key":"pmed.1004790.ref001","article-title":"Screening for fetal chromosomal abnormalities: ACOG practice bulletin, number 226","volume":"136","author":"American College of Obstetricians and Gynecologists\u2019 Committee on Practice Bulletins \u2013 Obstetrics, Committee on Genetics, Society for Maternal-Fetal Medicine","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"11","key":"pmed.1004790.ref002","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.1038\/ejhg.2015.57","article-title":"Non-invasive prenatal testing for aneuploidy and beyond: challenges of responsible innovation in prenatal screening","volume":"23","author":"W Dondorp","year":"2015","journal-title":"Eur J Hum Genet"},{"issue":"6","key":"pmed.1004790.ref003","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1111\/aogs.13841","article-title":"Current use of noninvasive prenatal testing in Europe, Australia and the USA: a graphical presentation","volume":"99","author":"K Gadsb\u00f8ll","year":"2020","journal-title":"Acta Obstet Gynecol Scand"},{"key":"pmed.1004790.ref004","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1146\/annurev-genom-083118-015053","article-title":"The emergence and global spread of noninvasive prenatal testing","volume":"22","author":"V Ravitsky","year":"2021","journal-title":"Annu Rev Genomics Hum Genet"},{"issue":"13","key":"pmed.1004790.ref005","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1002\/pd.2873","article-title":"Performance of first-trimester combined test for Down syndrome in different maternal age groups: reason for adjustments in screening policy?","volume":"31","author":"MAJ Engels","year":"2011","journal-title":"Prenat Diagn"},{"issue":"1","key":"pmed.1004790.ref006","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1002\/uog.12511","article-title":"First-trimester contingent screening for trisomy 21 by biomarkers and maternal blood cell-free DNA testing","volume":"42","author":"KH Nicolaides","year":"2013","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"9076","key":"pmed.1004790.ref007","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/S0140-6736(97)02174-0","article-title":"Presence of fetal DNA in maternal plasma and serum","volume":"350","author":"YM Lo","year":"1997","journal-title":"Lancet"},{"issue":"6","key":"pmed.1004790.ref008","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1016\/j.ajhg.2022.04.018","article-title":"Clinical impact of additional findings detected by genome-wide non-invasive prenatal testing: follow-up results of the TRIDENT-2 study","volume":"109","author":"L van Prooyen Schuurman","year":"2022","journal-title":"Am J Hum Genet"},{"issue":"6","key":"pmed.1004790.ref009","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1038\/s41436-021-01101-4","article-title":"Outcome of publicly funded nationwide first-tier noninvasive prenatal screening","volume":"23","author":"K Van Den Bogaert","year":"2021","journal-title":"Genet Med"},{"issue":"22","key":"pmed.1004790.ref010","doi-asserted-by":"crossref","first-page":"2426","DOI":"10.1200\/JCO.21.02260","article-title":"Noninvasive prenatal test results indicative of maternal malignancies: a nationwide genetic and clinical follow-up study","volume":"40","author":"CJ Heesterbeek","year":"2022","journal-title":"J Clin Oncol"},{"key":"pmed.1004790.ref011","doi-asserted-by":"crossref","first-page":"101024","DOI":"10.1016\/j.lanepe.2024.101024","article-title":"Prenatal cell-free DNA testing of women with pregnancy-associated cancer: a retrospective cross-sectional study","volume":"45","author":"CJ Heesterbeek","year":"2024","journal-title":"Lancet Reg Health Eur"},{"issue":"1","key":"pmed.1004790.ref012","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1186\/s12913-017-2618-0","article-title":"Implementing non-invasive prenatal testing for aneuploidy in a national healthcare system: global challenges and national solutions","volume":"17","author":"RV van Schendel","year":"2017","journal-title":"BMC Health Serv Res"},{"issue":"6","key":"pmed.1004790.ref013","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1159\/000491750","article-title":"Clinical and economic impact of adopting noninvasive prenatal testing as a primary screening method for fetal aneuploidies in the general pregnancy population","volume":"45","author":"E Kostenko","year":"2019","journal-title":"Fetal Diagn Ther"},{"issue":"7","key":"pmed.1004790.ref014","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1007\/s10198-017-0946-y","article-title":"Cost-effectiveness of cell-free DNA in maternal blood testing for prenatal detection of trisomy 21, 18 and 13: a systematic review","volume":"19","author":"L Garc\u00eda-P\u00e9rez","year":"2018","journal-title":"Eur J Health Econ"},{"issue":"6","key":"pmed.1004790.ref015","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1016\/j.jogc.2019.12.007","article-title":"Noninvasive prenatal testing for trisomies 21, 18, and 13, sex chromosome aneuploidies, and microdeletions in average-risk pregnancies: a cost-effectiveness analysis","volume":"42","author":"X Xie","year":"2020","journal-title":"J Obstet Gynaecol Can"},{"issue":"8","key":"pmed.1004790.ref016","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-069485","article-title":"Expansion of non-invasive prenatal screening to the screening of 10 types of chromosomal anomalies: a cost-effectiveness analysis","volume":"13","author":"B Soukkhaphone","year":"2023","journal-title":"BMJ Open"},{"issue":"5","key":"pmed.1004790.ref017","doi-asserted-by":"crossref","first-page":"596","DOI":"10.1002\/uog.20301","article-title":"Cost-effectiveness of five prenatal screening strategies for trisomies and other unbalanced chromosomal abnormalities: model-based analysis","volume":"54","author":"A Le Bras","year":"2019","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"5","key":"pmed.1004790.ref018","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1038\/s41431-023-01330-y","article-title":"Down syndrome screening and diagnosis practices in Europe, United States, Australia, and New Zealand from 1990-2021","volume":"31","author":"HC Wilmot","year":"2023","journal-title":"Eur J Hum Genet"},{"key":"pmed.1004790.ref019","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.ejogrb.2022.03.009","article-title":"Provision of antenatal care in Europe-A scientific study commissioned by European Board and College of Obstetrics and Gynaecology (EBCOG)","volume":"272","author":"G Topcu","year":"2022","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"issue":"1","key":"pmed.1004790.ref020","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/cge.13155","article-title":"Cell-free DNA noninvasive prenatal screening for aneuploidy versus conventional screening: a systematic review of economic evaluations","volume":"94","author":"L Nshimyumukiza","year":"2018","journal-title":"Clin Genet"},{"issue":"3","key":"pmed.1004790.ref021","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1038\/s41431-023-01504-8","article-title":"Psychological impact of additional findings detected by genome-wide Non-Invasive Prenatal Testing (NIPT): TRIDENT-2 study","volume":"32","author":"IM Bakkeren","year":"2024","journal-title":"Eur J Hum Genet"},{"issue":"7","key":"pmed.1004790.ref022","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1111\/bioe.12760","article-title":"Rethinking counselling in prenatal screening: an ethical analysis of informed consent in the context of non-invasive prenatal testing (NIPT)","volume":"34","author":"A Kater-Kuipers","year":"2020","journal-title":"Bioethics"},{"issue":"4","key":"pmed.1004790.ref023","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1002\/pd.6242","article-title":"Factors involved in the decision to decline prenatal screening with noninvasive prenatal testing (NIPT)","volume":"43","author":"L van Prooyen Schuurman","year":"2023","journal-title":"Prenat Diagn"},{"issue":"17","key":"pmed.1004790.ref024","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1056\/NEJMoa1407349","article-title":"Cell-free DNA analysis for noninvasive examination of trisomy","volume":"372","author":"ME Norton","year":"2015","journal-title":"N Engl J Med"},{"key":"pmed.1004790.ref025","unstructured":"Recommendations for further investigation in case of suspicion for Trisomy 21, 18 and 13 and additional findings detected with NIPT (in Dutch). 2018. Available from: https:\/\/www.nvog.nl\/wp-content\/uploads\/2018\/06\/Protocol-vervolgonderzoek-bij-afwijkende-NIPT-versie-1-dd-06062018-DEF.pdf"},{"issue":"7","key":"pmed.1004790.ref026","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1002\/pd.4833","article-title":"The maternal age-related first trimester risks for trisomy 21, 18 and 13 based on Danish first trimester data from 2005 to 2014","volume":"36","author":"TS Hartwig","year":"2016","journal-title":"Prenat Diagn"},{"key":"pmed.1004790.ref027","unstructured":"Centraal Bureau voor de Statistiek (CBS). Geboorte 1 Jan 2024. 2019. Available from: https:\/\/opendata.cbs.nl"},{"issue":"11","key":"pmed.1004790.ref028","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1007\/s40273-019-00837-x","article-title":"A need for change! A coding framework for improving transparency in decision modeling","volume":"37","author":"F Alarid-Escudero","year":"2019","journal-title":"Pharmacoeconomics"},{"key":"pmed.1004790.ref029","unstructured":"Online national digital registration system for prenatal screening Peridos. Available from: https:\/\/www.peridos.nl"},{"key":"pmed.1004790.ref030","unstructured":"Scientific Center for Quality of Healthcare (IQ healthcare). Professionalsmonitor 2014-2020 Prenatale screening op down-. edwards- en patausyndroom en het Structureel Echoscopisch Onderzoek."},{"key":"pmed.1004790.ref031","unstructured":"Working Group on Prenatal Diagnostics. (2012-2019). Annual Reports."},{"issue":"6","key":"pmed.1004790.ref032","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1016\/j.ajhg.2019.10.005","article-title":"TRIDENT-2: national implementation of genome-wide non-invasive prenatal testing as a first-tier screening test in the Netherlands","volume":"105","author":"KRM van der Meij","year":"2019","journal-title":"Am J Hum Genet"},{"issue":"2","key":"pmed.1004790.ref033","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1177\/0969141313484904","article-title":"Detection of trisomy 18 and trisomy 13 using first and second trimester Down\u2019s syndrome screening markers","volume":"20","author":"JP Bestwick","year":"2013","journal-title":"J Med Screen"},{"issue":"7","key":"pmed.1004790.ref034","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1016\/j.gim.2022.03.019","article-title":"Systematic evidence-based review: the application of noninvasive prenatal screening using cell-free DNA in general-risk pregnancies","volume":"24","author":"NC Rose","year":"2022","journal-title":"Genet Med"},{"issue":"4","key":"pmed.1004790.ref035","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1002\/uog.5373","article-title":"Prenatal detection of trisomy 21 by second-trimester ultrasound examination and maternal age in a non-selected population of 49 314 births in Norway","volume":"32","author":"K Offerdal","year":"2008","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"6","key":"pmed.1004790.ref036","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1097\/AOG.0b013e3181c15064","article-title":"Role of second-trimester genetic sonography after Down syndrome screening","volume":"114","author":"KM Aagaard-Tillery","year":"2009","journal-title":"Obstet Gynecol"},{"key":"pmed.1004790.ref037","doi-asserted-by":"crossref","first-page":"785730","DOI":"10.1155\/2014\/785730","article-title":"Influence of second-trimester ultrasound markers for Down syndrome in pregnant women of advanced maternal age","volume":"2014","author":"M Rumi Kataguiri","year":"2014","journal-title":"J Pregnancy"},{"issue":"2","key":"pmed.1004790.ref038","doi-asserted-by":"crossref","first-page":"233","DOI":"10.7863\/jum.2004.23.2.233","article-title":"Second-trimester sonography and trisomy 18","volume":"23","author":"R Bronsteen","year":"2004","journal-title":"J Ultrasound Med"},{"issue":"9","key":"pmed.1004790.ref039","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.7863\/jum.2007.26.9.1209","article-title":"Sonographic detection of trisomy 13 in the first and second trimesters of pregnancy","volume":"26","author":"WJ Watson","year":"2007","journal-title":"J Ultrasound Med"},{"issue":"4","key":"pmed.1004790.ref040","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1002\/uog.20353","article-title":"Risk of miscarriage following amniocentesis or chorionic villus sampling: systematic review of literature and updated meta-analysis","volume":"54","author":"LJ Salomon","year":"2019","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"2","key":"pmed.1004790.ref041","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1111\/aogs.13037","article-title":"Detection of fetal abnormalities by second-trimester ultrasound screening in a non-selected population","volume":"96","author":"C Rydberg","year":"2017","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"1","key":"pmed.1004790.ref042","doi-asserted-by":"crossref","first-page":"137","DOI":"10.3109\/14767051003758879","article-title":"Changes in fetal prevalence and outcome for trisomies 13 and 18: a population-based study over 23 years","volume":"24","author":"C Irving","year":"2011","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"5","key":"pmed.1004790.ref043","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1002\/uog.6446","article-title":"Diagnostic performance of routine ultrasound screening for fetal abnormalities in an unselected Swedish population in 2000-2005","volume":"34","author":"G Romosan","year":"2009","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"8","key":"pmed.1004790.ref044","first-page":"1","article-title":"Fetal and perinatal mortality: United States, 2013","volume":"64","author":"MF MacDorman","year":"2015","journal-title":"Natl Vital Stat Rep"},{"issue":"8","key":"pmed.1004790.ref045","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1159\/000517729","article-title":"The natural history of trisomy 21: outcome data from a Large Tertiary Referral Centre","volume":"48","author":"C O\u2019Connor","year":"2021","journal-title":"Fetal Diagn Ther"},{"issue":"4","key":"pmed.1004790.ref046","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1002\/ajmg.a.38123","article-title":"Revised estimates of the risk of fetal loss following a prenatal diagnosis of trisomy 13 or trisomy 18","volume":"173","author":"A Cavadino","year":"2017","journal-title":"Am J Med Genet A"},{"issue":"5","key":"pmed.1004790.ref047","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1586\/14737159.2016.1152890","article-title":"Cytogenetic confirmation of a positive NIPT result: evidence-based choice between chorionic villus sampling and amniocentesis depending on chromosome aberration","volume":"16","author":"D Van Opstal","year":"2016","journal-title":"Expert Rev Mol Diagn"},{"key":"pmed.1004790.ref048","unstructured":"The Zorgproductenviewer is an online tool from the Dutch Healthcare Authority (NZa) that provides detailed information on healthcare products, including the maximum allowed tariffs. Available from: https:\/\/zorgproducten.nza.nl\/"},{"key":"pmed.1004790.ref049","unstructured":"Erasmus Medical Center Rotterdam Passantenprijslijst (Visitor Price List). 2022. Available from: https:\/\/www.erasmusmc.nl\/nl-nl\/patientenzorg\/passantenprijslijst"},{"issue":"1","key":"pmed.1004790.ref050","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.jogc.2017.05.015","article-title":"Cell-free DNA-based non-invasive prenatal screening for common aneuploidies in a Canadian Province: a cost-effectiveness analysis","volume":"40","author":"L Nshimyumukiza","year":"2018","journal-title":"J Obstet Gynaecol Can"},{"issue":"12","key":"pmed.1004790.ref051","doi-asserted-by":"crossref","first-page":"2382","DOI":"10.1002\/ajmg.a.61365","article-title":"Trisomy 13 and 18-prevalence and mortality-a multi-registry population based analysis","volume":"179","author":"N Goel","year":"2019","journal-title":"Am J Med Genet A"},{"issue":"5","key":"pmed.1004790.ref052","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1111\/jir.12371","article-title":"Estimates of live birth prevalence of children with Down syndrome in the period 1991-2015 in the Netherlands","volume":"61","author":"G de Graaf","year":"2017","journal-title":"J Intellect Disabil Res"},{"key":"pmed.1004790.ref053","unstructured":"Health Council of the Netherlands. WBO: the non-invasive prenatal test (NIPT) as a population screening (The Hague). 2023. Available from: https:\/\/www.gezondheidsraad.nl\/documenten\/adviezen\/2023\/02\/20\/advies-wbo-de-nipt-als-bevolkingsonderzoek"},{"issue":"6","key":"pmed.1004790.ref054","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1111\/aogs.13842","article-title":"Clinical performance of non-invasive prenatal testing for trisomies 21, 18 and 13 in twin pregnancies: a cohort study and a systematic meta-analysis","volume":"99","author":"Y He","year":"2020","journal-title":"Acta Obstet Gynecol Scand"},{"key":"pmed.1004790.ref055","article-title":"Performance of non-invasive prenatal testing in vanishing-twin and multiple pregnancies: results of TRIDENT-2 study","author":"JCA van Eekhout","year":"2025","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"4","key":"pmed.1004790.ref056","article-title":"Introduction of a nationwide first-trimester anomaly scan in the Dutch national screening program","volume":"232","author":"EER Lust","year":"2025","journal-title":"Am J Obstet Gynecol"}],"updated-by":[{"DOI":"10.1371\/journal.pmed.1004790","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000}}],"container-title":["PLOS Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1004790","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T18:42:05Z","timestamp":1762972925000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1004790"}},"subtitle":[],"editor":[{"given":"Jeremy D.","family":"Goldhaber-Fiebert","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,11,5]]},"references-count":56,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,5]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pmed.1004790","relation":{},"ISSN":["1549-1676"],"issn-type":[{"value":"1549-1676","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,5]]}}}