Diagnostic potential of cell-free fetal nucleic acids in predicting pregnancy complications: A systematic review and meta-analysis on trisomy, pre-eclampsia, and gestational diabetes.

Abstract

Background: Recent studies reveal an association between increased cell-free fetal (cff) nucleic acid in maternal blood and pregnancy challenges like loss, pre-eclampsia, growth restriction, and preterm labor.

Objective: This article assesses the role of cff nucleic acids as potential diagnostic markers for the prediction and monitoring progression of severe pregnancy-related complications.

Materials and methods: In this systematic review and meta-analysis, various databases were searched. Original articles reporting on the role of cff nucleic acids in predicting the complications of pregnancy were included. I square test and funnel plot were used to analyze heterogeneity and publication bias, respectively. The quality of studies was assessed using the critical appraisal checklists for studies created by the Joanna Briggs Institute.

Results: 70 publications were selected for the final qualitative analysis. Articles were published between 2010 and 2023, and most studies were conducted in the USA and China. The majority of studies were conducted on the quantity of cff-DNA (n = 40), and the remaining on microRNA (n = 18), messenger RNA (n = 11), and cell-free RNA (n = 1). The pooled sensitivity of cff nucleic acids for detecting trisomy was found to be 90.9 (95% CI: 80.9-100%). MicroRNA levels were significantly increased in participants with gestational diabetes mellitus, with a standardized mean difference of 1.22 (95% CI: -0.90-3.34).

Conclusion: Fetal nucleic acids can serve as accurate noninvasive diagnostic tools for predicting serious complications during pregnancy.