Non-invasive prenatal sequencing for multiple Mendelian monogenic disorders using circulating cell-free fetal DNA

Nat Med. 2019 Mar;25(3):439-447. doi: 10.1038/s41591-018-0334-x. Epub 2019 Jan 28.


Current non-invasive prenatal screening is targeted toward the detection of chromosomal abnormalities in the fetus1,2. However, screening for many dominant monogenic disorders associated with de novo mutations is not available, despite their relatively high incidence3. Here we report on the development and validation of, and early clinical experience with, a new approach for non-invasive prenatal sequencing for a panel of causative genes for frequent dominant monogenic diseases. Cell-free DNA (cfDNA) extracted from maternal plasma was barcoded, enriched, and then analyzed by next-generation sequencing (NGS) for targeted regions. Low-level fetal variants were identified by a statistical analysis adjusted for NGS read count and fetal fraction. Pathogenic or likely pathogenic variants were confirmed by a secondary amplicon-based test on cfDNA. Clinical tests were performed on 422 pregnancies with or without abnormal ultrasound findings or family history. Follow-up studies on cases with available outcome results confirmed 20 true-positive, 127 true-negative, zero false-positive, and zero-false negative results. The initial clinical study demonstrated that this non-invasive test can provide valuable molecular information for the detection of a wide spectrum of dominant monogenic diseases, complementing current screening for aneuploidies or carrier screening for recessive disorders.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abnormalities, Multiple / diagnostic imaging
  • Abnormalities, Multiple / genetics
  • Achondroplasia / diagnosis
  • Achondroplasia / genetics
  • Acrocephalosyndactylia / diagnosis
  • Acrocephalosyndactylia / genetics
  • Adult
  • Bone and Bones / abnormalities
  • Cell-Free Nucleic Acids
  • Collagen Type I / genetics
  • Collagen Type I, alpha 1 Chain
  • De Lange Syndrome / diagnosis
  • De Lange Syndrome / genetics
  • Female
  • Genetic Diseases, Inborn / diagnosis*
  • Genetic Diseases, Inborn / genetics
  • High-Throughput Nucleotide Sequencing
  • Humans
  • Hydrops Fetalis / diagnostic imaging
  • Hydrops Fetalis / genetics
  • Lymphangioma, Cystic / diagnostic imaging
  • Lymphangioma, Cystic / genetics
  • Nuchal Translucency Measurement
  • Osteogenesis Imperfecta / diagnosis
  • Osteogenesis Imperfecta / genetics
  • Predictive Value of Tests
  • Pregnancy
  • Prenatal Diagnosis
  • Sequence Analysis, DNA
  • Thanatophoric Dysplasia / diagnosis
  • Thanatophoric Dysplasia / genetics
  • Ultrasonography, Prenatal


  • Cell-Free Nucleic Acids
  • Collagen Type I
  • Collagen Type I, alpha 1 Chain

Supplementary concepts

  • Nuchal bleb, familial