Down Syndrome Due to Unbalanced Homologous Acrocentric Rearrangements and its Recurrence in Subsequent Pregnancies: Prenatal Diagnosis by Amniocentesis

Chen, Chih-Ping; Chern, Schu-Rern; Tsai, Fuu-Jen; Wu, Pei-Chen; Chiang, Shu-Shien; Lee, Chen-Chi; Wang, Wayseen

doi:10.1016/S1028-4559(09)60331-4

« Previous Next »Taiwanese Journal of Obstetrics and Gynecology
Volume 48, Issue 4 , Pages 403-407, December 2009

Down Syndrome Due to Unbalanced Homologous Acrocentric Rearrangements and its Recurrence in Subsequent Pregnancies: Prenatal Diagnosis by Amniocentesis

Chih-Ping Chen
- Department of Obstetrics and Gynecology, Taipei, Taiwan
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Biotechnology, Asia University, Taichung, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Institute of Clinical and Community Health Nursing, Taipei, Taiwan
- Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Correspondence to: Dr Chih-Ping Chen, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, 92, Section 2, Chung-Shan North Road, Taipei, Taiwan
Schu-Rern Chern
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
Fuu-Jen Tsai
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Genetics, Taipei, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taipei, Taiwan
Pei-Chen Wu
- Department of Obstetrics and Gynecology, Taipei, Taiwan
Shu-Shien Chiang
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
Chen-Chi Lee
- Department of Obstetrics and Gynecology, Taipei, Taiwan
Wayseen Wang
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Bioengineering, Tatung University, Taipei, Taiwan

Accepted 22 October 2009.

Summary

Objective

To present our experience of amniocentesis for the prenatal diagnosis of Down syndrome due to unbalanced homologous acrocentric rearrangements and its recurrence in subsequent pregnancies.

Case Report

From January 1987 to September 2009, six cases with rea(21q21q) Down syndrome were diagnosed among 31,194 patients who underwent amniocentesis at Mackay Memorial Hospital, Taipei, Taiwan. Cytogenetic analysis of parental blood lymphocytes was performed in each case, and polymorphic DNA markers were used to investigate the nature of the aberrant chromosome. Three of the six cases were associated with recurrence in subsequent pregnancies. The rea(21q21q) Down syndrome was associated with advanced maternal age in three cases, a previous child with rea(21q21q) Down syndrome in three cases, an abnormal maternal serum screening result in one case, and an abnormal ultrasound finding in one case. All six cases arose de novo. Among the six cases with molecular analysis results, all had isochromosome 21, five of which were determined to be of maternal origin.

Conclusion

We found a frequency of 0.019% for rea(21q21q) Down syndrome in patients undergoing amniocentesis. Down syndrome caused by the homologous rearrangement rea(21q21q) can be associated with recurrence. Prenatal diagnosis of rea(21q21q) Down syndrome should include extensive cytogenetic and molecular analyses of the parents and probands.

Key Words: amniocentesis , Down syndrome , homologous acrocentric rearrangement , i(21q) , isochromosome , recurrence