The Netherlands launched a nationwide implementation study on non-invasive prenatal testing (NIPT) as a first-tier test offered to all pregnant women. This started on April 1, 2017 as the TRIDENT-2 study, licensed by the Dutch Ministry of Health. In the first year, NIPT was performed in 73,239 pregnancies (42% of all pregnancies), 7,239 (4%) chose first-trimester combined testing, and 54% did not participate. The number of trisomies 21 (239, 0.33%), 18 (49, 0.07%), and 13 (55, 0.08%) found in this study is comparable to earlier studies, but the Positive Predictive Values (PPV)-96% for trisomy 21, 98% for trisomy 18, and 53% for trisomy 13-were higher than expected. Findings other than trisomy 21, 18, or 13 were reported on request of the pregnant women; 78% of women chose to have these reported. The number of additional findings was 207 (0.36%); these included other trisomies (101, 0.18%, PPV 6%, many of the remaining 94% of cases are likely confined placental mosaics and possibly clinically significant), structural chromosomal aberrations (95, 0.16%, PPV 32%,) and complex abnormal profiles indicative of maternal malignancies (11, 0.02%, PPV 64%). The implementation of genome-wide NIPT is under debate because the benefits of detecting other fetal chromosomal aberrations must be balanced against the risks of discordant positives, parental anxiety, and a potential increase in (invasive) diagnostic procedures. Our first-year data, including clinical data and laboratory follow-up data, will fuel this debate. Furthermore, we describe how NIPT can successfully be embedded into a national screening program with a single chain for prenatal care including counseling, testing, and follow-up.

ObjectivesWe examined whether misleading information (i.e. misinformation) may promote symptom reporting in non-clinical participants.DesignA test–retest study in which we collected baseline data about participants' psychological symptoms and then misinformed them that they had rated two target symptoms relatively highly. During an interview, we determined whether participants would notice this misinformation and at direct and one-week follow-up, we evaluated whether the misinformation would exacerbate retest measures of the same symptoms.SettingA psychological laboratory.ParticipantsA total of 78 undergraduate students.Main outcome measuresParticipants' scores on a widely used self-report measure of psychological symptoms.ResultsWe found that most participants (63%) were blind to the discrepancies between their original symptom ratings and the upgraded scores they were misinformed with. Furthermore, at the one-week follow-up retest, blind participants revised their symptom ratings in the direction of the misinformation (i.e. they increased their ratings of these symptoms).ConclusionIntrospective monitoring of common psychological symptoms is poor and this creates an opportunity for misinformation and symptom escalation. Our finding bears relevance to theories about the iatrogenic amplification of medically unexplained symptoms.

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We conducted three studies that address the residual effects of instructed feigning of symptoms. In Experiment 1 (N = 31), undergraduates instructed to exaggerate symptoms on a malingering test continued to report more neurocognitive and psychiatric symptoms than did nonmalingering controls, when later asked to respond honestly to the same test. In Experiment 2 (N = 28), students completed a symptom list of psychiatric complaints and then were asked to explain why they had endorsed two target symptoms that they did not, in actuality, endorse. A total of 57% of participants did not detect this mismatch between actual and manipulated symptom endorsement and even tended to adopt the manipulated symptoms when provided with an opportunity to do so. In Experiment 3 (N = 28), we found that self-deceptive enhancement is related to the tendency to continue to report neurocognitive and psychiatric symptoms that initially had been produced intentionally. "Blindness" for the intentional aspect of symptom endorsement may explain the intrinsic overlap between feigning and somatoform complaints.

IntroductionThe introduction of the non-invasive prenatal test (NIPT) has shifted the prenatal screening landscape. Countries are exploring ways to integrate NIPT in their national prenatal screening programs, either as a first-or second-tier test. This study aimed to describe how the uptake of fetal aneuploidy screening changed after the introduction of NIPT as a second-tier and as a first-tier test within the national prenatal screening program of the Netherlands. Material and methodsA population-based register study in the Netherlands, recording uptake of fetal aneuploidy screening. Data from all pregnant women choosing to have the first-trimester combined test (FCT) or first-tier NIPT between January 2007 and March 2019 were retrospectively collected using national registration systems. Uptake percentages for fetal aneuploidy screening (FCT and NIPT) were calculated and stratified by region and maternal age.Statistical significance was determined using trend analysis and chi-square tests. ResultsBetween 2007 and 2013 FCT uptake increased from 14.8% to 29.5% (p=0.004). In April 2014 NIPT was introduced as a second-tier test for high-risk women after FCT (TRIDENT-1 study). FCT uptake rose from 29.5% in 2013 to 34.2% in 2015 (p<0.0001). After the introduction of NIPT as a first-tier test for all women in April 2017 (TRIDENT-2 study), FCT uptake declined significantly from 35.8% in 2016 to 2.6% in 2018 (p<0.0001). NIPT uptake increased to 43.4% in 2018. Regionally, NIPT uptake ranged from 31.8% to 67.9%. Total uptake (FCT and NIPT) between 2007 and 2018 increased significantly from 14.8% to 45.9% (p<0.0001). However, total uptake stabilized at 46% for both years of TRIDENT-2 (April 2017-March 2019.Conclusions An increase in total fetal aneuploidy screening uptake up to 45.9% was observed after the introduction of NIPT. Uptake appears to have stabilized within a year after introducing first-tier NIPT.