Children with corpus callosum anomalies: clinical characteristics and developmental outcomes.

INTRODUCTION: Corpus callosum abnormalities are complex, aetiologically diverse, and clinically heterogeneous conditions. Counselling parents regarding their causes and associated syndromes, and predicting the neurodevelopmental and seizure risk prognosis, is challenging. MATERIAL AND METHODS: We describe the clinical characteristics, associated anomalies, and neurodevelopmental outcomes of children with agenesis of corpus callosum (ACC). Fifty-one neonates with ACC/hypoplasia of the corpus callosum were identified over a 17-year period, and their medical records were retrospectively reviewed. RESULTS: Patients were classified into two groups depending on the presence or absence of associated abnormalities. The first group (17 patients, 33.4%) presented with isolated callosal anomalies. The second group included 34 patients (66.6%) with associated cerebral and extracerebral anomalies. We achieved an identifiable genetic aetiology in 23.5% of our cohort. Magnetic resonance imaging was performed in 28 patients (55%), and of these 39.3% had additional brain anomalies. During the study period, five patients died early in the neonatal period and four were lost to follow up. Of the 42 followed patients, 13 (31%) showed normal neurodevelopment, 13 (31%) showed mild delay, and 16 (38%) had a severe delay. Fifteen (35.7%) had epilepsy. CONCLUSIONS AND CLINICAL IMPLICATIONS: We have confirmed that callosal defects are frequently accompanied by brain and somatic anomalies. Additional abnormalities were shown to be significantly associated with developmental delay and increased risk of epilepsy. We have highlighted essential clinical features that may provide diagnostic clues to physicians and we have given examples of underlying genetic disorders. We have provided recommendations about extended neuroimaging diagnostics and widespread genetic testing that may impact upon daily clinical practice. Paediatric neurologists may therefore use our findings to help base their decisions regarding this matter.

Genotyping of STR and DIP-STR Markers in Plasma Cell-Free DNA for Simple and Rapid Noninvasive Prenatal Diagnosis of Zygosity of Twin Pregnancies.

Due to the high rate of complications, special medical care must be provided especially for monozygotic twin pregnancies, which are characterized as having 2.5 times higher mortality of fetuses. In recent years, examination of cell-free DNA (cfDNA) circulating in maternal plasma has become a useful noninvasive method of prenatal diagnosis. However, fetal DNA constitutes only 3-20% of plasma cfDNA during pregnancy. Short tandem repeats (STRs) are routinely used in forensic examination of DNA mixtures and are able to identify 5% minority components. Haplotypes of deletion/insertion polymorphisms and STRs (DIP-STRs) are able to detect even 0.1% minority components of DNA mixtures. Thus, STRs and DIP-STRs seem to be a perfect tool for detection of fetal alleles in DNA isolated from maternal plasma. Here, we present a novel noninvasive prenatal diagnosis technique of determination of pregnancy zygosity based on examination of feto-maternal microchimerism of plasma cfDNA with the use of STRs and DIP-STRs. Our preliminary results based on 22 STR loci showed 67% sensitivity, 100% specificity and 82% accuracy for prenatal detection of twin dizygosity. The corresponding values for seven DIP-STRs were 13%, 100% and 54%, respectively. Owing to assay performance, low DNA input requirements, low costs (below 10 USD per patient) and simplicity of analysis, genotyping of STR/DIP-STR markers in maternal plasma cfDNA may become a useful supplementary test for noninvasive prenatal diagnosis of twin zygosity in cases when chorionicity and zygosity cannot be reliably determined by ultrasound examination and prognostic value may be provided by a DNA test determining pregnancy zygosity.

Socio-demographic and psychological determinants of exclusive breastfeeding after six months postpartum - a Polish case-cohort study.

OBJECTIVES: The purpose of this study was to explore the socio-demographic and psychological factors connected with exclusive breastfeeding after 6 months postpartum. MATERIAL AND METHODS: A total of 251 women filled in questionnaires in the first week postpartum, then again after 3 and 6 months. The questionnaires included socio-demographic and medical questions, as well as psychological tools: the NEO-FFI Personality Inventory, the Berlin Social Support Scales (BSSS), and the Edinburgh Postnatal Depression Scale (EPDS). Further detailed questions concerning breastfeeding were relevant to this study. RESULTS: The rate of exclusive breastfeeding after 6 months was 39.68%. It was found that exclusive breastfeeding was most strongly connected with attending prenatal classes (ORa = 2.84, CI 1.18-6.87, p = 0.01), formula supplementation after 3 months (ORa = 0.01, CI 0.002-0.08, p < 0.001) and the mother's subjective satisfaction with feeding the infant after 3 months (ORa = 1.44, CI 1.01-2.06, p = 0.04). No other psychological (as far as personality, social support or risk of postpar-tum depression are concerned), demographic or medical factors were significant. Only factors pertaining to breastfeeding were significant. CONCLUSIONS: The prevalence of exclusive breastfeeding in Poland is unsatisfactory. Women should have easy access to prenatal classes with the most up-to-date knowledge on lactation and be advised against supplementing with formula, whenever possible. This could lead to higher satisfaction with breastfeeding.

Diversity of dendritic cells generated from umbilical cord or adult peripheral blood precursors.

Following the discovery of methods to generate large numbers of specific dendritic cells (DCs) ex vivo, the possibility of exploiting these cells in immunotherapeutic strategies will become a reality. It seems to be rationally to analyse the influence of the precursor source for further features and applications. For the needs of the given project DCs were derived from precursors derived from adult peripheral blood (APB) and umbilical cord blood (UCB). During some expansions of UCB CD34+ cells were separated giving non-adherent DCs (NA-DCs) or adherent DCs (A-DCs), whereas DCs derived from UCB precursors without separation gave rise to All-DCs. DC subpopulations were stimulated by lipopolysaccharides (LPS) or interferon-γ (IFN-γ), and afterwards the morphology, phenotype, and stimulatory properties were analysed. Our findings demonstrated that DCs generated from APB and UCB precursors were not equivalent and exhibited opposite features when expanded in comparable conditions. Additionally, all three subpopulations of UCB-derived DCs presented functional dissimilarities. Based on our results we concluded that the precursor source and the composition of media must be considered as crucial to the success of potential therapeutic application.

Medical and psychosocial determinants of risk of postpartum depression: a cross-sectional study.

OBJECTIVE: The aim of this study was to investigate the degree of risk of maternal postpartum depression during the second month of puerperium. METHOD: In total, 387 postnatal women filled out a questionnaire concerning their health and social status, as well as the following tests: the Edinburgh Postnatal Depression Scale (EPDS), the Patient Health Questionnaire-9 (PHQ-9), the Neo Five-Factor Inventory (NEO-FFI) Personality Inventory and the Berlin Social Support Scales. After 4-8 weeks, patients responded to another questionnaire with the EPDS and the PHQ-9. RESULTS: In total, 48 patients (12.40%) were found to be at risk of postpartum depression between the fourth and eighth weeks after delivery. Premenstrual syndrome [adjusted odds ratio (ORa)=2.93, confidence interval (CI) 1.30-6.63] and EPDS>12 points during the first week after the delivery (ORa=3.74, CI 1.59-9.04) increased the risk of postnatal depression. A similar role is played by a high result in neuroticism scale of the NEO-FFI (ORa=1.50, CI 1.17-1.92) and a positive family history of any psychiatric disorder (ORa=1.03, CI 1.01-1.06). CONCLUSION: A history of premenstrual syndrome and a higher risk of affective disorder soon after a childbirth are associated with greater chances of depressive symptoms in the second month postpartum. This is also the case if a patient is neurotic and has a relative with a history of any psychiatric disorder. Such women should have their mental status carefully evaluated.

Personality type, social support and other correlates of risk for affective disorders in early puerperium.

OBJECTIVES: The purpose of this study was to assess the prevalence of risk for postpartum mood disorders in mothers during the early postnatal period and to search for coexisting conditions. MATERIAL AND METHODS: We studied 546 women in the first week after delivery. The subjects filled out a questionnaire concerning their health, social and demographic status, the Edinburgh Postnatal Depression Scale, the Patient Health Questionnaire, the NEO-FFI Personality Inventory and the Berlin Social Support Scales. RESULTS: Probable mood disorders affected 15.85% of these patients. The risk increased with a current cesarean section (ORa = 2.54), a higher level of neuroticism (ORa = 1.65), greater fear of childbirth (ORa = 1.18), a lower level of extraversion (ORa = 0.77) and greater need for social support (ORa = 2.68). CONCLUSIONS: High level of neuroticism and introversion, as well as higher fear of delivery and the need of social support are among factors increasing the probability of mood disturbances in early postpartum period. A cesarean section might elevate the risk similarly. The mental health of such patients should be carefully examined.

Relationship, social support, and personality as psychosocial determinants of the risk for postpartum blues.

OBJECTIVES: The purpose of the study was to identify factors increasing or decreasing the risk for postpartum blues. MATERIAL AND METHODS: A total of 101 women in their first week postpartum were included in the study. The Edinburgh Postnatal Depression Scale, questions concerning their medical and social status, and psychological tests (the Personality Inventory NEO-FFI, The Mieczyslaw Plopa and Jan Rostowski Marriage Questionnaire, and the Berlin Social Support Scales) were used. RESULTS: The probability of postpartum blues was detected in 16.8% of the respondents. The risk decreased with higher satisfaction with intimacy (OR = 0.81), partner similarity (OR = 0.78), and the overall satisfaction with the relationship (OR = 0.94), while higher disappointment elevated that risk (OR = 1.12). As far as social support is concerned, further inde-pendent factors included perceived available social support (OR = 0.31), perceived instrumental social support (OR = 0.24), need for support (OR = 2.74), and protective buffering support (OR = 3.41). High level of neuroticism as well as fear of childbirth increased the risk for postpartum blues (OR = 2.17 and OR = 1.30, respectively). High level of extraversion and better quality of sleep constituted protective factors (OR = 0.74 and OR = 0.60, respectively). CONCLUSIONS: Maternal disappointment with marriage/relationship, neuroticism and introversion, poor quality of sleep, fear of childbirth, and seeking social support are among the factors signaling the need for careful observation for signs of possible postpartum mood disorders both, during hospitalization and the follow-up visits.

[DNA profiling as a method of zygosity determination in multiple pregnancy]. / Profilowanie DNA jako metoda okreslania zygotycznosci w ciazy wieloraczej.

The aim of the report was to present a method of zygosity determination in multiple pregnancy. The study wascarried out on same-sex neonates born as a result of spontaneous quadruplet pregnancy. Zygosity was determinedby DNA profiling. The pregnancy was confirmed to be polyzygotic. DNA profiling may be used as a method ofzygosity determination in multiple pregnancy.

Cytokine profiles during delivery affect cord blood hematopoietic stem and progenitors cells.

The study was aimed to determine the correlations between serum levels of cytokines (GM-CSF, IL-4, IL-10 and TNF) in maternal (MB) and cord blood (CB) and some features of cord blood hematopoietic stem and progenitor cells (CB HSPCs). Study material was MB and concomitant CB samples collected from 98 volunteers at the moment of delivery. The IL-4, IL-10, TNF and GM-CSF concentrations in serum and in supernatants from PMA-stimulated mononuclear cells isolated from both blood types were measured using BD Cytometric Bead Array Flex Set System. CB HSPCs (CD34(+)CD45(low)) proportion was also estimated by flow cytometry. The most relevant results concerned the tendency to down regulation of CB HSPCs number with an increase of IL-4, IL-10 and GM-CSF levels, only the TNF concentration seems to have no influence on HSPCs pole size. The strongest positive correlations were found between CD34(+)CD45(low) HSPCs number and IL-10 and GM-CSF in MB serum and GM-CSF and TNF from CB supernatants. The strongest negative correlations were found between CD34(+)CD45(low) HSPCs number and IL-4 and GM-CSF in CB serum and IL-10 in MB supernatants. Interestingly, we observed 'opposite correlation' between serum and supernatant from CB and MB. We concluded that elevated serum levels of IL-4, IL-10 and GM-CSF in CB are indicative of enhanced differentiation of HSPCs and characterize a normal perinatal development. Elevated levels of cytokines seem to stimulate differentiation of HSPCs what is advantageous for neonates during perinatal period.

A Proposed Molecular Mechanism of High-Dose Vitamin D3 Supplementation in Prevention and Treatment of Preeclampsia.

A randomized prospective clinical study performed on a group of 74 pregnant women (43 presenting with severe preeclampsia) proved that urinary levels of 15-F(2t)-isoprostane were significantly higher in preeclamptic patients relative to the control (3.05 vs. 2.00 ng/mg creatinine). Surprisingly enough, plasma levels of 25-hydroxyvitamin D3 in both study groups were below the clinical reference range with no significant difference between the groups. In vitro study performed on isolated placental mitochondria and placental cell line showed that suicidal self-oxidation of cytochrome P450scc may lead to structural disintegration of heme, potentially contributing to enhancement of oxidative stress phenomena in the course of preeclampsia. As placental cytochrome P450scc pleiotropic activity is implicated in the metabolism of free radical mediated arachidonic acid derivatives as well as multiple Vitamin D3 hydroxylations and progesterone synthesis, we propose that Vitamin D3 might act as a competitive inhibitor of placental cytochrome P450scc preventing the production of lipid peroxides or excess progesterone synthesis, both of which may contribute to the etiopathogenesis of preeclampsia. The proposed molecular mechanism is in accord with the preliminary clinical observations on the surprisingly high efficacy of high-dose Vitamin D3 supplementation in prevention and treatment of preeclampsia.

Temperament and the mother-infant dyad: associations with breastfeeding and formula feeding with a bottle.

Breastfeeding supports the formation of an emotional bond between mothers and their children. The feeding method is associated with both the child's temperament and the mother's perception of herself and the child. Therefore, the present study focuses on the feeding method, mothers' reaction during feeding, and infants' temperament traits. Ninety-eight mothers with children aged 3 to 5 months participated in the study. Children were assessed with the Children Development Scale (A. Matczak et al., 2007) to measure their temperament. Mothers completed the Mother and Baby Scale (D. Wolke & I. St James-Roberts, 1987, as cited in T.B. Brazelton & K. Nugent, 1995), which measures mothers' evaluation of their children's behaviors during feeding and their overall experiences with their children's care. The results show that breastfed newborns, as compared to bottle-fed newborns, demonstrate higher vigor, which includes activity and the intensity of reaction. Bottle-fed children demonstrate higher regularity than do breastfed children. Mothers who bottle-feed their children perceive themselves to be less confident in the feeding domain than do mothers who breastfeed. Our results indicate that children's temperament might be an important factor in the decision regarding the feeding method. The study supports the idea of promoting knowledge of children's behaviors during feeding among mothers even before their children are born, such as during antenatal classes.

[Estimation of fetal middle cerebral artery peak systolic velocity at 18-39 weeks of gestation in Polish population]. / Ocena wartosci maksymalnej predkosci skurczowej w tetnicy srodkowej mózgu plodu miedzy 18. a 39. tygodniem ciazy w polskiej populacji.

OBJECTIVES: The aim of this paper was to establish normal values of fetal middle cerebral artery peak systolic velocity (MCA-PSV) between 18-39 weeks' gestation in the Polish population and to compare the results with values published by other authors, for different populations seeking the discrepancies between them. MATERIAL AND METHODS: 280 healthy pregnant women from the Polish population underwent ultrasound examination. The cross-sectional data were obtained based on the measurements of fetal middle cerebral artery peak systolic velocity A chart of normal MCA-PSV values as a function of the gestational age was constructed. RESULTS: Normal ranges for MCA-PSV in the Polish population were established. The results were compared with values published by other authors, for different populations. CONCLUSIONS: The use of MCA-PSV measurements has proven itself to be a reliable method in diagnosis of fetal anemia. Differences in normal values of MCA-PSV in the Polish population compared with other nations have been observed.

The influence of intravenous ondansetron on maternal blood haemodynamics after spinal anaesthesia for caesarean section: a double-blind, placebo-controlled study.

OBJECTIVE: verification of a hypothesis assuming that 5-HT3 receptor blockade by intravenous administration of ondansetron reduces the incidence of hypotension and bradycardia in patients undergoing spinal anaesthesia for Caesarean section. MATERIAL AND METHODS: The study design was approved by the Bioethics Committee and included 72 patients undergoing elective Caesarean section, randomly assigned to ondansetron group (group 0) or placebo group (group P). Finally group 0 encompassed 35 patients administered ondansetron 8 mg i.v. dissolved in 10 ml 0.9% NaCl whereas group P consisted of 34 patients receiving 0.9% NaCl 10 mg. Systolic and diastolic pressures were measured every 2 minutes since the onset of anaesthesia. Heart rate (HR) was monitored continuously The criterion of hypotension requiring ephedrine was a decrease in systolic pressure by 20% compared to its baseline value or a decrease in systolic pressure below 90 mm Hg. The criterion of bradycardia was a decrease in HR below 60/min. RESULTS: Hypotension was observed in 14 group 0 patients (39%) and in 15 group P patients (44%); the difference was not statistically significant. Bradycardia was noted in 1 group 0 patient (3%) and in 2 group P patients (6%); the difference was not statistically significant. CONCLUSION: A hypothesis assuming a reduction in pressure following subarachnoid anaesthesia for Caesarean section after the administration of 8 mg of ondansetron was not confirmed.

[Analysis of pregnancy, labor and neonatal course in babies with prenatally-diagnosed complete atrioventricular heart block]. / Analiza przebiegu ciazy, porodu i losów noworodków z prenatalnie diagnozowanym calkowitym blokiem przedsionkowo--komorowym.

INTRODUCTION: Complete heart block (third-degree atrioventricular block) is a defect of the conduction system of the heart, in which the impulse generated in the sinoatrial node does not propagate to the ventricles, and thus the latter contract independently of the atria. A third-degree atrioventricular block can be either congenital or acquired. In 60-70% of the cases, the congenital heart block results from destruction of the conduction system of the fetal heart by anti-Ro/SSA and anti-La/SSB antibodies present in maternal serum. The antibodies are synthesized in the course of autoimmune maternal conditions, most often systemic lupus erythematosus or rarer rheumatoid arthritis, dermatomyositis or Sjögren's syndrome. The complete block can occur as an isolated defect or be associated with structural anomalies of the fetal heart. MATERIAL AND METHODS: A total of five patients whose fetuses were diagnosed with the third-degree atrioventricular block have been hospitalized at the Department of Obstetrics, Medical University of Gdansk between 2012 and 2014. RESULTS: We present the data of the five patients, hospitalized at the Department of Obstetrics, Medical University of Gdansk, whose fetuses were diagnosed prenatally with the complete heart block. The cases differ in terms of etiology clinical outcome, and postnatal treatment. All data are presented in Table I. CONCLUSIONS: We emphasize the role of appropriate pregnancy management and careful monitoring of the fetal condition. From obstetrical perspective, it is important to monitor the condition of fetuses with the third-degree atrioventricular block ultrasonographically and echocardiographically; in turn, cardiotocography is less useful in this setting. Therefore, a non-reactive cardiotocographic tracing should not constitute an indication for a preterm delivery. An affected fetus should be delivered in a tertiary center for perinatal care that cooperates with a pediatric cardiology center. An efficient program for cardologic prenatal care and close cooperation between obstetricians, neonatologists, pediatric cardiologists, and cardiac surgeons constitute the key to a successful outcome.

Influence of place of residence on indications for genetic amniocentesis in the Pomeranian region of Poland before and after introduction of the Prenatal Screening Program in 2008.

BACKGROUND: The aim of the study was to analyze differences in the indications for amniocentesis in patients living in urban and rural areas before and after introduction of the Prenatal Screening Program by Polish National Health Insurance agency in the Pomeranian region in 2008. MATERIAL AND METHODS: Indications for 2578 amniocenteses performed in the Department of Obstetrics of the Medical University of Gdansk between 1996 and 2010 were recorded. RESULTS: Advanced maternal age accounted for 69% of women in urban areas and 61% of women in rural areas being referred for amniocentesis (p<0.001). There was also a significant difference between locations in chromosomal abnormality in previous pregnancy, accounting for 4% of referrals for amniocentesis in urban areas compared with 7% of referrals in rural areas. In urban areas, advanced maternal age accounted for 73% of referrals between 1996-2007 compared with 60% of referrals for amniocentesis between 2008 and 2010 (p=0.004), and in rural areas it was 66% and 54%, respectively (p<0.001). Abnormal result of biochemical screening surprisingly accounted for 13% of referrals for amniocenteses between 1996-2007 in urban areas compared with 28% after 2008 (p<0.001). In rural areas this indication accounted for 12% referrals before 2008 and for 28% from 2008 onward (p<0.001). CONCLUSIONS: The results of the study suggest that in both urban and rural areas there was a significant decrease in advanced maternal age as a reason for referral for amniocentesis, but a significant increase in abnormal results of biochemical screening as an indication for amniocentesis after 2008.

Intra- and inter-observer variability of evaluation of uterine cervix elastography images during pregnancy.

OBJECTIVES: To evaluate reproducibility and repeatability of the assessment of elastography images of the uterine cervix using an Elastography Index. MATERIAL AND METHODS: Elastography images of the uterine cervix were obtained. Numeric scale called Elastography Index, previously published by the authors, was used to describe parts of the cervix. A total of 282 images were evaluated twice by an experienced and twice by an inexperienced operator RESULTS: Reproducibility and repeatability of the evaluation of internal and external os and cervical canal were over 90%. Inter-assay coefficient of variation was 1.84%, 6.76% and 7.27% respectively and 5.84% for anterior and 16.74% for posterior wall. Analysis of the second evaluation only of both operators revealed no significant difference for posterior wall as well (F-test; p = 0.09). CONCLUSION: Authors proved satisfactory reproducibility and repeatability of subjective assessment of elastography images of uterine cervix during pregnancy with the use of Elastography Index in the hands of experienced and inexperienced observer

Comparison of fetal myocardial contractility before and after laser photocoagulation of communicating vessels in twin-to-twin transfusion syndrome.

OBJECTIVES: To evaluate changes in myocardial contractility that occur after selective laser photocoagulation of communicating vessels (SLPCV) in fetuses from pregnancies complicated with twin-to-twin transfusion syndrome (TTTS). METHODS: The study included 51 pregnant women between 16 and 26 weeks of gestation who underwent SLPCV due to TTTS. Ultrasonography was performed before SLPCV and on postoperative day 1, 3(4) and 7. Fetal heart contractility in both fetuses was evaluated by determining the shortening fractions of the left and right ventricles (FS LV and FS RV), and the myocardial performance index (Tei-Index). RESULTS: There was a significant increase in postoperative FS LV and FS RV in recipients (from 35.7% to 44%, P = 0.037 and from 27.6% to 32.9%, P = 0.021, respectively). Pre-operative Tei-Index values for both the left (0.55) and right ventricle (0.6) were above normal. The mean postoperative Tei-Index for the left ventricle decreased significantly to 0.49 (P = 0.011), while no significant change was observed in the right ventricle (0.57). No significant differences between pre- and postoperative FS and Tei-Index values were noted in the donors. CONCLUSIONS: SLPCV is reflected by a significantly increased myocardial contractility in recipients.

Prognostic value of elastography in predicting premature delivery.

OBJECTIVES: The aim of the study was to assess changes in the consistency of the uterine cervix and correlate the obtained results with the risk of premature delivery and time from examination to delivery MATERIAL AND METHODS: Elastographic images of the cervix in a group of 44 patients, admitted to the hospital due to uterine contractions before 37 weeks of gestation, were recorded and analyzed. Elastograms were assessed with the use of Elastography Index (El), a five-step (0-4) color scale, which visualizes tissue hardness by encoding numerical values in specific colors (0-violet/the hardest tissue; 4-red/the softest tissue). Correlation between El for different parts of the uterine cervix was evaluated and analyzed in relation to preterm delivery and time from examination to delivery. RESULTS: Twenty-one patients delivered before term and 23 at term. A strong correlation for El of the internal os and time from examination to delivery (Pearson test, p<0.001), and risk of preterm birth (Mann-Whitney-Wilcoxon test, p<0.001), was noted. We also found a strong correlation between cervical canal length and risk of preterm delivery (Anova test, p=0.001), and time from examination to delivery (Pearson test, p=0.006). CONCLUSIONS: Elastography may offer a chance for an objective assessment of elasticity of the uterine cervix and may become an alternative to vaginal examination and Bishop score. Proper selection of patients with high or low risk of preterm delivery may facilitate good management decisions and, consequently decrease the percentage of immature deliveries, unnecessary medical procedures, and hospitalization.

Evolution of the indications for genetic amniocentesis after the introduction of the prenatal screening program by the national health insurance in Poland.

OBJECTIVE: In 2008, the Prenatal Screening Program was introduced by the National Health Insurance in the Pomeranian region of Poland. As of then, biochemical and ultrasound screening was offered to women eligible for amniocentesis according to the earlier policy. The aim of the study was to investigate the evolution of the indications for amniocentesis after the introduction of the Program. MATERIAL AND METHODS: In total, 2579 women referred for amniocentesis to the Department of Obstetrics, Medical University of Gdansk, were included in the study They were divided into two groups: 1705 women referred between 1996 and 2007 (group A) and 874 women referred between 2008 and 2010 (group B). Indications for amniocentesis were compared between the groups. RESULTS: A significant difference in the indications for amniocentesis was found between the groups (Kruskal-Wallis test; p < 0.001). Maternal age, fetal malformation in the previous pregnancy and anxiety were less frequent in group B (p < 0.0001, p = 0.0008 and p = 0.0156, respectively). In contrast, a higher frequency of positive biochemical screening and abnormal ultrasound results as indications for amniocentesis was found in group B (p < 0.0001 and p = 0.0008, respectively). CONCLUSIONS: The introduction of the Prenatal Screening Program by the National Health Insurance shifted the proportion of indications for amniocentesis from maternal age to positive results in biochemical and ultrasound screenings, and increased the number of invasive testing. Further observation of the trend and its influence on the detection rate is imperative to confirm that the proposed Program is adequate and does not require adjustments.