In current study, pregnant women who underwent amniocentesis for different reasons were classified, with the top three groups exhibiting the highest pathogenicity rates being Group A, Group D, and Group F. Pairwise comparisons with the reference group revealed that the detection rate of pathogenic variants in the group undergoing amniocentesis due to high-risk NIPT was as high as 92.16%, significantly higher than that of the reference group (69.02%). Previous studies have shown that NIPT demonstrates a high positive predictive value (PPV) for common aneuploidies, consistent with our findings, indicating that NIPT is highly sensitive in screening for chromosomal abnormalities[24, 25]. As a non-invasive test, NIPT analyzes cell-free fetal DNA (cffDNA) in maternal blood to detect potential fetal chromosomal abnormalities early in pregnancy, particularly showing high accuracy for common trisomies (such as trisomy 21, trisomy 18, and trisomy 13)[26]. Our results further confirm that patients undergoing amniocentesis due to abnormal NIPT findings are significantly more likely to detect pathogenic CNVs upon diagnosis, correlating with NIPT's efficacy in aneuploidy screening. In addition, the results indicated that the proportion of women undergoing amniocentesis due to high-risk trisomy 18 syndrome or parental chromosomal abnormalities was low within the overall cohort. Although no significant difference was observed compared to the reference group, the detection rate of pathogenic CNVs in these groups was indeed high, suggesting that these factors may play a critical role in the prenatal detection of CNV abnormalities. By contrast, other groups, such as advanced maternal age, abnormal ultrasound findings, or a history of adverse pregnancy, exhibited significantly lower pathogenicity rates compared to the reference group. This finding suggests that, in the absence of abnormal NIPT guidance, patients undergoing amniocentesis for conventional indications face a lower detection rate of pathogenic CNVs despite being at risk for chromosomal abnormalities, and the result aligns with previous studies, both domestically and internationally[27, 28]. For example, some studies have noted that the primary purpose of amniocentesis in advanced maternal age is to screen for aneuploidy (such as Down syndrome), yet the detection rate of chromosomal abnormalities is relatively low, particularly for small copy number variants[29, 30]. Similarly, women with a history of adverse pregnancy may have a pathogenic cause rooted in monogenic disorders rather than chromosomal structural abnormalities, resulting in fewer detectable copy number variants through CNV-seq[31, 32].
In current study, patients with detected copy number variants (CNVs) were divided into four groups based on the size of the CNV fragments. The group with multiple CNVs was adopted as the reference group, and a comparative analysis of pathogenic detection rates across the four groups was conducted. The results demonstrated a strong correlation between the size of the CNV fragments and their pathogenicity. Patients with larger CNV fragments (greater than 5.0 Mb) exhibited a higher detection rate of pathogenic variants, which aligns with findings from existing literature. Numerous studies have reported that larger CNV fragments are typically associated with more severe phenotypes and pathogenicity. For instance, deletions or duplications exceeding 5 Mb often impact the expression of multiple genes, leading to severe developmental defects or syndromes, such as DiGeorge syndrome (22q11.2 deletion syndrome) and Williams syndrome (7q11.23 deletion), which are frequently accompanied by larger fragment deletions or duplications[33–35]. This is consistent with our findings, where Group Ⅲ showed a significantly higher pathogenic detection rate compared to the reference group, further supporting the notion that large-scale genomic structural variations have a substantial impact on fetal health. In contrast, the group carrying CNV fragments smaller than 1 Mb had a notably lower pathogenic detection rate. Small-scale CNVs, particularly those under 1 Mb, are relatively common in the general population and do not necessarily lead to overt clinical symptoms. The finding is consistent with several international cohort studies, which indicate that smaller CNV fragments are often benign variants with no significant clinical impact and are detected at higher frequencies in healthy individuals. For CNV fragments between 1.0 and 5.0 Mb, our study found no significant difference in pathogenic detection rates compared to the reference group. It suggests that medium-sized CNV fragments may exhibit heterogeneity, potentially leading to severe clinical phenotypes in some cases, while representing moderate-risk variants in others[36, 37]. The pathogenicity of these variants may depend on the specific genes involved, the nature of the variation (deletion or duplication), and the functional roles of the affected genes. Some studies have highlighted the need for special attention to CNV fragments between 1 Mb and 5 Mb in prenatal diagnosis, particularly when they involve key genes related to development[38, 39].
The current study perform a comparative analysis of pathogenic detection rates for different reasons of prenatal amniocentesis and varying sizes of CNV fragments, provides important clinical reference points for the interpretation of CNVs in prenatal diagnosis. Patients who underwent amniocentesis due to abnormal NIPT results exhibited a significantly higher pathogenic detection rate compared to other groups, highlighting the need for clinicians to pay close attention to positive NIPT findings and promptly pursue confirmatory testing. Moreover, for patients carrying larger CNV fragments, clinicians should be vigilant regarding their potential pathogenicity and make timely intervention decisions in conjunction with other imaging or clinical phenotypes. In contrast, while smaller CNVs are frequently detected, most are benign or neutral variants, and over-interpretation should be avoided in clinical practice to reduce unnecessary psychological stress. In clinical settings, the size of CNV fragments should be considered an important reference for assessing pathogenicity, but it is not the sole criterion. Gene function, CNV type (deletion or duplication), genomic location, and other genomic characteristics must also be taken into account. It is worth mentioning that as we continue to accumulate genomic and phenotypic data from the Northwestern population, we will further adopt larger datasets for more in-depth study, aiming to make the results more reliable and optimize clinical decisions for prenatal diagnosis