Scientists have known for some time that fetal DNA can be detected in the maternal bloodstream during pregnancy (1). Up to 10% of circulating cell-free-DNA (ccfDNA) can be attributed to the fetus. Fetal ccfDNA is released from the placenta, mainly through apoptosis, and enters the maternal bloodstream, where it can be easily collected and detected by PCR amplification. This method of collection has a much lower risk of miscarriage compared to more invasive collection methods such as amniocentesis and chorionic villus sampling.
Amplification of fetal ccfDNA enables a number of prenatal genetic testing such as gender determination and detection of fetal aneuploidy and other mutations. Testing of ccfDNA also allows identification of fetuses with a higher risks of hemolytic disease of the newborn (erythroblastosis fetalis) due to expression of the Rh factor in an Rh– negative mother, who can develop antibodies against the Rh factor and mount an immune response against fetal red blood cells. Finally, ccfDNA allows prenatal paternity determination (2). However, these tests have limitations.