In about 95% of cases
the extra chromosome 21 is of maternal origin, and of these
cases approximately 80% are due to an error during
meiosis I. About 4% of Down syndrome patients have an
unbalanced Robertsonian translocation involving chromosome
21. Approximately 60% of these translocations
involve the long arm of chromosome 13, 14, or 15 (most
frequently chromosome 14). About half of these translocations
are de novo and half are inherited from a balanced
carrier parent (usually the mother). Nearly 40% of
unbalanced Robertsonian translocations involve only
chromosomes 21 and 22. Most of these (90%) involve
21/21 long-arm fusions or isochromosomes and nearly all
are de novo. The rare parent who is a balanced 21/21
isochromosome carrier has a 100% risk for having a viable
offspring with Down syndrome. Female carriers of
balanced 14/21 or 21/22 Robertsonian translocations have
a 10–15% risk for an unbalanced Down syndrome child.
Male carriers have a risk of less than 5%. Mosaicism
involving a mixture of normal diploid cells and trisomy 21
cells is present in about 2% of Down syndrome patients