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The aim of this study was to compare screening performance for Down syndrome of the absolute risk (AR) method to the first trimester combined test (FCT) at different maternal ages.There was a retrospective analysis of 32,448 FCT. AR was defined as final risk divided by maternal age risk.The likelihood of receiving a true prediction was comparable between both methods in all age groups. With the AR method, two extra Down syndrome cases were detected in women <30 years, three cases were missed in women ≥36 years, and the likelihood of receiving a false prediction decreased overall (OR 0.82, CI 0.77–0.87; P < 0.0001), in women aged 36–40 years (0.45, CI 0.41–0.51; P < 0.0001), in women aged 41–45 years (0.18, CI 0.13–0.26; P < 0.0001) and increased in women aged ≤25 years (2.12, CI 1.52–2.96; P < 0.004).The AR method results in a significant decreased likelihood of receiving a false prediction with a comparable likelihood of receiving a true prediction. Thus, fewer invasive diagnostic tests will be performed. It will take away the misunderstanding about differences in screening performance for women of different ages. This might lead to a higher uptake of first trimester screening resulting in a more efficient screening policy. © 2013 John Wiley & Sons, Ltd.