Birinci ve İkinci Trimester Tarama Testlerinde Kullanılan Biyokimyasal Belirteçlerin Kötü Obstetrik Sonuçlarla İlişkisi

Amaç: Fetal anöploidi tarama testleri biyokimyasal belirteçlerinin değerleri ile olumsuz maternal ve fetal sonuçların ilişkisinin değerlendirilmesidir. Gereç ve Yöntem: Gebe polikliniğine ikili ve üçlü test için başvuran, çalışma kriterlerine uyan 503 gebe çalışmaya alındı. Anöploidi taraması serum belirteçleri ile kötü obstetrik sonuçlar ve yenidoğan sonuçları arasındaki ilişki araştırıldı. Regresyon analizinde düzeltilmiş odds oranı, %95 güven aralığı ve p-değerleri her bir belirteç için bulundu. Bulgular: Gebelikle ilişkili plazma protein-A Multiple of the Median (MoM) değeri preeklampsi/gestasyonel hipertansiyon izlenen gebelerde anlamlı olarak düşük izlenmiştir (0,63 vs 0,89, p=0,014). Yüksek serbest beta insan koryonik gonadotropin (hCG) MoM değerleri olan olguların intrauterin gelişme geriliği riski yüksektir (p=0,029). Alfa fetoprotein (AFP) MoM değerleri 10. persantil ve altında olan gebelerde 24. hafta ve sonrasında fetal kayıp riski 9 kat fazla bulunmuştur (p=0,036). Yüksek AFP değerlerinde ise düşük doğum ağırlığı oranları 5 kat yüksek olarak saptanmıştır (p=0,023). İkinci trimesterde düşük hCG değerlerinde intrauterin gelişme geriliği riski artmaktayken (p=0,011), yüksek hCG değerlerinde gebelikle indüklenen hipertansif hastalıkların riskinin belirgin olarak arttığı saptanmıştır (p=0,001). Ayrıca yüksek hCG saptandığında ablasyo plasenta riski de oldukça yüksek bulunmuştur (p=0,023). Düşük unkonjuge estriol (uE3) değerlerinde preeklampsi/gestasyonel hipertansiyon ve düşük doğum ağırlığı riskinin arttığı gözlenmiştir, uE3 değerleri düştükçe bu ilişki kuvvetlenmektedir. Yüksek hCG (%31 vs %6, p

The Relationship of Biochemical Markers used in the First and Second Trimester Screening Tests with Poor Obstetric Results

Objectives: This study aims to determine the relationship between poor obstetric and perinatal outcomes and maternal serum aneuploidy markers of first and second trimesters. Materials and Methods: Five hundred three singleton pregnancies who underwent prenatal screening for aneuploidy were examined. The association between serum aneuploidy markers and poor obstetric and perinatal outcomes was investigated. In the regression analysis, adjusted odds ratio, 95% confidence interval and p-values were found for each marker. Results: The median Multiple of the Median (MoM) of pregnancy-associated plasma protein A was significantly lower in pregnancies with pregnancy induced hypertension (0.63 vs 0.89, p=0.014). Women with elevated free β human chorionic gonadotropin (hCG) MoM levels were more likely to experience intrauterine growth retardation (p=0.029). By examining low (≤10th percentile) alpha fetoprotein (AFP) MoM levels, we found a 9 fold increase in risk of fetal death at or after 24 weeks of gestation (p=0.036). In case of high AFP levels, 5 fold increase in risk of IUGR was observed (p=0.023). While decreased levels of second-trimester hCG were associated with IUGR (p=0.011), increased risk of pregnancy induced hypertension was significantly associated with elevated hCG levels (p=0.001). Increased risk of abruptio placentae was associated with elevated hCG levels (p=0.023). Low levels of unconjugated estriol (uE3) appeared to be associated with pregnancy induced hypertension and low birth weight, the risks of which increased as depressed levels of uE3 became more extreme. Elevated hCG (31% vs 6%, p

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. Malone FD, Canick JA, Ball RH, et al. First-trimester or second-trimester screening, or both, for Down’s syndrome. N Engl J Med. 2005;353:2001-2011.
2. Alldred SK, Takwoingi Y, Guo B, et al. First and second trimester serum tests with and without first trimester ultrasound tests for Down’s syndrome screening. Cochrane Database Syst Rev. 2017;3:CD012599.
3. Alamillo CM, Krantz D, Evans M, et al. Nearly a third of abnormalities found after first-trimester screening are different than expected: 10-year experience from a single center. Prenat Diagn. 2013;33:251-256.
4. Kazerouni NN, Currier RJ, Hodgkinson C, et al. Ancillary benefits of prenatal maternal serum screening achieved in the California program. Prenat Diagn. 2010;30:981-987.
5. Dugoff L, Hobbins JC, Malone FD, et al. First-trimester maternal serum PAPP-A and free-beta subunit human chorionic gonadotropin concentrations and nuchal translucency are associated with obstetric complications: a population-based screening study (The FASTER Trial). Am J Obstet Gynecol. 2004;191:1446-1451.
6. Krantz D, Goetzl L, Simpson JL, et al. Association of extreme first-trimester free human chorionic gonadotropin-beta, pregnancy-associated plasma protein A, and nuchal translucency with intrauterine growth restriction and other ad verse pregnancy outcomes. Am J Obstet Gynecol. 2004;191:1452-1458.
7. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics and the Society forMaternal-FetalMedicin. ACOG Practice Bulletin No. 204: Fetal Growth Restriction. Obstet Gynecol. 2019;133:97-109.
8. No authors listed. Practice Bulletin No. 145: Antepartum Fetal Surveillance. Obstet Gynecol. 2014;124:182-192.
9. No authors listed. ACOG Practice Bulletin No. 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2019;133:1.
10. American Diabetes Association. Erratum. Classification and diagnosis of diabetes. Sec. 2. In Standards of Medical Care in Diabetes-2016. Diabetes Care 2016;39(Suppl.1):S13-S22.
11. Dugoff L, Hobbins JC, Malone FD, et al. Quad screen as a predictor of adverse pregnancy outcome. Obstet Gynecol. 2005;106:260-267.
12. Dugoff L; Society for Maternal–Fetal Medicine. First- and second-trimester maternal serum markers for aneuploidy and adverse obstetric outcomes. Obstet Gynecol. 2010;115:1052-1061.
13. O’Gorman N, Wright D, Syngelaki A, et al. Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11-13 weeks gestation. Am J Obstet Gynecol. 2016;214:103.
14. Goetzinger KR, Singla A, Gerkowicz S, et al. The efficiency of first-trimester serum analytes and maternal characteristics in predicting fetal growth disorders. Am J Obstet Gynecol. 2009;201:412.
15. Hung TH, Shau WY, Hsieh CC, et al. Risk factors for placenta accreta. Obstet Gynecol. 1999;93:545-550.
16. Oztas E, Ozler S, Caglar AT, et al. Analysis of first and second trimester maternal serum analytes for the prediction of morbidly adherent placenta requiring hysterectomy. Kaohsiung J Med Sci. 2016;32:579-585.
17. Krause TG, Christens P, Wohlfahrt J, et al. Second-trimester maternal serum alpha-fetoprotein and risk of adverse pregnancy outcome(1). Obstet Gynecol. 2001;97:277-282.
8. Milunsky A, Jick SS, Bruell CL, et al. Predictive values, relative risks, and overall benefits of high and low maternal serum alpha-fetoprotein screening in singleton pregnancies: new epidemiologic data. Am J Obstet Gynecol. 1989;161:291-297.
19. Kırlangıç MM, Açmaz G, Şahin E, et al. The assessment of the perinatal outcomes of the patients who underwent quad screening test. Perinatal Journal. 2020;28:28-35.
20. Yaron Y, Cherry M, Kramer RL, et al. Second-trimester maternal serum marker screening: maternal serum alpha-fetoprotein, beta-human chorionic gonadotropin, estriol, and their various combinations as predictors of pregnancy outcome. Am J Obstet Gynecol. 1999;181:968-974.
21. Gagnon A, Wilson RD; Society Of Obstetricians And Gynaecologists Of Canada Genetics Committee. Obstetrical complications associated with abnormal maternal serum markers analytes. J Obstet Gynaecol Can. 2008;30:918-932.
22. Huerta-Enochian G, Katz V, Erfurth S. The association of abnormal alpha-fetoprotein and adverse pregnancy outcome: does increased fetal surveillance affect pregnancy outcome? Am J Obstet Gynecol. 2001;184:1549-1555.
23. van Rijn M, van der Schouw YT, Hagenaars AM, et al. Adverse obstetric outcome in low- and high- risk pregnancies: predictive value of maternal serum screening. Obstet Gynecol. 1999;94:929-934.
24. Chandra S, Scott H, Dodds L, et al. Unexplained elevated maternal serum alpha-fetoprotein and/or human chorionic gonadotropin and the risk of adverse outcomes. Am J Obstet Gynecol. 2003;189:775-781.
25. No authors listed. ACOG Committee Opinion No. 743. Low-dose aspirin use during pregnancy. Obstet Gynecol. 2018;132:44-52.
26. Wenstrom KD, Hauth JC, Goldenberg RL, et al. The effect of low-dose aspirin on pregnancies complicated by elevated human chorionic gonadotropin levels. Am J Obstet Gynecol. 1995;173:1292-1296.