The predictive value of maternal serum screening tests for adverse pregnancy outcomes

AbstractAim: Free beta-human chorionic gonadotropin (Fβ-hCG), pregnancy-associated plasma protein-A (PAPP-A), alpha-fetoprotein (AFP), unconjugated estriol (uE3), and inhibin-A have been shown to be useful not only in identifying chromosomal abnormalities in the first and second trimesters, but also in predicting adverse pregnancy outcomes (APOs). In this study, we aimed to investigate the predictive value of maternal serum screening tests for various APOs including preeclampsia, intrauterine growth retardation (IUGR), preterm labor, and gestational diabetes mellitus (GDM).Material and Methods: The study was carried out at our clinics and included a total of 220 pregnant women who respectively underwent the double and quadruple marker testsduring the 11th to 14th and 15th to 22nd gestational weeksbetween January 2017 and December 2018. Patient data (maternal age, parity/gravidity, gestational age, history of infertility, use of in vitro fertilization, maternal/ fetal complications, preterm labor, mode of delivery, birth weight, and length of stay in the neonatal intensive care unit) were reviewed retrospectively.Results: The AFP levels were statistically significantly higher in patients with IUGR (p=0.022),GDM (p=0.036), and preterm labor (p=0.021), compared to the control group with no APO. No significant correlation was found between preeclampsia and the serum markers.Conclusion: Our results show that elevated maternal serum AFP levels might be associated with various APOs,requiring closerpatient follow-up for early diagnosis and treatment.

PDF

___

1. Pergament E, Stein AK, Fiddler M, et al. Adverse pregnancy outcome after a false-positive screen for Down syndrome using multiple markers.Obstet Gynecol 1995;86:255-8.
2. Alldred SK, Deeks JJ, Guo B, et al. Second trimester serum tests for Down’s syndrome screening. Cochrane Database Syst Rev 2012;6:CD009925.
3. Wald NJ, Rodeck C, Hackshaw AK, et al. First and second trimester antenatal screening for Down’s syndrome: the results of the Serum, Urine and Ultrasound Screening Study (SURUSS). Health Technol Assess 2003;7:1-77.
4. Palomaki GE, Steinort K, Knight GJ, et al. Comparing three screening strategies for combining first-and second-trimester Down syndrome markers. Obstet Gynecol 2006;107:367-75.
5. Loucky J, Belaskova S, Prusa R, et al. The effect of inhibinA on prenatal screening results for Down syndrome in the high risk Czech pregnant women. Clin Lab 2019;65.
6. Kaewsuksai P, Jitsurong S. Prospective study of the feasibility and effectiveness of a second-trimester quadruple test for Down syndrome in Thailand.Int J Gynaecol Obstet 2017;139:217-21.
7. 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.
8. Dugoff L, Hobbins JC, Malone FD, et al. Quad screen as a predictor of adverse pregnancy outcome.Obstet Gynecol 2005;106:260-7.
9. Lao MR, Calhoun BC, Bracero LA, et al. The ability of the quadruple test to predict adverse perinatal outcomes in a high-risk obstetric population. J Med Screen 2009;16:55-9.
10. Baer RJ, Currier RJ, Norton ME, et al. Obstetric, perinatal, and fetal outcomes in pregnancies with false-positive integrated screening results. Obstet Gynecol 2014;123:603-9.
11. Cuckle HS. Screening for pre-eclampsia-lessons from aneuploidy screening. Placenta 2011;32:42-8.
12. Balci S. Prediction of poor pregnancy and poor neonatal outcomes. J Turk Ger Gynecol Assoc 2016;17:143-9.
13. Hughes AE, Sovio U, Gaccioli F, et al. The association between first trimester AFP to PAPP-A ratio and placentally-related adverse pregnancy outcome. Placenta 2019;81:25-31.
14. 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;30:918-32.
15. Singnoi W, Wanapirak C, Sekararithi R ,et al. A cohort study of the association between maternal serum inhibin-A and adverse pregnancy outcomes: a population-based study. BMC Pregnancy Childbirth 2019;19:124.
16. Ananth CV, Wapner RJ, Ananth S, et al. First-trimester and second trimester maternal serum biomarkers as predictors of placental abruption.Obstet Gynecol 2017;129:465-72.
17. Kim SY, Ryu HM, Yang JH, et al. Maternal serum and amniotic fluid inhibin A levels in women who subsequently develop severe preeclampsia. J Korean Med Sci 2006;21:452-6.
18. Broumand F,Lak SS, Nemati F, et al. A study of the diagnostic value of inhibin-Atests for occurrence of preeclampsia in pregnant women. Electron Physician2018;10:6186-92.
19. Yazdani S, Rouholahnejad R, Asnafi N, et al. Correlation of pregnancy outcome with quadruple screening test at second trimester.Med J Islam Repub Iran 2015;29:281.
20. Ozturk H, Erkaya S, Altinbas S, et al. The role of unexplained high serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) levels in the second trimester to determine poor obstetric outcomes.Turk J Obstet Gynecol 2014;11:142-7.
21. Wang X, Chen Y, Kuang H, et al. Associations between maternal AFP and β-HCG and preterm birth.Am J Perinatol 2019;36:1459-63.
22. Tancrede S, Bujold E, Giguer Y, et al. Mid-trimester maternal serum AFP and hCG as markers of preterm and term adverse pregnancy outcomes. J Obstet Gynaecol Can 2015;37:111-6.
23. Bartkute K, Balsyte D, Wisser J, et al. Pregnancy outcomes regarding maternal serum AFP value in second trimester screening. J Perinat Med 2017;45:817-20.
24. Belovic DK, Plesinac S, Dotlic J, et al. Biochemical markers for prediction of hypertensive disorders of pregnancy.J Med Biochem 2019;38:71-82.
25. Long W, Zhou Q, Wang H, et al. Second-trimester maternal serum screening biomarkers in the risk assessment for preeclampsia. Ann Clin Lab Sci 2018;48:308-13.
26. Puntachai P, Wanapirak C, Sirichotiyakul S, et al. Associations between pregnancy outcomes and unexplained high and low maternal serum alphafetoprotein levels.Arch Gynecol Obstet 2015;292:81-5.
27. Raty R, Anttila L, Virtanen A, et al. Maternal mid trimester free beta-HCG and AFP serum levels in spontaneous singleton pregnancies complicated by gestational diabetes mellitus, pregnancy-induced hypertension or obstetric cholestasis. Prenat Diagn 2003;23:1045-8.