Prediction of adverse pregnancy outcomes by combinations of first and second trimester biochemistry markers used in the routine prenatal screening of Down syndrome

Abstract

There are significant associations between the levels of first and second trimester serum markers and adverse obstetric outcomes. However, even combinations of these markers can only predict adverse obstetric outcomes with modest accuracy.

Maternal Serum Alpha-Fetoprotein in Normal Pregnancy at 11–13 Weeks’ Gestation

“…Additionally, in pregnancies with normal fetuses, high serum AFP is associated with increased risk for adverse pregnancy outcome, including fetal death, preeclampsia, preterm delivery and fetal growth restriction [4,5] . In the last few years, the introduction of successful second-trimester sonographic diagnosis of neural tube defects [6,7] and the improved detection of aneuploidies by a combination of fetal nuchal translucency (NT) thickness and maternal serum free ␤ -hCG and pregancy-associated plasma protein-A (PAPP-A) at 11-13 weeks' gestation, compared to second-trimester biochemical testing, have reduced the Serum …”

Predictive values of maternal serum PAPP-A level, uterine artery Doppler velocimetry, and fetal biometric measurements for poor pregnancy and poor neonatal outcomes in pregnant women

“…Markers that could indicate these changes prior to the onset of disorder will provide us a chance to take early preventive measures and even to prevent this in the future. For this reason, the world of perinatology has carried out many studies, particularly in recent years, on numerous placental biochemical markers, various Doppler ultrasound techniques and parameters, and various ultrasonographic methods to evaluate fetal and placental development in order to determine placental defects (1,8,10,11). We aimed to determine the predictive value of the maternal serum PAPP-A level of the first trimester, uterine artery Doppler velocimetry of the second trimester, and FBMs of the second and third trimester for poor pregnancy and poor neonatal outcomes which would probably occur due to placentation defect in pregnant women, and we found that the early prediction of unfavorable maternal and unfavorable neonatal outcomes of placental insufficiency might be possible using some test results, such as FBMs or an assessment of the HC/AC ratio, even though there is no method that can be used alone as a screening test.…”

“…Several studies have recently shown that low serum levels of pregnancy-associated plasma protein A (PAPP-A) might be associated with poor pregnancy and poor neonatal outcomes (1,8,9). PAPP-A, which was first purified from the serums of pregnant women in 1974, is a member of the metzincin family of metalloproteinases (10,11).…”

Clinical Significance of Abnormal Results of Second Trimester Hormones in the Absence of Aneuploidy

“…The association between mid-trimester maternal serum markers and pregnancy complications, including fetal loss, gestational hypertension, preeclampsia, intrauterine growth restriction (IUGR), preterm delivery, placental abruption, and intrauterine fetal death has been reported before (1)(2)(3). Furthermore, AFP has been reported as an important predictor of pregnancy complications.…”