Second-trimester prenatal screening for Down syndrome and the relationship of maternal serum biochemical markers to pregnancy complications with adverse outcome

Abstract

In a group of 26 524 control pregnancies and a group of 3728 pregnancies affected by one or more of the pregnancy complications of low birthweight, intra‐uterine growth restriction (IUGR), preterm delivery and stillbirth, I have compared the relative risk of occurrence of these complications in pregnancies which had a raised maternal serum AFP (>2.0 MoM), raised maternal serum free β‐hCG (>2.0 MoM), low AFP (<0.5 MoM), low free β‐hCG (<0.5 MoM), combined raised AFP and free β‐hCG (>2.0 MoM), and in those with an increased Down syndrome risk (1 in 250 or greater). In the low birthweight group, only an increased AFP and decreased free β‐hCG showed significance with relative risks of 1.6 and 2.1. In the IUGR group, also only an increased AFP and decreased free β‐hCG showed significance with relative risks of 1.6 and 2.3. In the preterm delivery group, raised AFP, reduced free β‐hCG, and combined elevated AFP and free β‐hCG showed significance with relative risks of 3.8, 1.8 and 6.2. In the stillbirth group, raised AFP, reduced free β‐hCG, and combined elevated AFP and free β‐hCG showed significance with relative risks of 4.5, 2,4 and 7.2. An isolated raised free β‐hCG or an increased Down syndrome risk were not associated with an increased relative risk for any of the pregnancy complications investigated. However, apart from the six to seven‐fold increased risk when both AFP and free β‐hCG are above 2.0 MoM, suggesting increased risk of preterm delivery or impending fetal death, the clinical utility of such significant differences is probably poor. Copyright © 2000 John Wiley & Sons, Ltd.

Second trimester serum alpha-fetoprotein level is a significant positive predictor for intrauterine growth restriction in pregnant women with hyperemesis gravidarum

“…Infants of mothers with hyperemesis have lower birth weights and the mothers are more likely to have infants that are small for gestational age (8). Although elevated maternal serum AFP level usually shows an elevated risk for neural tube defects, they are also related to adverse pregnancy outcomes such as preeclampsia, spontaneous abortion, preterm delivery, low birth weight, IUGR, oligohydramnios, placental abruption and stillbirth (9)(10)(11)(12), all of which are thought to be associated with abnormal placentation (13). In our study, a significant association between serum AFP values and IUGR was observed.…”

“…However, Ashour et al (23) suggested that the utility of hCG level as a screening test for preeclampsia was limited. Besides, the relationship between obstetric complications and elevated hCG levels was not confirmed in two other studies (10,24). In another study, preterm delivery, preeclampsia and large for gestational age were found to be associated with only hCG levels of 3 MoM and the authors concluded that increased fetal surveillance is not warranted with lower values (25).…”

The obstetric syndromes: clinical relevance of placental hormones

“…Similarly, Kirkegaard et al demonstrated a strong association between free β-hCG levels below 0.3 MoM and SGA fetuses [77]. Finally, in a group of 3728 pregnancies affected by one or more of the pregnancy complications of low birth weight, IUGR, PTD and stillbirth, first-trimester free β-hCG levels below 0.5 MoM showed relative risks of 2.3 for developing IUGR [78]. It is still necessary to specify that there are conflicting opinions on the role of free β-hCG in PE and IUGR [11].…”

Screening to prevent spontaneous preterm birth: systematic reviews of accuracy and effectiveness literature with economic modelling

“…Appendix 5, Table 79 summarises each study's salient features. [153][154][155][156][157][158][159][160][161][162][163][164][165][166][167][168][169][170][171] One citation contributed to two separate studies and results. 156 The most common gestation tested was the mid-trimester (14-28 weeks commonly reported their results were 2.0 and 2.5 multiples of the median (MoMs).…”

“…There were 23 primary articles, of which 19 evaluated the use of mid-trimester maternal serum hCG as a predictor of spontaneous preterm birth (n = 177,730 women) 157,158,162,165,166,[184][185][186][187][188][189][190][191][192][193][194][195][196][197] while one article evaluated it in early first trimester (n = 169), 198 and three articles evaluated cervicovaginal hCG as a predictor of spontaneous preterm birth in women who presented with symptoms of threatened preterm labour (n = 248). 139,199,200 Appendix 5, Table 85 summarises each study's salient features, stratified according to the population of women tested, i.e.…”