The impact of maternal weight discrepancies on prenatal screening results for Down syndrome

Huang, Tianhua; Meschino, Wendy S.; Okun, Nan; Dennis, Alan; Hoffman, Barry; Lepage, Nathalie; Rashid, Shamim; Aul, Ritu; Farrell, Sandra A.

doi:10.1002/pd.4090

Cited by 27 publications

(8 citation statements)

References 7 publications

(9 reference statements)

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“…Similar to a previous study that reported maternal weight correction in the first trimester, screening can be best achieved using the log-linear procedure [11]. Although including a weight correction parameter seems to have an almost negligible impact on true positive rates and false positive rates, for an individual woman, weight correction can have a non-negligible impact on calculating specific risk [12]. Thus, to improve the accuracy of screening tests for individual specific risk, the MoM values of serum markers should be adjusted for maternal weight.…”

Section: Discussionmentioning

confidence: 62%

Normative weight-adjusted models for the median levels of first trimester serum biomarkers for trisomy 21 screening in a specific ethnicity

et al. 2017

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ObjectiveTo establish normative weight-adjusted models for the median levels of first trimester serum biomarkers for trisomy 21 screening in southern Thai women, and to compare these reference levels with Caucasian-specific and northern Thai models.MethodsA cross-sectional study was conducted in 1,150 normal singleton pregnancy women to determine serum pregnancy-associated plasma protein-A (PAPP-A) and free β-human chorionic gonadotropin (β-hCG) concentrations in women from southern Thailand. The predicted median values were compared with published equations for Caucasians and northern Thai women.ResultsThe best-fitting regression equations for the expected median serum levels of PAPP-A (mIU/L) and free β- hCG (ng/mL) according to maternal weight (Wt in kg) and gestational age (GA in days) were: and Both equations were selected with a statistically significant contribution (p< 0.05). Compared with the Caucasian model, the median values of PAPP-A were higher and the median values of free β-hCG were lower in the southern Thai women. And compared with the northern Thai models, the median values of both biomarkers were lower in southern Thai women.ConclusionThe study has successfully developed maternal-weight- and gestational-age-adjusted median normative models to convert the PAPP-A and free β-hCG levels into their Multiple of Median equivalents in southern Thai women. These models confirmed ethnic differences.

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Section: Discussionmentioning

confidence: 62%

Normative weight-adjusted models for the median levels of first trimester serum biomarkers for trisomy 21 screening in a specific ethnicity

et al. 2017

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“…A recent Canadian study found that, of women with a weight discrepancy of >5 pounds (lbs) (2.3 kg) and within 50 units of the risk cut‐off, the chance of a screening result changing ranged from 33 to 43%. However, among women with a Down syndrome infant, weight discrepancies of up to 15 lbs (~8 kg) made no difference . One possible explanation is that adjustment for weight does not alter screening results when abnormal serum biomarkers levels are pronounced.…”

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confidence: 99%

Maternal body weight and first trimester screening for chromosomal anomalies

Khambalia

Roberts

Morris

et al. 2014

Aust N Z J Obstet Gynaecol

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Prenatal risk ratios for Down syndrome adjust for maternal weight because maternal serum biomarker levels decrease with increasing maternal weight. This is accomplished by converting serum biomarker values into a multiple of the expected median (MOM) for women of the same gestational age. Weight is frequently not recorded and the impact of using MOMs not adjusted for weight for calculating risk ratios is unknown. The aim of this study is to examine the effect of missing weight on first trimester Down syndrome risk ratios by comparing risk ratios calculated using weight-unadjusted-and -adjusted MOMs. Findings at the population level indicate that the impact of not correcting for maternal weight on first trimester screening results for chromosomal anomalies would lead to 84 per 10,000 pregnancies changing from negative to positive and 56 per 10,000 pregnancies changing from positive to negative. PAPP-A. Antenatal and birth data for the study region was recorded in an electronic obstetric surveillance system. Information from the obstetric database used in this study included: selfreported pre-pregnancy weight and height, parity, smoking status during pregnancy, chorionic villus sampling < 20 weeks, amniocentesis <20 weeks, any birth defect and birth outcome. Body mass index (BMI; kg/m 2 ) was calculated using maternal weight and height from the obstetric database and categorised using international standards.

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“…MoM values provide a simple way to compare the deviation of an individual from the overall population. When using software to calculate Down syndrome risk, the level of serological markers in pregnant women was correlated with their race, age, gestational age, weight, diabetes and smoking, and the correction of gestational age and weight is most significant (21). Several regression equations have been developed for risk estimate correction (6,13,22).…”

Section: Discussionmentioning

confidence: 99%

Integrating multiple of the median values of serological markers with the risk cut-off value in Down syndrome screening

Zhou

Zhang

et al. 2018

BST

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To assess the predictive value of integrating multiple of the median (MOM) with the risk cutoff value for serological screening of Down syndrome. In this retrospective study, women with singleton pregnancies who underwent triple serological screening for Down syndrome were followed, and their screening results and pregnancy outcomes were recorded. The range of MoM value of each indicator was calculated, different protocols integrating various MoM values with the risk cutoff value were compared. A total of 120,269 women with singleton pregnancy were screened and included in the analysis, of those 52 fetuses were confirmed as trisomy-21 by amniocentesis chromosomal karyotyping. Using a risk cutoff value of 1:380, 8,809 samples tested positive and the screen positive rate was 7.32% (8,809/120,269). The normal reference ranges (5-95%) of the MoM value of AFP, β-hCG, and uE3 were 0.60-1.72, 0.43-2.21 and 0.60-1.58, respectively. The detection rate of each screening protocol integrating different MoM percentile values was between 75% and 79%, the positive rate was between 7% and 18%, and the false positive rate was between 7% and 18%. Protocol-6 which combined the screening risk cutoff value and β-hCG MoM ≥ 97.5% percentile is an optimal protocol with a relatively high detection rate (78.8%) and low false positive rate (8.2%). Integrating MoM values of serological indicators can appropriately increase detection rate when interpreting the results of Down syndrome screening.

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The impact of maternal weight discrepancies on prenatal screening results for Down syndrome

Abstract: A weight discrepancy of five or more pounds has a significant impact on the risk of Down syndrome; correction of maternal weight would improve the accuracy of the screening test.

Cited by 27 publications

References 7 publications

Normative weight-adjusted models for the median levels of first trimester serum biomarkers for trisomy 21 screening in a specific ethnicity

Normative weight-adjusted models for the median levels of first trimester serum biomarkers for trisomy 21 screening in a specific ethnicity

Maternal body weight and first trimester screening for chromosomal anomalies

Integrating multiple of the median values of serological markers with the risk cut-off value in Down syndrome screening

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