Second-trimester maternal serum marker screening: Maternal serum α- fetoprotein, β-human chorionic gonadotropin, estriol, and their various combinations as predictors of pregnancy outcome

Yuval Yaron, Michele Cherry, Ralph L. Kramer, Joseph E. O'Brien, Mordechai Hallak, Mark P. Johnson, Mark I. Evans

Research output: Contribution to journalArticlepeer-review

159 Scopus citations

Abstract

OBJECTIVE: We evaluated the value of all 3 common biochemical serum markers, maternal serum α-fetoprotein, β-human chorionic gonadotropin, and unconjugated estriol, and combinations thereof as predictors of pregnancy outcome. STUDY DESIGN: A total of 60,040 patients underwent maternal serum screening. All patients had maternal serum α-fetoprotein measurements; β- human chorionic gonadotropin was measured in 45,565 patients, and 24,504 patients had determination of all 3 markers, including unconjugated estriol. The incidences of various pregnancy outcomes were evaluated according to the serum marker levels by using clinically applied cutoff points. RESULTS: In confirmation of previous observations, increased maternal serum α- fetoprotein levels (>2.5 multiples of the median) were found to be significantly associated with pregnancy-induced hypertension, miscarriage, preterm delivery, intrauterine growth restriction, intrauterine fetal death, oligohydramnios, and abruptio placentae. Increased β-human chorionic gonadotropin levels (>2.5 multiples of the median [MoM]) were significantly associated with pregnancy-induced hypertension, miscarriage, preterm delivery, and intrauterine fetal death. Finally, decreased unconjugated estriol levels (<0.5 MoM) were found to be significantly associated with pregnancy-induced hypertension, miscarriage, intrauterine growth restriction, and intrauterine fetal death. As with increased second-trimester maternal serum α-fetoprotein levels, increased serum β-human chorionic gonadotropin and low unconjugated estriol levels are significantly associated with adverse pregnancy outcomes. These are most likely attributed to placental dysfunction. CONCLUSION: Multiple-marker screening can be used not only for the detection of fetal anomalies and aneuploidy but also for detection of high-risk pregnancies.

Original languageEnglish
Pages (from-to)968-974
Number of pages7
JournalAmerican Journal of Obstetrics and Gynecology
Volume181
Issue number4
DOIs
StatePublished - 1 Jan 1999

Keywords

  • Estriol
  • Human chorionic gonadotropin
  • Pregnancy outcome
  • α-Fetoprotein

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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