Down syndrome biochemical markers and screening for preeclampsia at first and second trimester: correlation with the week of onset and the severity.
ABSTRACT To estimate the combined screening performance of first and early second trimester prenatal serum markers for Down syndrome, in screening for the development of preeclampsia, and analyze the correlation among marker levels, week of onset, and severity of the disease.
A retrospective cohort study was carried out on 32 women with preeclampsia and 3044 controls. Serum samples from these pregnancies were assayed for pregnancy-associated plasma protein-A (PAPP-A), alpha-fetoprotein (AFP), unconjugated estriol (uE3), human chorionic gonadotrophin (hCG), and inhibin-A. A likelihood ratio and the odds of being affected given a positive result (OAPR) of various combinations of markers were calculated and receiver operating characteristic (ROC) curves analysis was performed.
In the pregnancies that subsequently developed preeclampsia, first trimester PAPP-A concentration was significantly lower and concentrations of early second trimester inhibin-A and hCG significantly elevated. Levels of early second trimester uE3 and AFP were not significantly altered. We also found that inhibin-A correlates with both onset of the disease and the severity.
Down syndrome biochemical markers levels are altered in those patients who subsequently developed preeclampsia and may be a useful screening test for preeclampsia. Inhibin-A is the most predictive marker and correlates with the severity of subsequent preeclampsia and inversely with the week of occurrence of preeclampsia.
Article: The relationship between second trimester alpha fetoprotein levels and adverse pregnancy outcome[show abstract] [hide abstract]
ABSTRACT: Design: Retrospective analysis. Setting: East London Hospital. Subjects: 724 women who had maternal se- rum alpha-fetoprotein levels measured between 15 to 19 weeks gestation. Main outcome measure: The main outcome measures were defined as any case of pre- eclampsia, small-for-gestational age (SGA) birth- weight < 5th centile, placental abruption, stillbirth or early neonatal death. Methods: Women with MSAFP > 2.0 Multiples of Median (MoM) were classified as screen positive. Results: 41 (5.7%) women developed pre-eclampsia. Women with MSAFP > 2.0 Multiples of the Median (MoM) were significantly more likely to develop pre-eclampsia (p < 0.00001), deliver a SGA < 5th centile (p < 0.00001), or have a stillbirth/early neonatal death (p < 0.001) compared to women with MSAFP < 2.0 MoM. The odds ratio (OR) for develop- ing pre-eclampsia was 5.2 (95% confidence interval [CI] 2.4 - 11.3), and 8.2 (CI 2.9 - 23.3) for preeclamp- sia requiring delivery before 37 weeks gestation. Con- clusion: Unexplained elevated MSAFP in the second trimester was strongly associated with a subsequent risk of pre-eclampsia especially those requiring pre- term delivery, as well as other complications related to uteroplacental insufficiency.Open Journal of Obstetrics and Gynecology 03/2013; 3:262-266.