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

Am J Obstet Gynecol. 1999 Oct;181(4):968-74. doi: 10.1016/s0002-9378(99)70334-0.

Abstract

Objective: We evaluated the value of all 3 common biochemical serum markers, maternal serum alpha-fetoprotein, beta-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 alpha-fetoprotein measurements; beta-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 alpha-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 beta-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 alpha-fetoprotein levels, increased serum beta-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 aneu-ploidy but also for detection of high-risk pregnancies.

MeSH terms

  • Abruptio Placentae / blood
  • Biomarkers / blood*
  • Chorionic Gonadotropin, beta Subunit, Human / blood*
  • Estriol / blood*
  • Female
  • Fetal Death / blood
  • Fetal Growth Retardation / blood
  • Humans
  • Hypertension / blood
  • Oligohydramnios / blood
  • Pregnancy
  • Pregnancy Complications, Cardiovascular / blood
  • Pregnancy Outcome
  • Pregnancy Trimester, Second
  • Prenatal Diagnosis*
  • alpha-Fetoproteins / analysis*

Substances

  • Biomarkers
  • Chorionic Gonadotropin, beta Subunit, Human
  • alpha-Fetoproteins
  • Estriol