Mid-trimester maternal serum AFP and hCG as markers of preterm and term adverse pregnancy outcomes.

Abstract

To evaluate the predictive values of mid-trimester serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) for preterm and term placenta-mediated adverse pregnancy outcomes (PMAPOs). We extracted data for nulliparous women with a singleton pregnancy without aneuploidy or lethal fetal anomalies from a prospective cohort study. Maternal serum AFP and hCG measured between 13 and 17 weeks of gestation and expressed as multiples of the median (MoM) for gestational age were compared between women who developed a PMAPO (preeclampsia, intrauterine growth restriction, fetal death) before term or at term and women who did not develop any of these complications. Among 3466 nulliparous women, maternal serum AFP and hCG levels were available in 2110 and 2125 cases, respectively. Women who developed a PMAPO before term had a higher median level of serum AFP (1.4 vs. 1.1 MoM; P < 0.01) and hCG (1.3 vs. 1.1 MoM; P < 0.01) than controls. A serum hCG > 2.0 MoM was associated with a higher risk of PMAPO before term (RR 4.6; CI 95% 2.3 to 9.1) but had no impact on the risk of PMAPO at term (RR 1.1; CI 95% 0.7 to 1.7). Maternal serum AFP > 2.0 MoM was also associated with a significant increase in the risk of preterm PMAPO (RR 3.9; CI 95% 1.6 to 9.8) but not term PMAPO (RR 1.2; CI 95% 0.6 to 2.3). Maternal serum AFP or hCG > 2.0 MoM increases the risk of preterm PMAPO but not term PMAPO in our population. We suggest that women with elevated serum AFP or hCG should receive standard pregnancy care once they have reached 37 weeks of gestation if fetal growth is in the normal range.