Second trimester maternal serum marker and adverse pregnancy outcome

Abstract

Objective The aim of this study is to assess the risk of adverse pregnancy outcome by maternal serum markers in Quad test and to compare the existing cutoff (2.0 MoM) with 95 percentile cutoff generated from our consecutive population in predicting adverse pregnancy outcome. Methods We generated 95 percentile cutoff as our own reference using 3,000 consecutive women who performed Quad test. Except for follow-up loss, fetal aneuploidy and anomaly, 2,598 women were analyzed for the assessment of adverse pregnancy outcome consisted of preeclampsia (PE), preterm birth (<32 weeks), low birth weight and fetal death in utero. Results We confirmed high levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and inhibin A are associated with development of PE, preterm birth, and low birth weight. In general, 95 percentile cutoff corresponded similarly with 2.0 MoM except AFP. Combination of serum markers increased the odds ratio for predicting adverse pregnancy outcome. The women with higher level of both AFP and inhibin A (2.0 ≥ MoM) had 9.8 times higher risk for PE, 24.8 times higher risk for preterm birth, and 5.6 times higher risk for low birth weight. The women with higher level of AFP, hCG, and inhibin A had 8.2 times higher risk for PE, 29.4 times higher risk for preterm birth. Notably, negative predictive value of serum markers for PE and preterm birth are over 98% either in alone and in combination. Conclusion Maternal serum makers either in alone and in combination offer valuable information on the risk assessment of adverse pregnancy outcome.