Abstract
BackgroundThe purpose of this study was to determine whether first trimester trisomy screening (FTS) parameters are affected by alcohol and drug use.MethodsA routine combined FTS including measurements of maternal serum levels of free β-human chorionic gonadotropin subunit (free β-hCG) and pregnancy-associated plasma protein A (PAPP-A) were measured at 9–11 weeks of gestation, and fetal nuchal translucency thickness (NTT) at 11–13 weeks of gestation. In total 544 women with singleton pregnancies [71 alcohol and drug abusers, 88 smokers, 168 non-smokers delivering a small for gestational age (SGA) child, and 217 unexposed control women] were assessed.ResultsFree β-hCG levels were higher in alcohol and drug abusing than in unexposed pregnant women [mean 1.5 vs. 1.2 multiples of medians (MoM); P = 0.013]. However, stepwise multiple linear regression analyses suggested that smoking could explain increased free β-hCG. Additionally, we observed lower PAPP-A levels in the smoking mothers (0.9 vs. 1.2 MoM; P = 0.045) and in those giving birth to an SGA child compared to the controls (1.1 vs.. 1.2 MoM; P < 0.001). Fetal NTT did not differ significantly between any of the groups.ConclusionsThe present study shows increased free β-hCG levels in alcohol and drug abusers, but maternal smoking may explain the result. Maternal serum PAPP-A levels were lower in smoking than non-smoking mothers, and in mothers delivering an SGA child. However, FTS parameters (PAPP-A, free β-hCG and NTT) seem not to be applicable for the use as alcohol biomarkers because of their clear overlap between alcohol abusers and healthy controls.
Highlights
The purpose of this study was to determine whether first trimester trisomy screening (FTS) parameters are affected by alcohol and drug use
Synopsis Higher free Free β-human chorionic gonadotropin subunit (β-hCG) levels and unaltered pregnancy-associated plasma protein A (PAPP-A) levels were found in alcohol-abusing pregnant mothers
There is growing evidence that decreased PAPP-A is associated with a delivery of a small for gestational age (SGA) child at the end of pregnancy, even though the systematic review and meta-analysis of Morris et al [10] showed that the sensitivity of PAPP-A to predict the birth of an SGA child remains low
Summary
The purpose of this study was to determine whether first trimester trisomy screening (FTS) parameters are affected by alcohol and drug use. A combined first trimester screening (FTS) test for chromosomal abnormalities includes measurements of pregnancy-associated plasma protein A (PAPP-A) and free β-human chorionic gonadotropin subunit (free βhCG) from maternal serum, fetal nuchal translucency thickness (NTT), and recording the mothers age. This combination identifies 85–95% of all fetuses with trisomies 21, 18 and 13, at a false positive rate of 5% [8]. The influence of drug abuse on first trimester screening parameters has not been previously reported It seems that maternal opioid use does not significantly affect second trimester free βhCG levels [12]
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