Maternal Serum hCG Research Articles

Maternal serum beta-HCG and alpha-fetoprotein concentrations in singleton pregnancies following assisted reproduction.

The reason for the elevated levels of HCG in assisted reproduction pregnancies remains unknown. Our hypothesis was that this increase is caused by the ovarian superovulation therapy. We compared the beta-HCG and alpha-fetoprotein (AFP) multiples of the median (MoM) in singleton pregnancies after IVF or ICSI with those achieved by frozen embryo transfer (FET) in spontaneous cycles. The HCG and AFP MoMs (plus minus SEMs) of 59 FET pregnancies were compared with 144 IVF (including 48 ICSI) pregnancies. The maternal HCG of pregnancies following ovarian stimulation was 1.31 plus minus 0.08 MoM compared with 1.35 plus minus 0.12 MoM in the unstimulated ones. The values for AFP were 1.06 plus minus 0.05 versus 1.11 plus minus 0.05 respectively. No significant differences could be observed between pregnancies following stimulated IVF/ICSI and unstimulated FET cycles. Our results show that second trimester maternal serum HCG is also elevated in singleton pregnancies following spontaneous FET cycles. The increased maternal serum HCG in IVF pregnancies is thus not related to superovulation therapy. Because of the elevated maternal serum HCG levels, serum screening cannot be performed reliably in pregnancies following assisted reproduction technology. Ultrasonographic detection of the nuchal translucency is unaffected and should be used for this group of women undergoing assisted reproduction.

Physiopathologie de l’hormone chorionique gonadotrope humaine (hCG) dans la trisomie 21 fœtale

The reason why maternal serum hCG is increased the second trimester of trisomy 21 associated pregnancy, is still unclear. It results from the placental immaturity which affects the differenciation of cytotrophoblasts into the endocrine syncytiotrophoblast. During the second half of the gestation, the hCG production rate could be comparable as those observed during the first trimester. The physiological peak of hCG could be delayed from the first to the second trimester. hCG could be highly glycosylated and thus its half life would be modified.

Maternal serum HCG is higher in the presence of a female fetus as early as week 3 post-fertilization.

Maternal serum HCG (MSHCG) is higher when the fetus is a female than when it is male. This has been demonstrated in the second and third trimesters of pregnancy, and recently at 10-14 weeks gestation. In this study we assessed whether this gender-related difference can be detected as early as week 3 post-fertilization. The IVF setting was chosen because it provides precise dating of gestational age and early sonography for the number of gestational sacs. The study included 347 IVF cycles from 335 patients. Only pregnancies with a single implanted embryo that resulted in a single live birth of known gender were included. MSHCG was measured on days 14-20 post-fertilization, and levels were expressed as gestational age-corrected multiples of the median (MoMs). The log10 MSHCG MoMs were compared according to fetal gender. MSHCG levels were significantly higher (18.5%) in week 3 post-fertilization in the presence of a female fetus (P < 0.0002). Because a fetal gender-related difference in MSHCG can be demonstrated as early as week 3 post-fertilization, the difference may be attributed to placental factors and not to the effects of the fetal hypothalamic-hypophyseal-gonadal axis.

Antibodies against oxidised low density lipoproteins in pregnant women

Oxidized low density lipoproteins (oxLDL) formed in vivo induce a humoral immune response. Oxidative modification of LDL renders it immunogenic and a heterogeneous population of specific anti-oxLDL antibodies is produced. These antibodies could represent a biological marker of oxidative stress and serve as markers of atherosclerosis. Autoantibodies against oxLDL (oLAb) have been detected in human subjects practically of every age. oLAb also appear in the blood of pregnant women. Some studies have shown that the levels of antibodies to oxLDL were elevated in women with established preeclampsia. The present study was aimed to estimate the oLAb IgG levels in the first and second trimester of pregnancy. Furthermore, we estimated the correlation between maternal serum (MS) levels of oLAb and alpha-1-fetoprotein (MS AFP), human chorionic gonadotrophin (MS HCG) and trophoblast-specific-beta-1-glycoprotein (MS SP1), because these proteins are determined as a part of prenatal biochemical screening for fetal congenital abnormalities. Our study deals with the oLAb changes in women with pregnancy-induced hypertension. We also investigated the correlation between oLAb IgG and anticardiolipin antibodies IgG (ACA) in the serum of pregnant women. We examined 40 pregnant women attending Institute for Mother and Child Care for their antenatal care as outpatients. Routine blood samplings between the 9-13th week of pregnancy and 16-18th week of pregnancy were performed as a part of biochemical prenatal screening for fetal congenital abnormalities (Group 1). Their mean age was 27±4.1 years. Furthermore, we examined 26 women in the second or third trimester with pregnancy-induced hypertension (Group 2). Group 2 was compared with 49 pregnant women in the second or third trimester who were normotensive (Group 3). We used commercial standardized ELISA kits for determination of oLAb IgG, ACA IgG, MS AFP and MS HCG, MS SP1 was analyzed by single radial immunodiffusion. We did not find any differences in the levels of oLAb IgG in the first and second trimester in the women of Group 1. The correlation between oLAb and ACA IgG was not statistically significant (Spearman coefficient r=0.22, p=0.1). The correlation between oLAb IgG with MS AFP, MS HCG and MS SP1 was not statistically significant. Weak negative correlation for AFP and HCG was suggested both in the first and in the second trimester. The levels of oLAb IgG in the group of women with pregnancy-induced hypertension were significantly lower than in the group of normotensive women (348±388 U/ml v.s. 579±400 mU/ml, p&lt;0.01). We can conclude that the levels of oLAb do not differ in the first and second trimester of gravidity. However, we cannot exclude the possible influence of an inverse relationship between oLAb IgG titers and the synthesis of fetoplacental antigens. This finding is important especially in the context of the results of prenatal biochemical screening. Pregnancy-induced hypertension is associated with lower levels of oLAb. Weak cross-reactivity between oLAb and anticardiolipin antibodies may exist but there is a possibility that there are two different populations of antibodies reacting with various antigens.

516 Timing of spontaneous abortion after amniocentesis

TIMING OF SPONTANEOUS ABORTION AFTER AMNIOCENTESIS DENA TOWNER ], LINDA GREVE t, BOB CURRIER 2, FRED LOREy2; lUniversity of California, Davis, Obstetrics & Gynecology, Sacramento, G&; 2Genetic Disease Branch, DHS, Berkeley, CA OBJECTIVE: To compare, in a prenatal diagnosis population, when spontaneous abortions (SAB) occur in women accepting and declining an amniocen tesis. STUDY DESIGN: From the Calitornia State Expanded AFP program, 44,525 women with outcomes ascertained were identified where the fetal ultrasound was normal and if an aumiocentesis was pertc)rlned it was uornlal. There were 156 spontaneous abortions at < 24 weeks gestation. An amniocentesis was performed in 69. The remaining 87 had declined anmiocentesis. The two groups were compared tot maternal age, gestational age (GA) at prenatal diagnosis (PDC) visit, number of days to loss after PDC visit, GA at loss, maternal sermn AFP (MSAFP), maternal serum hCG (MShCG), and maternal seruna estriol (MSuE3). Student t test and Logrank test were used to compare the groups. RESULTS: The overall rate of SAB was 0.36%. There was no statistical difference between the two groups in the factors assessed: GA at loss was 21 weeks 2 days ~br both groups (P = .93), days until loss was 23 days with amnio and 20.4 days w, ithout (P = .29), maternal age was 30.5 years with amnio and 30.1 years in those declining (P = .72), MSAFP was 3.18 MoM in those with amnio and 2.83 MoM in those declining (P = .36), MShCG was 2.10 MoM in those having an anmio and 1.80 MoM in those declining (P = .24). The Logrank test revealed no significant difference between the groups for either GA at loss (P= .61) or days until loss (P= .40). The Figure shows the cumulative losses by GA at loss. CONCLUSION: There is no clustering of losses innnediately following anmiocentesis with the average time to loss about 3 weeks. The same pattern is present in the women declining amniocentesis, suggesting there is minimal impact of amniocentesis in this population of women.

397 Maternal serum HCG in HIV+ women—implications for prenatal screening and trophoblast function?

397 Maternal serum HCG in HIV+ women—implications for prenatal screening and trophoblast function?

Elevated Maternal Serum hCG in the Second Trimester Increases Prematurity Rate and Need for Neonatal Intensive Care in Primiparous Preeclamptic Pregnancies

Objective. This study was designed to investigate the association between the serum concentrations of maternal second trimester human chorionic gonadotropin (hCG) and the severity of preeclampsia.Methods. At Kuopio University Hospital, a total of 487 preeclamptic primiparas had undergone maternal serum screening for Down's syndrome between January 1993 and December 1998. Of these, 37 women had unexplained elevated serum hCG concentrations [>2.5 multiples of the median (MoM)], whereas the remaining 450 preeclamptic women had normal hCG results. Pregnancy characteristics and outcome measures in these groups were evaluated using logistic regression.Results. Elevated midtrimester hCG concentrations were associated with higher rates of low-birth-weight infants, preterm delivery, and need for neonatal intensive care. The adjusted odds ratios was 2.11 [95% confidence interval (CI): 1.03–4.32], 2.08 (95% CI: 1.10–4.30), and 2.27 (95% CI: 1.14–4.51), respectively.Conclusions. In primiparous preeclamptic pregnancies, an elevated maternal serum hCG concentration is a marker of early-onset and severe disease with significant maternal and perinatal morbidity. This finding, in turn, reinforces the association between elevated hCG concentrations and placental damage in early pregnancy. Elevated maternal serum hCG levels identify a subgroup of preeclamptic patients who deserve more intensive observation.

Elevated maternal serum hCG in the second trimester increases prematurity rate and need for neonatal intensive care in primiparous preeclamptic pregnancies.

This study was designed to investigate the association between the serum concentrations of maternal second trimester human chorionic gonadotropin (hCG) and the severity of preeclampsia. At Kuopio University Hospital, a total of 487 preeclamptic primiparas had undergone maternal serum screening for Down's syndrome between January 1993 and December 1998. Of these, 37 women had unexplained elevated serum hCG concentrations [> 2.5 multiples of the median (MoM)], whereas the remaining 450 preeclamptic women had normal hCG results. Pregnancy characteristics and outcome measures in these groups were evaluated using logistic regression. Elevated midtrimester hCG concentrations were associated with higher rates of low-birth-weight infants, preterm delivery, and need for neonatal intensive care. The adjusted odds ratios was 2.11 [95% confidence interval (CI): 1.03-4.32], 2.08 (95% CI: 1.10-4.30), and 2.27 (95% CI: 1.14-4.51), respectively. In primiparous preeclamptic pregnancies, an elevated maternal serum hCG concentration is a marker of early-onset and severe disease with significant maternal and perinatal morbidity. This finding, in turn, reinforces the association between elevated hCG concentrations and placental damage in early pregnancy. Elevated maternal serum hCG levels identify a subgroup of preeclamptic patients who deserve more intensive observation.

Efficacy of screening for fetal down syndrome in the United States from 1974 to 1997

Objective: To estimate the 16-week prevalence of Down syndrome in the United States from 1974 to 1997 and to determine the efficacy of maternal age cutoffs and triple screens for detecting it antenatally. Methods: Using natality statistics for the United States from 1974 to 1997 of maternal-age–specific live births to women 13–49 years old, we evaluated advanced maternal age (35–49 years at delivery) and the triple serum test (maternal serum alpha-fetoprotein, hCG, and unconjugated estriol) as screening tests for Down syndrome. Efficacy was evaluated using sensitivity, false-positive rate, positive predictive value, and likelihood ratio (likelihood ratio = sensitivity/false-positive rate). Results: In 1974, the estimated second-trimester prevalence of Down syndrome was one in 740, but by 1997 that had increased to one in 504. The proportion of Down syndrome fetuses at 16 weeks’ gestation in women 35–49 years old increased from 28.5% in 1974 to 47.3% in 1997. However, live births to women 35–49 years old increased more rapidly from 4.7% in 1974 to 12.6% in 1997. The likelihood ratio for maternal age to identify an affected pregnancy decreased during the study period and was substantially lower than that using the serum test. Conclusion: A maternal age cutoff of 35 years in the 1990s resulted in high false-positive rates and was less efficacious based on likelihood ratio and positive predictive value. Serum testing of all pregnant women would reduce the number of amniocenteses and decrease procedure-related losses.

P97Elevated maternal midtrimester chorionic gonadotropin is associated with fetal cerebral blood flow redistribution

BackgroundElevated midtrimester human chorionic gonadotropin (hCG) is associated with adverse maternal and perinatal outcome. The aims of the study were to evaluate the association between elevated hCG and fetal arterial circulation and to determine the relationship between maternal and perinatal complications and elevated hCG.MethodsPulsatility indices (PI) of middle cerebral artery (MCA) and umbilical artery (UA) were determined prospectively in 72 consecutive patients with abnormal maternal serum hCG (&gt; 2.5 MoM). Each patient had between two to four US scans during pregnancy. Patients with known structural or chromosomal anomalies were excluded from the study.ResultsOut of 72 women with hCG &gt; 2.5 MoM, 48% (35/72) had hCG &gt; 3.5 and 24% (17/72) had. hCG levels &gt; 4.5 MoM. MCA PI was lower in women with hCG &gt; 4.5 MoM between 28 and 36 wks' gestation, but not between 18 and 27 wks' gestation (fig). No differences of MCA PI were found when the cutoff point of hCG was 3.5. PI of the UA was not different between the groups.Women with hCG levels &gt; 4.5 MoM had a higher prevalence of PIH and preeclampsia, preterm deliveries and cesarean sections in comparison to women with hCG &lt; 4.5 MoM. Birthweight was lower and the rate of Apgar score &lt; 7 was higher. No differences were not found with cutoff 3.5MoM.ConclusionsMaternal midtrimester hCG &gt; 4.5 mom is associated with cerebral blood flow redistribution and with higher rates of maternal and perinatal complications in comparison to maternal hCG of 2.5–4.5 MoM.

Intrahepatic cholestasis of pregnancy has no effect on maternal serum second trimester alpha-fetoprotein and hCG

To investigate the association between intrahepatic cholestasis and Down's syndrome screening analytes (alpha-fetoprotein [AFP] and hCG) during the second trimester. Measurements of maternal serum AFP and hCG concentrations were retrospectively analyzed in relation to intrahepatic cholestasis in a cohort of 33 consecutive singleton pregnancies affected by cholestasis from January 1995 through December 1997 at the University Hospital of Kuopio, and then compared with those in healthy singleton control pregnancies (n=5680) from the same clinic over the same period of time. Geometric means of maternal serum AFP and hCG concentrations in pregnancies affected by cholestasis were 1.12 and 0.98 multiples of the median [MoM], respectively. Mean maternal age was significantly higher in the subjects than in controls (30.6 years compared with 28.8 years). In relation to Down's syndrome risk assessment, the pattern of the two markers together with maternal age indicated high risk as often in the study subjects as in the controls. Median serum AFP and hCG concentrations in pregnancies complicated by intrahepatic cholestasis were not significantly different from those in unaffected pregnancies. There is no need to take the hepatic disorder into account in maternal serum screening.

The development of a sialic acid specific lectin-immunoassay for the measurement of human chorionic gonadotrophin glycoforms in serum and its application in normal and Down's syndrome pregnancies.

We have developed and validated a lectin-immunoassay for the recognition of sialic acid residues on hCG glycoforms in serum. This assay employs a hCG specific capture antibody and a sialic acid specific lectin (Wheat Germ Agglutinin) labelled with horse radish peroxidase. The standard curve covered hCG concentrations of 0-4000 IU/l (3rd IS for hCG, 75/537) with an analytical sensitivity of 1.0 IU/l. The within and between batch coefficient of variation was < 7% for all doses. Cross-reactivity of < 1% with TSH, LH, FSH, hCGalpha, hCGbeta and desialylated hCG confirmed assay specificity. Dilutions of serum of < 10% final concentration were parallel to the standard curve (within and between batch CV, < 6%). The assay working range was 100 - > 500 000 IU/l and the recovery of hCG from serum was in the range of 94.5% to 115.4%, with a mean value of 102.1%. The assay detected a time dependent change in hCG sialylation during normal pregnancy with the relative abundance of sialylated hCG declining after week 9 and increasing after week 15 of gestation. In addition preliminary studies showed that maternal serum hCG concentrations measured with the lectin-immunoassay were elevated in high risk Down's pregnancies (as defined by conventional screening tests between weeks 16-18 gestation, median multiple of median, 3.14; range 1.81-19.12, P < 0. 001) and low risk (1.57, 0.49-6.14, P = 0.034) compared to normal (1. 00, 0.32-3.20) pregnancies. Furthermore, the lectin immunoassay had greater discriminatory power compared to conventional immunoassay of hCG and hCGbeta between normal and both low and high risk Down's pregnancies. This assay will allow analysis of serum samples for the investigation of sialylated variants of hCG glycoforms in various pathological and physiological situations.

Second trimester maternal serum hCG level in an Asian population: normal reference values by ultrasound dating.

To establish normative data of maternal serum chorionic gonadotropin (hCG) during the second trimester in an Asian population. We measured the maternal serum hCG levels in 17,955 normal singleton pregnancies between 15 and 21 weeks of gestation. The gestation age was estimated by measurement of fetal biparietal distance (BPD) in all cases. Median values of hCG at various gestational weeks were calculated and the values of hCG were converted to multiple of median (MoM). The incidences of low MoM value and high MoM value were also calculated. The mean and median values of hCG were 57,153 mIU/ml and 50,120 mIU/ml, respectively, at 15 weeks of gestation and then decreased to 30,898 mIU/ml and 26,226 mIU/ml, respectively, at 21 weeks. We found 8.6% and 9.4% of normal singleton pregnancies have hCG MoM values >2.0 MoM and <0.5 MoM, respectively. Our report provides a normal reference data of second trimester maternal hCG levels by ultrasound dating in an Asian population.

Maternal serum second trimester AFP and hCG in pregnancies with placenta previa.

This study was undertaken to investigate the association between placenta previa and Down syndrome screening analytes-alpha-fetoprotein (AFP) and hCG-during the second trimester. Measurements of maternal serum AFP and hCG concentrations were retrospectively analysed in relation to placenta previa in a cohort of 46 consecutive singleton pregnancies affected by placenta previa from January 1993 through December 1997 at the University Hospital of Kuopio, Finland, and then compared with those in healthy singleton control pregnancies (N=9560) from the same clinic over the same period of time. Geometric means of maternal serum AFP and hCG concentrations in pregnancies with placenta previa were 1.13 and 0. 85 multiples of the median (MoM), respectively. The mean maternal age was higher in the subjects than in the controls (30.9 years compared with 28.8 years) (p<0.01). In relation to Down syndrome risk assessment, the pattern of the two markers together with maternal age indicated high risk as often in the study subjects as in the controls. Even though the maternal serum AFP and hCG differences were not statistically significant, they may be of some clinical importance, and further studies are needed to evaluate whether placental site should be taken into account in maternal serum screening.

Intrahepatic cholestasis of pregnancy has no effect on maternal serum second trimester alpha-fetoprotein and hCG

Intrahepatic cholestasis of pregnancy has no effect on maternal serum second trimester alpha-fetoprotein and hCG

Anonychia and absence of distal phalanges in a patient with apparently balanced t(17;21)(q24.2;g11.2)

Anonychia involving all 20 digits is a rare malformation which can occur alone or as part of several syndromes (Type B brachydactyly, Laband syndrome, deafnessonchodystrophy, facio-audio-synphalangism, anonychia-ectrodactyly, etc.). The distal phalanges are often absent or hypoplastic. Both autosomal dominant and autosomal recessive anonychia/onchodystrophy have been reported. None of the genes for syndromic or non-syndromic anonychia have been mapped.We report an infant with 20 digit anonychia, absence of terminal phalanges, and minor facial anomalies (mild micrognathia, small mouth, slightly beaked nose with broad nasal bridge). She was the product of a pregnancy complicated only by advanced maternal age and elevated maternal serum HCG. Amniocentesis showed her karyotype to be 46XX t(17;21)(q24.2;q11.2). This was an apparently balanced de novo translocation. Parental chromosomes were normal. Prenatal ultrasound and fetal echocardiography were interpreted as normal and the patient was born at term with a weight of 3496g, length of 47cm and OFC 35.5 cm. Examination in the newborn period showed absence of all nails and distal phalanges (confirmed on X-ray) with the above-mentioned minor facial anomalies. There were no features to suggest any of the known anonychia syndromes. Repeat karyotype confirmed the apparently balanced translocation. On follow-up at 3 months of age, her general health, growth and psychomotor development were normal.The occurrence of anonychia in a patient with an apparently balanced translocation could be due to a subtle microdeletion or duplication, altered function of a gene or genes near the breakpoints, or could be coincidental. The normal growth and development of the patient as well as the absence of previous reports of anonychia in patients with duplications or deletions involving 17q or 21q make subtle chromosomal imbalance less likely. Disruption of a gene near the breakpoint could have a dominant effect or perhaps unmask a recessive gene on the other allele. Chromosome studies in other patients with anonychia could lead to mapping of a gene for nail development.

Second Trimester Maternal Serum hCG Level in an Asian Population: Normal Reference Values by Ultrasound Dating

Objective: To establish normative data of maternal serum chorionic gonadotropin (hCG) during the second trimester in an Asian population.Methods: We measured the maternal serum hCG levels in 17,955 normal singleton pregnancies between 15 and 21 weeks of gestation. The gestation age was estimated by measurement of fetal biparietal distance (BPD) in all cases. Median values of hCG at various gestational weeks were calculated and the values of hCG were converted to multiple of median (MoM). The incidences of low MoM value and high MoM value were also calculated. Results: The mean and median values of hCG were 57,153 mIU/ml and 50,120 mIU/ml, respectively, at 15 weeks of gestation and then decreased to 30,898 mIU/ml and 26,226 mIU/ml, respectively, at 21 weeks. We found 8.6% and 9-4% of normal singleton pregnancies have hCG MoM values >2.0 MoM and <0.5 MoM, respectively.Conclusions: Our report provides a normal reference data of second trimester maternal hCG levels by ultrasound dating in an Asian population.

Turner Syndrome and Multiple-Marker Screening

The measurement of maternal serum concentrations of α-fetoprotein (AFP), human chorionic gonadotropin (hCG), and unconjugated estriol (uE3) in conjunction with maternal age has been used as a prenatal screen for Down syndrome and trisomy 18 (1)(2)(3). Several reports have found that pregnancies associated with Turner syndrome may also be identified as a result of an increased risk for Down syndrome (4)(5)(6)(7). The AFP/hCG/uE3 screening program at the Wake Forest University School of Medicine screens ∼15 000 maternal serum samples per year. Results from all samples screened between January 1989 and December 1997 and their respective outcomes were reviewed. In this study we report the maternal serum AFP concentrations in 19 pregnancies, the total hCG in 17 pregnancies, and the uE3 in 7 pregnancies identified with fetal Turner syndrome. In addition, these results are correlated with the ultrasound findings of cystic hygroma and hydrops. Results from 130 595 maternal serum samples assayed between January 1989 and December 1997 and their respective outcomes were reviewed. Maternal serum screening was performed between 15.0 and 20.9 weeks of gestation. An assay for total hCG was added to the screen in January 1991, and uE3 was added in November 1993. AFP and total hCG were measured by the Abbott IMx microparticle enzyme immunoassay system; uE3 was assayed with a radioimmunoassay by Diagnostic Systems Laboratories according to the manufacturer’s instructions. Maternal serum AFP values were corrected for gestational age, maternal weight, race, and insulin-dependent diabetic status. Maternal serum hCG and uE3 values were corrected for gestational age and maternal weight. A patient-specific Down syndrome risk was calculated using maternal age and a trivariate gaussian distribution (8). All median values were calculated in house. Samples were identified as having an …

Adverse Obstetric Outcome in Low- and High-Risk Pregnancies

In Brief Objective To determine whether the relationship between adverse pregnancy outcome and elevated maternal serum alpha-fetoprotein (MSAFP) and/or maternal serum hCG levels in women whose fetuses have no chromosomal abnormalities or neural tube defects is restricted to pregnancies with a priori elevated risk for pathology or also present in low-risk pregnancies. Methods The outcomes of pregnancy in two groups of patients with elevated MSAFP and/or maternal serum hCG values were compared with the outcomes of a reference group with normal serum values. The first study group consisted of 83 women without pre-existing risk for poor outcome as defined by the guidelines of the Dutch Society of Obstetrics and Gynecology. The second study group consisted of 62 women with a priori elevated risk according to these guidelines. Results Fetal or neonatal death, pregnancy-induced hypertension, placental abruption, placenta previa, preterm delivery, delivery of infants with birth weights in the 2.3rd percentile, and complications during the third stage of labor occurred significantly more often in patients with elevated values and low a priori risk than in women with normal values and without pre-existing risk factors. There was no significant increase in adverse pregnancy outcome in women with elevated values and high a priori risk compared with women with normal values and elevated a priori risk. Conclusion In women at low risk, elevated MSAFP and/or maternal serum hCG values are predictive of adverse pregnancy outcome. In women with a priori elevated risk, abnormal serum values do not increase this risk. Unexplained elevated serum alpha-fetoprotein or hCG levels increase the risk of adverse pregnancy outcome in women with low a priori risk but not in women with high a priori risk.

Adverse obstetric outcome in low- and high-risk pregnancies: predictive value of maternal serum screening

Objective: To determine whether the relationship between adverse pregnancy outcome and elevated maternal serum alpha-fetoprotein (MSAFP) and/or maternal serum hCG levels in women whose fetuses have no chromosomal abnormalities or neural tube defects is restricted to pregnancies with a priori elevated risk for pathology or also present in low-risk pregnancies. Methods: The outcomes of pregnancy in two groups of patients with elevated MSAFP and/or maternal serum hCG values were compared with the outcomes of a reference group with normal serum values. The first study group consisted of 83 women without pre-existing risk for poor outcome as defined by the guidelines of the Dutch Society of Obstetrics and Gynecology. The second study group consisted of 62 women with a priori elevated risk according to these guidelines. Results: Fetal or neonatal death, pregnancy-induced hypertension, placental abruption, placenta previa, preterm delivery, delivery of infants with birth weights in the 2.3rd percentile, and complications during the third stage of labor occurred significantly more often in patients with elevated values and low a priori risk than in women with normal values and without pre-existing risk factors. There was no significant increase in adverse pregnancy outcome in women with elevated values and high a priori risk compared with women with normal values and elevated a priori risk. Conclusion: In women at low risk, elevated MSAFP and/or maternal serum hCG values are predictive of adverse pregnancy outcome. In women with a priori elevated risk, abnormal serum values do not increase this risk.