Trimester Biochemical Markers Research Articles

Evaluating the predictive efficacy of first trimester biochemical markers (PAPP-A, fβ-hCG) in forecasting preterm delivery incidences

In this investigation, we explored the correlation between first-trimester biochemical markers and the incidence of preterm birth (PTB), irrespective of the cause, spontaneous preterm birth (sPTB), and preterm premature rupture of membranes (pPROM) within a cohort comprising 1164 patients. It was discovered that diminished levels of Pregnancy-Associated Plasma Protein-A (PAPP-A) between 11 and 13 + 6 weeks of gestation significantly contributed to the risk of preterm deliveries both before 35 and 37 weeks, as well as to pPROM instances. Furthermore, women experiencing sPTB before the 37th week of gestation also exhibited lower concentrations of PAPP-A. Moreover, reduced first-trimester concentrations of free beta-human chorionic gonadotropin (fb-HCG) were identified as a risk factor for deliveries preceding 37 weeks, pPROM, and sPTB before 35 weeks of gestation. Despite these correlations, the area under the curve for these biochemical markers did not surpass 0.7, indicating their limited diagnostic potential. The most significant discriminatory capability was noted for PAPP-A levels, with a threshold of < 0.71 multiples of the median (MoM) predicting PTB before 37 weeks, yielding an odds ratio of 3.11 (95% Confidence Interval [CI] 1.97–4.92). For sPTB, the greatest discriminatory potential was observed for PAPP-A < 0.688, providing an OR of 2.66 (95% CI 1.51–4.66). The cut-off points corresponded to accuracies of 76.05% and 79.1%, respectively. In regression analyses, the combined predictive models exhibited low explanatory power with R2 values of 9.2% for PTB and 7.7% for sPTB below 35 weeks of gestation. In conclusion, while certain biochemical markers demonstrated associations with outcomes of preterm birth, their individual and collective predictive efficacies for foreseeing such events were found to be suboptimal.

The predictive value of first trimester maternal serum pregnancy-associated plasma protein-a (papp-a) level in predicting gestational diabetes mellitus

Aims: The aim of this study is to evaluate the predictive value of first trimester biochemical markers in the subsequent development of gestational diabetes mellitus. Methods: Data were retrospectively collected from the file records of 361 pregnant patients, who were admitted to the 1st Obstetrics and Gynecology Clinic at Sisli Etfal Education and Training Hospital for first trimester prenatal screening test between 11-14 weeks of their gestation and who later had undergone 50 gram glucose challenge test at 24-28 weeks of their gestation, between November 2007 and February 2011. Age, patient weight, Crown rump length (CRL), gestational week, Pregnancy-Associated Plasma Protein-A (PAPP-A) concentration, PAPP-A multiple of median (MoM) value, Beta-human koryonik gonadotropin (B-HCG) concentration, B-HCG MoM value, 50 and 100 g oral glucose challange test result were recorded from the files. Gestational diabetes was diagnosed according to National Diabates Data Grup cutt-off values and criteria. The association between first trimester biochemical markers and subsequent development of gestational diabetes was evaluated. Results: In this study low PAPP-A and/or HCG MoM values and increased Nuchal translucency (NT) MoM values were found to be statistically significant for subsequent development of gestational diabetes. Conclusion: GDM is an important health problem that carries many risks of complications for both mother and fetus. Pregnant women with GDM may have high blood sugar levels before diagnosis at 24 weeks of gestation, so fetal growth may be negatively affected by maternal hyperglycemia. Use of first trimester screening maternal serum biomarkers may lead to early diagnosis of GDM and interventions to improve maternal and fetal outcomes.

Association of first trimester biochemical screening markers with adverse outcomes in pregnancies resulting from assisted reproduction techniques versus spontaneous pregnancies

Association of first trimester biochemical screening markers with adverse outcomes in pregnancies resulting from assisted reproduction techniques versus spontaneous pregnancies

The Effect on 2nd Trimester Biochemical Markers and Pregnancy Outcomes of Patients with Isolated Choroid Plexus Cyst Diagnosed in the Prenatal Period

Amaç: Prenatal ultrasonografide saptanan izole Koroid Pleksus Kistlerinde ikinci trimester yapılan biokimyasal belirteçlerine ve gebelik sonuçları üzerine etkisini araştırmak amaçlanmıştır. &#x0D; Materyal Metod: Çalışma retrospektif olarak dizayn edilmiş olup 2017-2022 yılları arasında Etlik Zübeyde Hanım Kadın Hastalıkları ve Eğitim Araştırma Hastanesinde yapılmıştır. Gebeliğinde izole koroid pleksus kisti saptanan 32 gebe ve tarama ve ultrasonografisi normal olan 31 gebe kontrol grubu olarak dahil edilmiştir. &#x0D; Bulgular: Çalışmaya toplam 63 gebe dahil edilmiştir. 32 gebede izole koroid pleksus kisti (KPK) vardı ve 31 gebe normaldi. Gruplar arasında Estriol (E3) MoM KPK olan grupta diğer gruba göre düşüktü ve istatiksel olarak anlamlıydı ama yinede kabul edilen sınır değerler arasındaydı diğer biokimyasal parametreler açısından anlamlı istatiksel fark bulunmadı. Doğum sonuçları arasında fark bulunamadı. Hiçbir yenidoğanda anomali saptanmadı. &#x0D; Sonuç: 2. Trimestar biokimyasal belirteçleri normal olan ve izole KPK sı olan fetuslarda anomali riski çok düşüktür

First-trimester biomarkers and ultrasound biometries in relation to growth discordance in monochorionic diamniotic twins

Objective The aim of this study was to investigate the association and predictive value between intertwin discordance in first trimester biometries crown-rump length (CRL) and nuchal translucency (NT), and the first trimester biochemical markers PAPP-A and free β-hCG in relation to birth weight discordance (BWD) ≥25% in monochorionic diamniotic (MCDA) twin pregnancies. Methods First trimester screening information and pregnancy outcome data on MCDA twin pregnancies with delivery from July 2008 to July 2017 were retrieved from the Danish Fetal Medicine Database. CRL discordance was divided into: <10% (reference group) and ≥10%. NT discordance was divided into: <20% (reference group) and ≥20%. The twin pregnancies were classified according to BWD into the following groups: <10% (reference group), 10–24.9%, and ≥25% including cases undergoing umbilical cord occlusion due to selective fetal growth restriction (sFGR). The twin pregnancies with the most severe BWD (BWD ≥25%) were subdivided into three groups including cases with only one growth-restricted (<10th centile) infant defined as sFGR, and cases where both twins were <10th centile. Median multiples of the median (MoM) values of PAPP-A and free ß-hCG were compared with the group with BWD <10% using the Wilcoxon two-sample test. The ability of CRL discordance and NT discordance to predict BWD ≥25% was examined by the area under the receiver operator characteristic (ROC) curve. Results A total of 762 MCDA pregnancies were included. The proportion of pregnancies with CRL discordance ≥10% and NT discordance ≥20% was significantly higher in the group with severe BWD discordance (27.0% vs. 4.7% (p < 0.001) and 40.9% vs. 23.9% (p = 0.001), respectively). When examining the three subgroups of severe BWD, we found a significantly higher percentage of pregnancies with CRL discordance ≥10% in the group where umbilical cord occlusion was performed (52.6% vs. 4.7% in the group with BWD <10% (p < 0.001)) and in the group of BWD ≥25% with sFGR (21.7% vs. 4.7% (p < 0.001)). Additionally, a significantly higher percentage of pregnancies with NT discordance ≥20% was found in the group where umbilical cord occlusion was performed (52.6% vs. 23.9% (p = 0.005)) and in the group with both twins <10th centile (66.7% vs. 23.9% (p = 0.003)). No statistically significant differences were found when comparing levels of PAPP-A and free β-hCG MoMs with the group with BWD <10%. In ROC curves, CRL discordance yielded an AUC for prediction of BWD ≥25% of 0.70 (95% CI 0.63–0.76), and for NT discordance AUC was 0.59 (95% CI 0.52–0.66)). OR for any BWD ≥ 25% was 6.7 (95% CI 3.8–12.0) for pregnancies with a CRL discordance ≥10% compared to pregnancies with a CRL discordance <10%. Conclusions This study shows that a discordance in CRL and NT in MCDA twins are both significantly associated with development of BWD. The most important predictor remains CRL discordance ≥10%, thereby suggesting the unequal growth pattern in many cases with BWD is evident already in the first trimester of the pregnancy. No association was found between first trimester biochemical markers and severe BWD.

Biochemical and ultrasonographic markers in fetal surveillance

Introduction/Objective. Fetal growth restriction (FGR) is associated with increased fetal and neonatal mortality and morbidity. The study objective was to investigate the correlation of maternal blood biochemical markers routinely determined in the first and second trimester screening and ultrasound fetal surveillance parameters in the prediction of fetal growth and condition in singleton pregnancies. Methods. In the first trimester we measured serum levels of beta subunit of human chorionic gonadotropin (?HCG) and pregnancy-associated plasma protein A (PAPP-A). In the second trimester we measured values of chorionic gonadotropin (HCG), alpha fetoprotein (AFP), unconjugated estriol (E3) and inhibin A, also examined ultrasonographic biometric fetal parameters, amniotic fluid index (AFI) and Doppler resistance indexes. FGR was defined as ultrasonographically determined fetal weight and growth parameters below the 10th percentile for the gestational age. Obtained biochemical and ultrasonographic parameters were correlated. Results. Study included 104 singleton pregnancies. ?HCG in the first trimester correlated negatively with fetal growth in the second and third trimester, and the second trimester AFI. Increased PAPP-A correlated positively with elevated resistance index in medial cerebral artery, lower biophysical profile scores, and intermediate type of non-stress test. Lower values of E3 were associated with FGR. Elevated serum AFP levels were linked to oligoamnion in the third trimester. There was no correlation of inhibin A levels with fetal condition. Conclusion. First and second trimester biochemical markers of pregnancy (?HCG, PAPP-A, HCG, AFP and E3) in combination with ultrasonographic biophysical parameters of fetus have predictive value for fetal growth and development.

Modified multiple marker aneuploidy screening as a primary screening test for preeclampsia

BackgroundAbnormal levels of maternal biochemical markers used in multiple marker aneuploidy screening have been associated with adverse pregnancy outcomes. This study aims to assess if a combination of maternal characteristics and biochemical markers in the first and second trimesters can be used to screen for preeclampsia (PE). The secondary aim was to assess this combination in identifying pregnancies at risk for gestational hypertension and preterm birth.MethodsThis case-control study used information on maternal characteristics and residual blood samples from pregnant women who have undergone multiple marker aneuploidy screening. The median multiple of the median (MoM) of first and second trimester biochemical markers in cases (women with PE, gestational hypertension and preterm birth) and controls were compared. Biochemical markers included pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PlGF), human chorionic gonadotropin (hCG), alpha feto-protein (AFP), unconjugated estriol (uE3) and Inhibin A. Logistic regression analysis was used to estimate screening performance using different marker combinations. Screening performance was defined as detection rate (DR) and false positive rate (FPR). Preterm and early-onset preeclampsia PE were defined as women with PE who delivered at < 37 and < 34 weeks of gestation, respectively.ResultsThere were 147 pregnancies with PE (81 term, 49 preterm and 17 early-onset), 295 with gestational hypertension, and 166 preterm birth. Compared to controls, PE cases had significantly lower median MoM of PAPP-A (0.77 vs 1.10, p < 0.0001), PlGF (0.76 vs 1.01, p < 0.0001) and free-β hCG (0.81 vs. 0.98, p < 0.001) in the first trimester along with PAPP-A (0.82 vs 0.99, p < 0.01) and PlGF (0.75 vs 1.02, p < 0.0001) in the second trimester. The lowest first trimester PAPP-A, PlGF and free β-hCG were seen in those with preterm and early-onset PE. At a 20% FPR, 67% of preterm and 76% of early-onset PE cases can be predicted using a combination of maternal characteristics with PAPP-A and PlGF in the first trimester. The corresponding DR was 58% for gestational hypertension and 36% for preterm birth cases.ConclusionsMaternal characteristics with first trimester PAPP-A and PlGF measured for aneuploidy screening provided reasonable accuracy in identifying women at risk of developing early onset PE, allowing triage of high-risk women for further investigation and risk-reducing therapy. This combination was less accurate in predicting women who have gestational hypertension or preterm birth.

Impact of preimplantation genetic testing for aneuploidies (PGT-A) on first trimester biochemical markers – PAPP-A (placenta-associated plasma protein) and free β-hCG (human chorionic gonadotropin)

Objective The objective of the study was to study the effect of preimplantation genetic testing for aneuploidies (PGT-A) performed at blastocyst stage on the levels of first trimester biomarkers. Methods This is an observational, collaborative, retrospective study. Seven hundred and twenty-eight patients were included in the study. Patients were with singleton pregnancies resulting from either natural conception (NC), or assisted reproductive techniques (ARTs) with PGT-A and frozen embryo transfer (FET) (ART/PGT-A/FET) or after ART without PGT-A and fresh ET (ART/no PGT-A/fresh ET) or FET (ART/no PGT-A/FET), who had first trimester combined screening test between 11 and 14 gestational weeks. They were stratified into four groups: group A (ART/PGT-A/FET) – 143 patients; group B (ART/no PGT-A/FET) – 100 patients; group C (ART/no PGT-A/fresh ET) – 346 patients, and group D (NC) – 139 patients. Results Statistically significant differences among the examined groups were observed for maternal age, BMI, ethnicity, and parity. The median placenta-associated plasma protein (PAPP-A) was lowest in the group with ART/PGT-A/FET and the highest result was obtained in the group with ART/no PGT-A/FET. Statistically significant difference in the median PAPP-A levels was identified among the examined groups (p = .0186). When a subgroup analysis was performed, a statistically significant difference was observed in the median PAPP-A between ART/PGT-A/FET group versus ART/no PGT-A/FET group (p = .01) and NC versus ART/no PGT-A/FET (p = .01). A similar trend toward statistical significance was noted when comparing NC versus ART/no PGT-A/fresh ET (p = .06). Multivariate analysis elucidated that when age is present in the model, the effect of any method of conception or testing for aneuploidy disappears. The other factors (BMI, ethnicity, and parity) do not influence the levels of PAPP-A. The lowest median free human chorionic gonadotropin (β-HCG) was recorded in the NC group and the highest result was identified in the group with IVF/PGT-A/FET. No statistically significant difference was observed in the median concentration levels of free β-hCG among the compared groups (p = .5789) and when subgroup analysis was performed (p>.05). The normality of the distribution of variables was analyzed by the Kolmogorov–Smirnov test and the median PAPP-A and free βhCG concentration difference by the Wilcoxon rank-sum test with nonparametric ANOVA. Conclusions Testing for aneuploidy (PGT-A) and the decision to transfer either fresh or cryopreserved embryos (ET) appear not to affect the levels of first trimester biochemical markers. The findings of the present study should be a baseline for future studies and could be used to improve the antenatal screening counseling for women with ART pregnancies and PGT-A.

Familial Beckwith-Wiedemann syndrome: Prenatal manifestation and a possible expansion of the phenotype

We describe a case of Beckwith-Wiedemann syndrome (BWS) demonstrating pre- and post-natal intra-familial variability. Our first encounter with the family occurred in the 1990s following the birth of 3 affected offspring. The first two pregnancies presented with exomphalos and elevated second trimester maternal serum alpha-fetoprotein (msAFP, 3.43 and 4.01 MOM, respectively) as well as elevated maternal human chorionic gonadotrophin (mhCG, 4.33 and 8.8 MOM, respectively). The diagnosis of BWS was confirmed postnatally in both cases. The third ongoing pregnancy presented only with elevated mhCG (7.09 MOM) and no malformation. Nonetheless BWS was suspected. The diagnosis was confirmed postnatally with clinical manifestations including macroglossia and cleft palate. Two affected female siblings were also diagnosed with Mullerian agenesis in adulthood.Suspecting a common genetic etiology, sequencing of the CDKN1C gene revealed a maternally inherited, likely pathogenic variant (NM_000076.2: c.367_385del; p.(Ala123Serfs*143)) causative of BWS. Chromosomal microarray and whole exome sequencing did not reveal any other pathogenic variant that would explain the Mullerian agenesis. One of the affected females underwent successful preimplantation genetic testing (PGT) with a surrogate and gave birth to a healthy female.To the best of our knowledge, this is the first report of Mullerian agenesis as a possible rare expansion of the BWS phenotype. In addition, this case highlights the potential role of abnormal second trimester biochemical markers (msAFP, mHCG) as possible indicators of BWS, especially in familial cases.

Maternal History and First Trimester Biochemical and Biophysical Markers in the Prediction of Spontaneous Preterm Delivery in Singleton Pregnancies

Maternal History and First Trimester Biochemical and Biophysical Markers in the Prediction of Spontaneous Preterm Delivery in Singleton Pregnancies

The Impact of Assisted Reproduction on First Trimester Biochemical Markers in Singleton and Twin Pregnancies

The objective was to determine the effect of in vitro fertilization (IVF) on nuchal translucency, free beta-human chorionic gonadotropin (Free b-HCG) and pregnancy-associated plasma protein-A (Papp-A) measurements for singleton and twin pregnancies. This was a retrospective population-based register study that included 2921women with 11-13 weeks of gestation singleton and twin pregnancies. All patients were evaluated for the first trimester Down syndrome combined screening. We identify the effect of assisted reproductive technologies (ART) such as in vitro fertilization (IVF) on the nuchal translucency (NT), free beta-human chorionic gonadotropin (b-HCG) and pregnancy-associated plasma protein-A (PAPP-A) values. The study included 2921 patients: 2526 with spontaneous conception (86.5%) and 395 following IVF (13.5%); in our study singleton pregnancies were 2660 (91.1%), dichorionic twin pregnancies 232 (7.9%) and 12 (0.4%) monochorionic twin pregnancies. The mean b-HCG were about 56.67 IU/l (95%CI: 54.98-58.36) in singleton pregnancies and 128.08 IU/l (95%CI: 115.72-140.45) in twin pregnancies. PAPP-A mean values in singleton pregnancies were 3.54 IU/l (95%CI: 3.42-3.66) and 5.25 IU/l (95%CI: 4.46-6.08) in twin pregnancies. The results were statistically significant with p value p�01. There were also significant differences between b-HCG values in spontaneous pregnancies HCG 63.35 IU/l (95%CI: 60.14-64.10) and IVF pregnancies HCG 99.9 IU/l (95%CI: 91.8-107.99) with p value p � 0.01. In our study the IVF had no impact on nuchal translucency values. Free b-HCG levels were higher in twin pregnancies and IVF pregnancies. PAPP-A concentrations were exceeded in twin pregnancies.

Second Trimester Biochemical Markers as Possible Predictors of Pathological Placentation: A Retrospective Case-Control Study

Objective: We aimed to evaluate the association between second trimester biochemical markers and pathological placentation. Methods: This was a retrospective case-control study (2007–2014) of singleton gestations at a university-affiliated tertiary center. Women with pathologic placentation were subdivided into three groups: placenta accreta (group A), placenta previa (group B), or both (group C). We compared second trimester biochemical screening markers taken between 16 + 0 and 19 + 6 weeks of gestation between groups A, B, and C, and women with normal placentation (group D). Obstetrical and neonatal outcomes, risk factors for pathologic placentation, and second trimester biochemical marker values were compared between groups. Results: Overall, 301 deliveries were evaluated: 64 (21%) in group A, 66 (22%) in group B, 17 (6%) in group C, and 153 (51%) in group D. Each of the pathological placentation groups individually had a higher median alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) multiples of median (MoM) than the controls, with the highest values of AFP and hCG observed among women with placenta accreta and the lowest values among the controls. When a multivariant analysis was applied, the hCG levels remained significantly correlated with pathological placentation. Receiver operation characteristic curves for AFP, hCG, or both were computed. For AFP the area under the ROC curve (AUC) was 0.573 (95% CI 0.515–0.630, p < 0.0274) and a cut-off value above 0.99 MoM demonstrated a sensitivity and specificity of 71 and 46%, respectively, for the prediction of pathological placentation. For hCG, the AUC was 0.662 (95% CI 0.605–0.715, p < 0.0001) and a cut-off value of 1.25 MoM demonstrated a sensitivity and specificity of 53 and 68%. When both markers were plotted, the AUC was 0.668 (95% CI 0.611–0.721, p < 0.0001) and sensitivity and specificity were 63 and 64%, respectively. A percentile MoM cut-off approach distinguished between two groups: a high-risk group (patients with AFP or hCG or both above the 75th percentile, odds ratio (OR) for pathological placentation 2.27, 95% CI 1.42–3.63), and a low-risk group (patients with AFP or hCG or both below the 25th percentile, OR for pathological placentation 0.38, 95% CI 0.24–0.60). Conclusion: Second trimester biomarkers such as hCG and AFP can be used to raise a suspicion towards characterizing women into high-risk and low-risk groups for pathological placentation.

OP09.07: First trimester biochemical and biophysical markers in patients with a first trimester CMV seroconversion

OP09.07: First trimester biochemical and biophysical markers in patients with a first trimester CMV seroconversion

First and Second Trimester Biochemical Markers in Maternal Epilepsy: A Case-Control Study

Background: Our aim is to investigate whether the maternal serum levels of first and second trimester serum analytes are altered in women with epilepsy in pregnancy. Methods: Maternal serum biochemical markers (estriol, alpha-fetoprotein [AFP], human chorionic gonadotrophin [hCG], free β hCG, pregnancy-associated plasma protein-A) were compared in a series of 122 pregnant women with epilepsy and in a cohort of 122 normal pregnant women. The serum samples were obtained between 11–13 6/7 weeks and 16–18 weeks gestation. Results: Second trimester serum estriol levels, expressed as multiples of the median (MoM), in the epileptic group (1.55 ± 0.77 MoM) were significantly higher than those in the control patients (1.13 ± 0.40 MoM) (p < 0.001). Of the women with epilepsy, 66.3% (n = 81) were exposed to antiepileptic drugs. Conclusion: Our study revealed that otherwise uncomplicated pregnant epileptic women had higher second trimester (18–20 weeks of gestation) estriol levels compared to non-epileptic pregnant women.

First trimester combined screening biochemistry in detection of congenital heart defects

Objective: To evaluate the performance of first trimester biochemical markers, pregnancy-associated plasma protein-A (PAPP-A), free beta human chorionic gonadotropin (fβ-hCG), and nuchal translucency (NT) in detection of severe congenital heart defects (CHDs).Methods: During the study period from 1 January 2008 to 31 December 2011, biochemical markers and NT were measured in 31,144 women as part of voluntary first trimester screening program for Down’s syndrome in Northern Finland. Data for 71 severe CHD cases and 762 controls were obtained from the hospital records and from the National Medical Birth Register, which records the birth of all liveborn and stillborn infants, and from the National Register of Congenital Malformations that receives information about all the CHD cases diagnosed in Finland.Results: Both PAPP-A and fβ-hCG multiple of median (MoM) values were decreased in all severe CHDs: 0.71 and 0.69 in ventricular septal defects (VSDs), 0.58 and 0.88 in tetralogy of Fallot cases (TOFs), 0.82 and 0.89 in hypoplastic left heart syndromes (HLHSs), and 0.88 and 0.96 in multiple defects, respectively. NT was increased in all study groups except of VSD group. ROC AUC was 0.72 for VSD when combining prior risk with PAPP-A and fβ-hCG. Adding NT did not improve the detection rate. With normal NT but decreased (<0.5 MoM) PAPP-A and fβ-hCG odds ratios for VSD and HLHS were 19.5 and 25.6, respectively.Conclusions: Maternal serum biochemistry improves the detection of CHDs compared to NT measurement only. In cases with normal NT measurement but low concentrations of both PAPP-A and fβ-hCG, an alert for possible CHD, especially VSD, could be given with thorough examination of fetal heart in later ultrasound scans.

Weight of Pregnant Women and their Influence on Second Trimester Biochemical Markers

Fetal aneuploidies screening was based for a long time on ultrasonographic and biochemical markers measurement. The risk calculated in accordance with second trimester biochemical markers (STBM) values relies on calculation of corrected MoM values. MoM (multiple of Medians) signify the deviation of a measured value from the expected value (Median). The Median is measured at the same gestational age in pregnancies which involve healthy fetuses. The correction of MoM includes an adjustment for certain parameters that influence the STBM value: demographical (ethnicity), behavioral (smoking status, weight), and others (mode of conceiving, etc.). In our article we aim to analyze: (1) the accuracy of software to calculate STBM corrected MoM values, (2) the effect of weight of pregnant women on STBM and (3) the capability of software to counterbalance this influence. Pregnant women (n=1242) were screened for aneuploidies based on an integrated test: first trimester ultrasound and STBM (AFP, hCG and uE3). The absolute value, multiple of median (MoM) and corrected multiple of median (MoMc) values were 33.94�0.45, 1.04�0.12 and 0.98�0.01 for AFP, 22530�477, 0.87�0.01 and 0.85�0.01 for hCG, respectively 0.97�0.03, 0.99�0.01 and 0.98�0.01 for uE3. The weight of pregnant women inversely correlates with absolute and MoM AFP, hCG and uE3 values. No correlation was found with AFP and hCG MoMc values. A very weak inverse correlation was found between weight and uE3 corrected MoM values. Our study confirms that there is a difference between provider and own calculated hCG MoMc values. The weight of pregnant women inversely correlates with STBM values. The software used for aneuploidies risk evaluation corrects the influence of weight of pregnant women, but a minimal influence on uE3 corrected MoM values is still present.

Influence of Weight of Pregnant Women on First Trimester Biochemical Markers Values

Values of first trimester biochemical markers (PAPP-A and free b-hCG) concentration are included in aneuploidies risk evaluation algorithm. Since both markers are produced by the fetus and placenta their concentration depends on the volume in which they are dissolved, respectively the weight of the pregnant women. Our study aimed to analyze the influence of maternal weight on first trimester biochemical markers concentration and the ability of the risk calculation software to correct this influence. Pregnancy-associated protein A (PAPP-A) and free � chorionic gonadotropin hormone (free � hCG) first trimester sera concentration respectively weight were measured in 1629 pregnant women. First trimester PAPP-A and free beta hCG concentrations inverse correlate with weight of pregnant women rho=-0.33, p[0.0001, respectively rho=-0.18, p[0.0001. Weight of pregnant women inversely correlates with multiple of median (MoM) values of first trimester markers too: rho=-0.38, p[0.0001 (PAPP-A), respectively rho=-0.17, p[0.0001 (free-b-hCG). The software counterbalances the influence of weight on biochemical markers values. PAPP-A corrected MoM (MoMc) values don�t inversely correlate with the weight (rho=-0.03, p=0.12), whereas free � hCG MoMc values showed an extremely weak inverse correlation (rho=-0.08, p=0.0008). The software counterbalances the influence of weight on PAPP-A values, whereas an extremely weak but insignificant inverse correlation between weight and free-beta hCG values persists after correction.

Maternal Serum Biochemical Indicators of Trophoblastic Cell and Endothelial Function at First Trimester of Pregnancy

Background: Preeclampsia is a worldwide pregnancy complication, and early identification of patients with an increased risk is one of the key goals in obstetrics. First trimester screening is crucial over the second trimester for understanding the early onset of the disorder, with basal levels of the biochemical parameters associated with the underlying placentation process. Objective: The study aims to assess the levels of serum biochemical markers in pregnant women at first trimester, to evaluate statistical significance and correlation of the values in support of trophoblastic cell integrity, endothelial function and oxidative stress. Materials and Methods: A longitudinal study was conducted on 86 pregnant women of age group 20 - 35 years, Primigravida with singleton pregnancy who visited prenatal check up between 11 - 13 weeks of gestation. Maternal sera was collected for screening Placental protein 13 (PP13), Caspase 3, Asymmetric dimethylarginine (ADMA), Nitric oxide (NO) by ELISA. Xanthine oxidase (XO) activity was assayed spectrophotometrically. Calcium and Uric acid (UA) were measured by dry chemistry analyser. Results: The mean ± SD values for mean arterial pressure (MAP) are 108.4 ± 18.9, UA 2.01 ± 0.85, Total oxidant status (TOS) 12.83 ± 5.17, Total antioxidant capacity (TAC) 24.10 ± 14.28, XO 1.01 ± 2.67, Caspase-3 1.76 ± 2.22, PP13 489.77 ± 53.6, Calcium 10.88 ± 1.97, ADMA 19.03 ± 17.08 and NO 1.16 ± 0.75. The statistical analysis by SPSS package version 20 revealed positive correlation between ADMA & Caspase-3 (r = +0.435), PP13 & NO (r = +0.241), TOS & TAC (r = +0.176), UA & ADMA (r = +0.176), UA & TAC (r = +0.168) and negative correlation between PP13 & ADMA (r = -0.158), NO & TOS (r = -0.114), UA & XO (r = -0.173), UA & NO (r = -0.186), UA & Caspase 3 (r = -0.106) and MAP & Calcium (r = -0.303). Conclusion: The study concludes that first trimester biochemical markers and their correlation predict the trophoblastic cell integrity and endothelial function during placentation under prevailing oxidative stress conditions, which may help in identifying women who subsequently go on to develop preeclampsia.

The first trimester aneuploidy biochemical markers in IVF/ICSI patients have no additional benefit compared to spontaneous conceptions in the prediction of pregnancy complications.

The aim of this study was to determine if the levels of biochemical aneuploidy markers in in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) pregnancies differ from those in spontaneous pregnancies and to verify if biochemical markers could predict pregnancy outcome in IVF/ICSI gestations. This was a prospective observational study performed in a group of 551 patients who underwent a combined first trimester prenatal screening (ultrasound scan and serum markers). All patients were divided into two groups according to the mode of conception: IVF/ICSI pregnancies (study group) and spontaneous conceptions (control group). The concentrations of first trimester biochemical markers were presented as multiples of median (MoM) and were compared between the study and control groups. Analysed pregnancy complications included: preterm delivery (PTD), small for gestational age (SGA), gestational hypertension (GH), preeclampsia (PE) and gestational diabetes (GDM). The analysis was performed on 183 IVF/ICSI and 368 spontaneously conceived gestations, with complete data regarding obstetric outcome. There were no significant differences in the concentrations of biochemical markers between the analysed groups. Pregnancy-associated plasma protein-A (PAPP-A) levels were lower in hypertensive than in normotensive patients, although the difference was not significant. Twenty-three patients had GDM (12.5%), 16 had GH or PE (8.7%), SGA was diagnosed in 18 (9.8%) and 25 delivered preterm (13.6%). The trend for lower PAPP-A MoM was visible in all affected patients, although the results did not reach statistical significance. The first trimester biochemical markers in assisted reproduction technique (ART) pregnancies do not seem to have additional effect on predicting the risk of pregnancy complications.

Does Active Smoking Influence the Second Trimester Biochemical Markers Concentrations?

Cigarette smoke contains over 7000 different substances some of them exerting harmful effects on embryo and pregnant woman. Nowadays 15 % of adult people and around 10-15% of pregnant women smoke. Previous studies showed that cigarette smoke compounds could exert pharmacodinamic effects and influence some of the second trimester biochemical markers concentration. Therefore there is a need to adjust the reference values of second trimester markers depending of the smoker status. The aim of our study was to analyse which of the markers are influenced by smoking and whether the software used to calculate the risk for aneuploidies is able to counterbalance this influence. Alpha-fetoprotein (AFP), chorionic gonadotropin hormone (hCG) and free estriol (uE3) values were measured in second trimester sera of 1242 pregnant women: 1089 non-smokers and 153 smokers. Only hCG second trimester values were influenced by smoking whereas AFP and uE3 values were not. The correction of medians according to the smoking status was able to counterbalance this effect.