Skip to main content

Advertisement

SpringerLink
Log in

Association Between Serum Markers Used in the Routine Prenatal Screening with Pregnancy Outcomes: A Cohort Study

  • Original Article
  • Published:
The Journal of Obstetrics and Gynecology of India Aims and scope Submit manuscript

Abstract

Background

Early detection of adverse pregnancy outcomes is an important topic in prenatal care. This study aimed to evaluate the association between maternal serum markers and pregnancy outcomes.

Materials and Methods

This hospital-based cohort study was performed according to the national Down syndrome screening protocol on 2923 eligible pregnant women. Pregnancies were classified into three groups of based on each biomarker. The participants were followed up until delivery, and the pregnancy outcomes were identified by hospital discharge records.

Results

High levels of free BHCG were significantly associated with an increased risk of preterm birth (B = − 0.31, SE = 0.158, OR = 0.730; P = 0.046). Based on multivariate analysis the high levels of MSAFP had a direct relationship with premature birth (B = − 0.84, SE = 0.361, OR = 0.431, P = 0.020), gestational hypertension (B = − 0.59, SE = 0.354, OR = 0.549. P = 0.091), IUGR (B = − 1.46, SE = 0.433, OR = 0.231, P = 0.001), and fetal death (B = − 1.50, SE = 0.533, OR = 0.223, P = 0.005). Furthermore, an increase in the levels of Inhibin-A could more likely lead to gestational hypertension (B = − 0.63, SE = 0.235, OR = 0.533).

Discussion

According to the result, maternal biomarkers, especially MSAFP, can be beneficial in identifying high-risk cases, in addition to examining the possibility of Down syndrome, facilitating achievement of the desired pregnancy outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

Data Availability Statement

The data that support the findings of this study are available on request from corresponding author upon reasonable request.

References

  1. Huang S-Y, Wang Y-C, Yin W-C, et al. Is maternal serum inhibin A a good predictor in preterm labor?-Experience from a community hospital in Taiwan. Biomed J. 2020;43(2):183–8. https://doi.org/10.1016/j.bj.2019.08.001.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Huang T, Hoffman B, Meschino W, et al. Prediction of adverse pregnancy outcomes by combinations of first and second trimester biochemistry markers used in the routine prenatal screening of Down syndrome. Prenat Diagn Publ Affil Int Soc Prenat Diagn. 2010;30(5):471–7. https://doi.org/10.1002/pd.2505.

    Article  Google Scholar 

  3. Taché V, Baer RJ, Currier RJ, et al. Population-based biomarker screening and the development of severe preeclampsia in California. Am J Obstet Gynecol. 2014;211(4):377-e1. https://doi.org/10.1016/j.ajog.2014.03.026.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Driscoll DA, Gross S. Prenatal screening for aneuploidy. N Engl J Med. 2009;360(24):2556–62.

    Article  CAS  Google Scholar 

  5. Dugoff L, Hobbins JC, Malone FD, et al. First-trimester maternal serum PAPP-A and free-beta subunit human chorionic gonadotropin concentrations and nuchal translucency are associated with obstetric complications: a population-based screening study (the FASTER Trial). Am J Obstet Gynecol. 2004;191(4):1446–51. https://doi.org/10.1016/j.ajog.2004.06.052.

    Article  CAS  PubMed  Google Scholar 

  6. Dugoff L, Hobbins JC, Malone FD, et al. Quad screen as a predictor of adverse pregnancy outcome. Obstet Gynecol. 2005;106(2):260–7. https://doi.org/10.1097/01.AOG.0000172419.37410.eb.

    Article  PubMed  Google Scholar 

  7. Krantz D, Hallahan T, Janik D, et al. Maternal serum screening markers and adverse outcome: a new perspective. J Clin Med. 2014;3(3):693–712. https://doi.org/10.3390/jcm3030693.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Jelliffe-Pawlowski L, Baer R, Blumenfeld Y, et al. Maternal characteristics and mid-pregnancy serum biomarkers as risk factors for subtypes of preterm birth. BJOG Int J Obstet Gynaecol. 2015;122(11):1484–93. https://doi.org/10.1111/1471-0528.13495.

    Article  CAS  Google Scholar 

  9. Baer RJ, Currier RJ, Norton ME, et al. Obstetric, perinatal, and fetal outcomes in pregnancies with false-positive integrated screening results. Obstet Gynecol. 2014;123(3):603–9. https://doi.org/10.1097/AOG.0000000000000145.

    Article  PubMed  Google Scholar 

  10. Sayın NC, Canda MT, Ahmet N, et al. The association of triple-marker test results with adverse pregnancy outcomes in low-risk pregnancies with healthy newborns. Arch Gynecol Obstet. 2008;277(1):47–53. https://doi.org/10.1007/s00404-007-0421-6.

    Article  PubMed  Google Scholar 

  11. Guanciali Franchi P, Palka C, Morizio E, et al. Sequential combined test, second trimester maternal serum markers, and circulating fetal cells to select women for invasive prenatal diagnosis. PLoS ONE. 2017;12(12):e0189235. https://doi.org/10.1371/journal.pone.0189235.g002.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Androutsopoulos G, Gkogkos P, Decavalas G. Mid-trimester maternal serum HCG and alpha fetal protein levels: clinical significance and prediction of adverse pregnancy outcome. Int J Endocrinol Metab. 2013;11(2):102. https://doi.org/10.5812/ijem.5014.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Audibert F, De Bie I, Johnson J-A, et al. No 348-Joint SOGC-CCMG guideline: update on prenatal screening for fetal aneuploidy, fetal anomalies, and adverse pregnancy outcomes. J Obstet Gynaecol Can. 2017;39(9):805–17. https://doi.org/10.1016/j.jogc.2017.01.032.

    Article  PubMed  Google Scholar 

  14. Spencer K. Second-trimester prenatal screening for Down syndrome and the relationship of maternal serum biochemical markers to pregnancy complications with adverse outcome. Prenat Diagn. 2000;20(8):652–6. https://doi.org/10.1002/1097-0223(200008)20:8%3c652::AID-PD882%3e3.0.CO;2-6.

    Article  CAS  PubMed  Google Scholar 

  15. Walton DL, Norem CT, Schoen EJ, et al. Second-trimester serum chorionic gonadotropin concentrations and complications and outcome of pregnancy. N Engl J Med. 1999;341(27):2033–8. https://doi.org/10.1056/NEJM199912303412701.

    Article  CAS  PubMed  Google Scholar 

  16. Nicolaides K, Spencer K, Avgidou K, et al. Multicenter study of first-trimester screening for trisomy 21 in 75 821 pregnancies: results and estimation of the potential impact of individual risk-orientated two-stage first-trimester screening. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2005;25(3):221–6. https://doi.org/10.1002/uog.1860.

    Article  CAS  Google Scholar 

  17. Pakniat H, Elmizadeh K, Senobari N. Relationship between low PAPP-A levels and preterm delivery. Journal of Mazandaran University of Medical Sciences, 2019;29(175):57–64. URL: http://jmums.mazums.ac.ir/article-1-11345-en.html

  18. Cuckle H, Arbuzova S, Spencer K, et al. Frequency and clinical consequences of extremely high maternal serum PAPP-A levels. Prenat Diagn Publ Affil Int Soc Prenat Diagn. 2003;23(5):385–8. https://doi.org/10.1002/pd.600.

    Article  CAS  Google Scholar 

  19. Yaron Y, Heifetz S, Ochshorn Y, et al. Decreased first trimester PAPP-A is a predictor of adverse pregnancy outcome. Prenat Diagn Publ Affil Int Soc Prenat Diagn. 2002;22(9):778–82. https://doi.org/10.1002/pd.407.

    Article  CAS  Google Scholar 

  20. D’Antonio F, Rijo C, Thilaganathan B, et al. Association between first-trimester maternal serum pregnancy-associated plasma protein-A and obstetric complications. Prenat Diagn. 2013;33(9):839–47. https://doi.org/10.1002/pd.4141.

    Article  CAS  PubMed  Google Scholar 

  21. Patil M, Panchanadikar T, Wagh G. Variation of papp-a level in the first trimester of pregnancy and its clinical outcome. J Obstet Gynecol India. 2014;64(2):116–9. https://doi.org/10.1007/s13224-013-0481-4.

    Article  Google Scholar 

  22. Proctor L, Toal M, Keating S, et al. Placental size and the prediction of severe early-onset intrauterine growth restriction in women with low pregnancy-associated plasma protein-A. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2009;34(3):274–82. https://doi.org/10.1002/uog.7308.

    Article  CAS  Google Scholar 

  23. Dehghani-Firouzabadi R, Tayebi N, Ghasemi N, et al. The Association between second-trimester maternal serum alpha-fetoprotein in 14–22 weeks and adverse pregnancy outcome. Acta Med Iran. 2010;48(4):234–8.

    PubMed  Google Scholar 

  24. Önderoğlu L, Kabukcu A. Elevated second trimester human chorionic gonadotropin level associated withadverse pregnancy outcome. Int J Gynecol Obstet. 1997;56(3):245–9. https://doi.org/10.1016/S0020-7292(96)02830-5.

    Article  Google Scholar 

  25. Yazdani S, Rouholahnejad R, Asnafi N, et al. Correlation of pregnancy outcome with quadruple screening test at second trimester. Med J Islam Repub Iran. 2015;29:281 (PMID: 26913244).

    PubMed  PubMed Central  Google Scholar 

  26. Başbuğ D, Başbuğ A, Gülerman C. Is unexplained elevated maternal serum alpha-fetoprotein still important predictor for adverse pregnancy outcome? Ginekol Pol. 2017;88(6):325–30. https://doi.org/10.5603/GP.a2017.0061.

    Article  PubMed  Google Scholar 

  27. Yaron Y, Cherry M, Kramer RL, et al. Second-trimester maternal serum marker screening: maternal serum α-fetoprotein, β-human chorionic gonadotropin, estriol, and their various combinations as predictors of pregnancy outcome. Am J Obstet Gynecol. 1999;181(4):968–74. https://doi.org/10.1016/S0002-9378(99)70334-0.

    Article  CAS  PubMed  Google Scholar 

  28. Odibo AO, Sehdev HM, Stamilio DM, et al. Evaluating the thresholds of abnormal second trimester multiple marker screening tests associated with intra-uterine growth restriction. Am J Perinatol. 2006;23(06):363–8. https://doi.org/10.1055/s-2006-947724.

    Article  PubMed  Google Scholar 

  29. Singnoi W, Wanapirak C, Sekararithi R, et al. A cohort study of the association between maternal serum Inhibin-A and adverse pregnancy outcomes: a population-based study. BMC Pregnancy Childbirth. 2019;19(1):124. https://doi.org/10.1186/s12884-019-2266-y.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Godbole K, Kulkarni A, Kanade A, et al. Maternal serum aneuploidy screen and adverse pregnancy outcomes. J Obstet Gynecol India. 2016;66(1):141–8. https://doi.org/10.1007/s13224-015-0826-2.

    Article  Google Scholar 

  31. Duric K, Skrablin S, Lesin J, et al. Second trimester total human chorionic gonadotropin, alpha-fetoprotein and unconjugated estriol in predicting pregnancy complications other than fetal aneuploidy. Eur J Obstet Gynecol Reprod Biol. 2003;110(1):12–5. https://doi.org/10.1016/S0301-2115(03)00081-2.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the women who participated in the study. We also appreciate the support from the Azad University of Medical Sciences.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Obstetrician, Instructor, Department of Midwifery, Faculty of Nursing and Midwifery, Islamic Azad University, Tabriz branch, Tabriz, Iran

    Zohreh Alizadeh-Dibazari

  2. Bachelor midwifery student, Student Research Committee, Islamic Azad University, Tabriz branch, Tabriz, Iran

    Zahra Alizadeh-Ghodsi

  3. Ph.D. of Reproductive Health, Assistant Professor, Department of Midwifery, Faculty of Nursing and Midwifery, Islamic Azad University, Tabriz branch, Tabriz, Iran

    Azita Fathnezhad-kazemi

Authors
  1. Zohreh Alizadeh-Dibazari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zahra Alizadeh-Ghodsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Azita Fathnezhad-kazemi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Azita Fathnezhad-kazemi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics Approval and Consent to Participate

This study was approved by the Ethics Committee of the Islamic Azad University Tabriz branch, Iran (code number: IR.IAU.TABRIZ.REC1397.001).

Informed Consent

Informed consent was obtained from all participants for being included in the study.

Human and Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Azita Fathnezhad-Kazemi is an Assistant professor, Department of Midwifery, Faculty of Nursing and Midwifery, Islamic Azad University, Tabriz branch, Tabriz, Iran.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alizadeh-Dibazari, Z., Alizadeh-Ghodsi, Z. & Fathnezhad-kazemi, A. Association Between Serum Markers Used in the Routine Prenatal Screening with Pregnancy Outcomes: A Cohort Study. J Obstet Gynecol India 72 (Suppl 1), 6–18 (2022). https://doi.org/10.1007/s13224-021-01508-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13224-021-01508-8

Keywords

Search

Navigation