PREDICTION OF ADVERSE PERINATAL OUTCOME BY MATERNAL SERUM SCREENING FOR DOWN-SYNDROME IN AN ASIAN POPULATION

Objective: To investigate the association between adverse perinatal ou tcomes and abnormal elevations of serum marker levels (alpha-fetoprote in [AFP] and free beta-hCG) or a false-positive screen for Down syndro me. Methods: Pregnancy outcome information was available for 5885 Taiw anese women under 35 years of age who had second-trimester maternal se rum screening for Down syndrome, using AFP and free beta-hCG, and deli vered a chromosomally normal fetus. Those with AFP at least 2.0 multip les of the median (MoM), free beta-hCG at least 2.5 MoM, or a false-po sitive screen (risk ratio at least 1:270) were identified, and the ris k for adverse perinatal outcome was assessed. Results: A serum AFP lev el at least 2.0 MoM (n = 176, 3.0%) was significantly associated with the occurrence of preterm delivery, low Apgar scores, small-for-gestat ional-age infants, low birth weight or very low birth weight, fetal de ath, premature rupture of membranes, oligohydramnios, and a higher inc idence of perinatal mortality. A serum free beta-hCG level at least 2. 5 MoM (n = 416, 7.1%) was significantly associated with low birth weig ht, an abnormally adherent placenta, and the occurrence of meconium-st ained amniotic fluid. A higher incidence of fetal structural anomalies other than neural tube or abdominal wall defects, large-for-gestation al-age infants, and postpartum hemorrhage was observed for a calculate d risk of at least 1:270 (n = 311, 5.3%) independent of the other bioc hemical markers. Conclusion: Asian women with unexplained elevations o f serum AFP or free beta-hCG, or a false-positive screen for Down synd rome are at increased risk for various adverse perinatal outcomes. Car eful fetal ultrasound examination and thoughtful strategy for perinata l management are warranted for these patients. (C) 1997 by The America n College of Obstetricians and Gynecologists.