Second-trimester maternal serum marker screening: Maternal serum alpha-fetoprotein, beta-human chorionic gonadotropin, estriol, and their various combinations as predictors of pregnancy outcome

OBJECTIVE: We evaluated the value of all 3 common biochemical serum markers , maternal serum alpha-fetoprotein. beta-human chorionic gonadotropin, and unconjugated estriol, and combinations thereof as predictors of pregnancy o utcome. STUDY DESIGN: A total of 60,040 patients underwent maternal serum screening . All patients had maternal serum alpha-fetoprotein measurements; beta-huma n chorionic gonadotropin was measured in 45,565 patients, and 24,504 patien ts had determination of all 3 markers, including unconjugated estriol. The incidences of various pregnancy outcomes were evaluated according to the se rum marker levels by using clinically applied cutoff RESULTS: In confirmation of previous observations, increased maternal serum alpha-fetoprotein levels (>2.5 multiples of the median) were found to be s ignificantly associated with pregnancy-induced hypertension, miscarriage, p reterm delivery, intrauterine growth restriction, intrauterine fetal death, oligohydramnios, and abruptio placentae. Increased beta-human chorionic go nadotropin levels (>2.5 multiples of the median [MoM]) were significantly a ssociated with pregnancy-induced hypertension, miscarriage, preterm deliver y, and intrauterine fetal death. Finally, decreased unconjugated estriol le vels (<0.5 MoM) were found to be significantly associated with pregnancy-in duced hypertension, miscarriage, intrauterine growth restriction, and intra uterine fetal death. As with increased second-trimester maternal serum alph a-fetoprotein levels, increased serum beta-human chorionic gonadotropin and low unconjugated estriol levels are significantly associated with adverse pregnancy outcomes. These are most likely attributed to placental dysfuncti on. CONCLUSION: Multiple-marker screening can be used not only for the detectio n of fetal anomalies and aneuploidy but also for detection of high-risk pre gnancies.