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Obstet Gynecol Sci > Volume 54(11); 2011 > Article
Korean Journal of Obstetrics & Gynecology 2011;54(11):651-658.
DOI: https://doi.org/10.5468/KJOG.2011.54.11.651    Published online November 1, 2011.
Second trimester maternal serum marker and adverse pregnancy outcome.
Se Eun Cho, Yoo Jeong Shin, Hyo Jeong Kim, Hyun Young Ji, Hye Min Kwak, Hyun Hwa Cha, Suk Joo Choi, Soo Young Oh, Soo Youn Lee, Cheong Rae Roh, Jong Hwa Kim
1Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. ohsymd@skku.edu
2Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
The aim of this study is to assess the risk of adverse pregnancy outcome by maternal serum markers in Quad test and to compare the existing cutoff (2.0 MoM) with 95 percentile cutoff generated from our consecutive population in predicting adverse pregnancy outcome. METHODS: We generated 95 percentile cutoff as our own reference using 3,000 consecutive women who performed Quad test. Except for follow-up loss, fetal aneuploidy and anomaly, 2,598 women were analyzed for the assessment of adverse pregnancy outcome consisted of preeclampsia (PE), preterm birth (<32 weeks), low birth weight and fetal death in utero. RESULTS: We confirmed high levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and inhibin A are associated with development of PE, preterm birth, and low birth weight. In general, 95 percentile cutoff corresponded similarly with 2.0 MoM except AFP. Combination of serum markers increased the odds ratio for predicting adverse pregnancy outcome. The women with higher level of both AFP and inhibin A (2.0 > or = MoM) had 9.8 times higher risk for PE, 24.8 times higher risk for preterm birth, and 5.6 times higher risk for low birth weight. The women with higher level of AFP, hCG, and inhibin A had 8.2 times higher risk for PE, 29.4 times higher risk for preterm birth. Notably, negative predictive value of serum markers for PE and preterm birth are over 98% either in alone and in combination. CONCLUSION: Maternal serum makers either in alone and in combination offer valuable information on the risk assessment of adverse pregnancy outcome.
Key Words: Quad test, Adverse pregnancy outcome, Alpha-fetoprotein, Human chorionic gonadotropin, Inhibin A

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