Document Detail

First trimester predictors of adverse pregnancy outcomes.
MedLine Citation:
PMID:  19133038     Owner:  NLM     Status:  MEDLINE    
AIM: To identify first trimester indicators of adverse pregnancy outcomes. METHOD: Data were obtained from the statewide evaluation of first trimester screening for Down syndrome in Western Australia which included 22,695 pregnancies screened between August 2001 and October 2003. Screening data were linked with pregnancy outcome information from the Hospital Morbidity Database and the Birth Defects Registry. The odds ratios (OR) of adverse outcomes were analysed for combined risk incorporating maternal age, nuchal translucency (NT) and biochemical parameters and then separately for each parameter (pregnancy-associated plasma protein-A (PAPP-A), free beta human chorionic gonadotropin (beta-hCG) and NT). RESULTS: Risk assessments for first trimester combined screening are derived from maternal age, ultrasound measurement of fetal NT, maternal serum free beta-hCG and PAPP-A. Increased combined risk for Down syndrome was significantly (P < 0.01) associated with spontaneous loss at or before 24 weeks gestation (OR 13.51), birth defects (OR 6.58) and preterm birth at or before 32 weeks gestation (OR 3.2). Maternal serum PAPP-A below the 5th centile was associated with Down syndrome (OR 8.43), spontaneous loss before 24 weeks (OR 5.04) and later than 24 weeks (OR 4.50), preterm delivery before 32 weeks (OR 3.11) and before 37 weeks (OR 2.24). NT above the 95th centile was associated with Down syndrome (OR 43.91), birth defects (OR 4.02) and spontaneous loss before 24 weeks (OR 6.24). Low levels of free beta-hCG and increased NT were less consistently associated with adverse outcomes and high levels of free beta-hCG showed limited use as an indicator. The detection rates for all outcomes other than Down syndrome were less than 40%. CONCLUSION: Biochemical indicators and NT that are measured during first trimester screening for Down syndrome show a number of associations with adverse outcomes, but do not show appropriate performance characteristics for screening tests. These data are consistent with the view that the individual components, specifically low PAPP-A levels alone, do not provide an effective screening tool for adverse pregnancy outcomes.
Kate J Brameld; Jan E Dickinson; Peter O'Leary; Carol Bower; Jack Goldblatt; Beverley Hewitt; Ashleigh Murch; Rosanne Stock
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Australian & New Zealand journal of obstetrics & gynaecology     Volume:  48     ISSN:  1479-828X     ISO Abbreviation:  Aust N Z J Obstet Gynaecol     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2009-01-09     Completed Date:  2009-04-02     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  0001027     Medline TA:  Aust N Z J Obstet Gynaecol     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  529-35     Citation Subset:  IM    
Office of Population Health Genomics, Department of Health, East Perth, Western Australia, Australia.
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MeSH Terms
Biological Markers / blood
Chorionic Gonadotropin, beta Subunit, Human / analysis*,  blood
Down Syndrome / blood,  diagnosis*,  epidemiology
Fetal Death / blood,  genetics
Genetic Testing
Logistic Models
Maternal Age
Middle Aged
Nuchal Translucency Measurement
Odds Ratio
Predictive Value of Tests
Pregnancy Complications
Pregnancy Outcome*
Pregnancy Trimester, First / blood*
Pregnancy-Associated Plasma Protein-A / analysis*,  metabolism
Risk Assessment
Ultrasonography, Prenatal / methods
Young Adult
Reg. No./Substance:
0/Biological Markers; 0/Chorionic Gonadotropin, beta Subunit, Human; EC 3.4.24.-/Pregnancy-Associated Plasma Protein-A

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