Document Detail

Prediction of patient-specific risk for fetal loss using maternal characteristics and first- and second-trimester maternal serum Down syndrome markers.
MedLine Citation:
PMID:  18771987     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To develop and evaluate a method of estimating patient-specific risk for fetal loss by combining maternal characteristics with serum markers. STUDY DESIGN: Data were obtained on 36,014 women from the FaSTER trial. Separate likelihood ratios were estimated for significant maternal characteristics and serum markers. Patient-specific risk was calculated by multiplying the incidence of fetal loss by the likelihood ratios for each maternal characteristic and for different serum marker combinations. RESULTS: Three hundred eighteen women had fetal loss < 24 weeks (early) and 103 > 24 weeks (late). Clinical characteristics evaluated included maternal age, body mass index, race, parity, threatened abortion, previous preterm delivery, and previous early loss. Serum markers studied as possible predictors of early loss included first-trimester pregnancy-associated plasma protein A and second-trimester alpha-fetoprotein, and unconjugated estriol. A risk assessment for early loss based on all of these factors yielded a 46% detection rate, for a fixed 10% false-positive rate, 39% for 5% and 28% for 1%. The only significant marker for late loss was inhibin A. The detection rate was 27% for a fixed 10% false-positive rate and only increased slightly when clinical characteristics were added to the model. CONCLUSION: Patient-specific risk assessment for early fetal loss using serum markers, with or without maternal characteristics, has a moderately high detection. Patient-specific risk assessment for late fetal loss has low detection rates.
Lorraine Dugoff; Howard S Cuckle; John C Hobbins; Fergal D Malone; Michael A Belfort; David A Nyberg; Christine H Comstock; George R Saade; Keith A Eddleman; Peer Dar; Sabrina D Craigo; Ilan E Timor-Tritsch; Steven R Carr; Honor M Wolfe; Mary E D'Alton;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  199     ISSN:  1097-6868     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-09-05     Completed Date:  2008-10-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  290.e1-6     Citation Subset:  AIM; IM    
Department of Obstetrics and Gynecology, University of Colorado at Denver Health Sciences Center, Aurora, CO, USA.
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MeSH Terms
Abortion, Spontaneous / epidemiology*
Biological Markers / blood
Body Mass Index
Down Syndrome / diagnosis
Estriol / blood
Likelihood Functions
Maternal Age
Pregnancy Outcome*
Pregnancy Trimester, First
Pregnancy Trimester, Second
Pregnancy-Associated Plasma Protein-A / analysis
Risk Assessment
Risk Factors
Sensitivity and Specificity
alpha-Fetoproteins / analysis
Grant Support
Reg. No./Substance:
0/Biological Markers; 0/alpha-Fetoproteins; 50-27-1/Estriol; EC 3.4.24.-/Pregnancy-Associated Plasma Protein-A

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