title: Prediction of adverse perinatal outcome by maternal serum screening for Down syndrome in an Asian population.
abstract: OBJECTIVE
  To investigate the association between adverse perinatal outcomes and abnormal elevations of serum marker levels (alpha-fetoprotein [AFP] and free beta-hCG) or a false-positive screen for Down syndrome.
  
  
  METHODS
  Pregnancy outcome information was available for 5885 Taiwanese women under 35 years of age who had second-trimester maternal serum screening for Down syndrome, using AFP and free beta-hCG, and delivered a chromosomally normal fetus. Those with AFP at least 2.0 multiples of the median (MoM), free beta-hCG at least 2.5 MoM, or a false-positive screen (risk ratio at least 1:270) were identified, and the risk for adverse perinatal outcome was assessed.
  
  
  RESULTS
  A serum AFP level at least 2.0 MoM (n = 176, 3.0%) was significantly associated with the occurrence of preterm delivery, low Apgar scores, small-for-gestational-age infants, low birth weight or very low birth weight, fetal death, premature rupture of membranes, oligohydramnios, and a higher incidence of perinatal mortality. A serum free beta-hCG level at least 2.5 MoM (n = 416, 7.1%) was significantly associated with low birth weight, an abnormally adherent placenta, and the occurrence of meconium-stained amniotic fluid. A higher incidence of fetal structural anomalies other than neural tube or abdominal wall defects, large-for-gestational-age infants, and postpartum hemorrhage was observed for a calculated risk of at least 1:270 (n = 311, 5.3%) independent of the other biochemical markers.
  
  
  CONCLUSIONS
  Asian women with unexplained elevations of serum AFP or free beta-hCG, or a false-positive screen for Down syndrome are at increased risk for various adverse perinatal outcomes. Careful fetal ultrasound examination and thoughtful strategy for perinatal management are warranted for these patients.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.
authors.forename: T T
authors.initials: TT
authors.lastname: Hsieh
authors.forename: T H
authors.initials: TH
authors.lastname: Hung
authors.forename: J J
authors.initials: JJ
authors.lastname: Hsu
authors.forename: W Y
authors.initials: WY
authors.lastname: Shau
authors.forename: C W
authors.initials: CW
authors.lastname: Su
authors.forename: F J
authors.initials: FJ
authors.lastname: Hsieh
mesh_terms: D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D016001:Confidence Intervals; D004314:Down Syndrome / Q000175:diagnosis*; D005189:False Positive Reactions; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis*; D006801:Humans; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011296:Prenatal Diagnosis; D013624:Taiwan; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; D000509:alpha-Fetoproteins