title: Association of low unconjugated estriol in the second trimester and adverse pregnancy outcome.
abstract: OBJECTIVE
  To investigate the association between a low unconjugated estriol (uE3) in the second trimester and adverse pregnancy outcomes.
  
  
  METHODS
  Three hundred nine women who underwent second-trimester maternal serum alpha-fetoprotein (AFP)-hCG-uE3 screening were divided into two groups: those with uE3 at most 0.75 multiples of the median (MoM) (n = 81) and those with uE3 exceeding 0.75 MoM (n = 228). Entry criteria included: hCG below 2 MoM, AFP below 2 MoM, age less than 35 years at delivery, complete prenatal records, and completed delivery. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for a variety of adverse pregnancy outcomes.
  
  
  RESULTS
  After adjusting for smoking and hCG, women with uE3 at or below 0.75 MoM were found to have significantly higher odds of developing fetal growth restriction, low amniotic fluid index (AFI), and small for gestational age (SGA) with ORs (and 95% CIs) of 6.73 (2.55, 17.74), 3.85 (1.53, 9.68), and 2.89 (1.27, 6.57), respectively, for each of the outcomes.
  
  
  CONCLUSIONS
  Low uE3 in the second trimester appears to be associated with fetal growth restriction, low AFI, and SGA, and the risk seems to be independent of risk for adverse infant outcome associated with elevated AFP or hCG.
authors.affiliation: Department of Obstetrics and Gynecology, Mountain Area Health Education Center, Asheville, North Carolina 28801, USA. heidib@orca.mtn.ncahec.org
authors.forename: T D
authors.initials: TD
authors.lastname: Kowalczyk
authors.forename: M L
authors.initials: ML
authors.lastname: Cabaniss
authors.forename: L
authors.initials: L
authors.lastname: Cusmano
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D004964:Estriol / Q000097:blood*; D005260:Female; D005317:Fetal Growth Retardation / Q000209:etiology; D006801:Humans; D007236:Infant, Small for Gestational Age; D016017:Odds Ratio; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second
chemical_list: D015415:Biomarkers; D004964:Estriol