title: First-trimester maternal serum PAPP-A, SP1 and M-CSF levels in normal and trisomic twin pregnancies.
abstract: OBJECTIVE
  To study PAPP-A and SP1 for biochemical trisomy screening in twin pregnancies and to investigate the role of maternal and placental compartments in marker production by comparing the levels of the decidual cytokine M-CSF with the PAPP-A and SP1 from the placenta.
  
  
  METHODS
  Thirteen twin pregnancies with at least one chromosomally abnormal fetus were compared with 68 normal twin pregnancies. Sera were obtained between 11 + 3 and 13 + 6 weeks of gestation, and PAPP-A, SP1 and M-CSF levels were determined by immunoassay. These concentrations were also compared with gestation-matched groups of 18 singleton normal pregnancies and 18 singleton Down syndrome pregnancies.
  
  
  RESULTS
  PAPP-A and SP1, but not M-CSF, levels were higher in normal twin pregnancy than in normal singleton pregnancy. SP1 levels, but not PAPP-A, correlated to M-CSF. PAPP-A, but not SP1, levels were reduced in abnormal twin pregnancies, with an increasing effect according to the number of affected fetuses, and were more pronounced in pregnancies with trisomy 18 or 13 than in trisomy 21 fetuses. M-CSF was inconsistent, with a trend towards increased levels in trisomy 21.
  
  
  CONCLUSIONS
  PAPP-A remains the best biochemical screening marker for fetal trisomies 21, 18 or 13, in singleton as well as in twin pregnancy. In contrast to SP1, its site of production is not likely to be restricted to the placenta. The role of the (maternally produced) M-CSF remains to be further investigated.
authors.affiliation: Department of Obstetrics and Gynaecology, Reproductive and Perinatal Medicine Research Laboratory, Inselspital KKL G3-825, University of Berne, CH-3010 Berne, Switzerland. nick.bersinger@dkf2.unibe.ch
authors.forename: N A
authors.initials: NA
authors.lastname: Bersinger
authors.forename: P
authors.initials: P
authors.lastname: Noble
authors.forename: K H
authors.initials: KH
authors.lastname: Nicolaides
mesh_terms: D000328:Adult; D005260:Female; D005820:Genetic Testing / Q000379:methods; D006801:Humans; D007118:Immunoassay; D007621:Karyotyping; D016173:Macrophage Colony-Stimulating Factor / Q000097:blood*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011272:Pregnancy, Multiple / Q000097:blood*; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis*; D011268:Pregnancy-Specific beta 1-Glycoproteins / Q000032:analysis*; D012189:Retrospective Studies; D014314:Trisomy; D014427:Twins
chemical_list: D011268:Pregnancy-Specific beta 1-Glycoproteins; D016173:Macrophage Colony-Stimulating Factor; D011266:Pregnancy-Associated Plasma Protein-A