Quad screen as a predictor of adverse pregnancy outcome.
OBJECTIVE
To estimate the effect of second-trimester levels of maternal serum alpha-fetoprotein (AFP), human chorionic gonadotrophin (hCG), unconjugated estriol (uE3), and inhibin A (the quad screen) on obstetric complications by using a large, prospectively collected database (the FASTER database).


METHODS
The FASTER trial was a multicenter study that evaluated first- and second-trimester screening programs for aneuploidy in women with singleton pregnancies. As part of this trial, patients had a quad screen drawn at 15-18 6/7 weeks. We analyzed the data to identify associations between the quad screen markers and preterm birth, intrauterine growth restriction, preeclampsia, and fetal loss. Our analysis was performed by evaluating the performance characteristics of quad screen markers individually and in combination. Crude and adjusted effects were estimated by multivariable logistic regression analysis. Patients with fetal anomalies were excluded from the analysis.


RESULTS
We analyzed data from 33,145 pregnancies. We identified numerous associations between the markers and the adverse outcomes. There was a relatively low, but often significant, risk of having an adverse pregnancy complication if a patient had a single abnormal marker. However, the risk of having an adverse outcome increased significantly if a patient had 2 or more abnormal markers. The sensitivity and positive predictive values using combinations of markers is relatively low, although superior to using individual markers.


CONCLUSIONS
These data suggest that components of the quad screen may prove useful in predicting adverse obstetric outcomes. We also showed that the total number and specific combinations of abnormal markers are most useful in predicting the risk of adverse perinatal outcome.
Dugoff
Lorraine
L
Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA. Lorraine.Dugoff@uchsc.edu
Hobbins
John C
JC
Malone
Fergal D
FD
Vidaver
John
J
Sullivan
Lisa
L
Canick
Jacob A
JA
Lambert-Messerlian
Geralyn M
GM
Porter
T Flint
TF
Luthy
David A
DA
Comstock
Christine H
CH
Saade
George
G
Eddleman
Keith
K
Merkatz
Irwin R
IR
Craigo
Sabrina D
SD
Timor-Tritsch
Ilan E
IE
Carr
Stephen R
SR
Wolfe
Honor M
HM
D'Alton
Mary E
ME
D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood*; D006063:Chorionic Gonadotropin / Q000097:blood*; D016208:Databases, Factual; D004964:Estriol / Q000097:blood*; D005260:Female; D005313:Fetal Death / Q000175:diagnosis; D005317:Fetal Growth Retardation / Q000175:diagnosis; D006801:Humans; D007265:Inhibins / Q000097:blood*; D008875:Middle Aged; D007752:Obstetric Labor, Premature / Q000175:diagnosis; D011225:Pre-Eclampsia / Q000175:diagnosis; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011446:Prospective Studies; D000509:alpha-Fetoproteins / Q000032:analysis*
D015415:Biomarkers; D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins; C422362:inhibin A; D007265:Inhibins; D004964:Estriol