title: Quad screen as a predictor of adverse pregnancy outcome.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA. Lorraine.Dugoff@uchsc.edu
authors.forename: Lorraine
authors.initials: L
authors.lastname: Dugoff
authors.forename: John C
authors.initials: JC
authors.lastname: Hobbins
authors.forename: Fergal D
authors.initials: FD
authors.lastname: Malone
authors.forename: John
authors.initials: J
authors.lastname: Vidaver
authors.forename: Lisa
authors.initials: L
authors.lastname: Sullivan
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Canick
authors.forename: Geralyn M
authors.initials: GM
authors.lastname: Lambert-Messerlian
authors.forename: T Flint
authors.initials: TF
authors.lastname: Porter
authors.forename: David A
authors.initials: DA
authors.lastname: Luthy
authors.forename: Christine H
authors.initials: CH
authors.lastname: Comstock
authors.forename: George
authors.initials: G
authors.lastname: Saade
authors.forename: Keith
authors.initials: K
authors.lastname: Eddleman
authors.forename: Irwin R
authors.initials: IR
authors.lastname: Merkatz
authors.forename: Sabrina D
authors.initials: SD
authors.lastname: Craigo
authors.forename: Ilan E
authors.initials: IE
authors.lastname: Timor-Tritsch
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Carr
authors.forename: Honor M
authors.initials: HM
authors.lastname: Wolfe
authors.forename: Mary E
authors.initials: ME
authors.lastname: D'Alton
mesh_terms: 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*
chemical_list: D015415:Biomarkers; D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins; C422362:inhibin A; D007265:Inhibins; D004964:Estriol