Prediction of patient-specific risk for fetal loss using maternal characteristics and first- and second-trimester maternal serum Down syndrome markers.
OBJECTIVE
To develop and evaluate a method of estimating patient-specific risk for fetal loss by combining maternal characteristics with serum markers.


METHODS
Data were obtained on 36,014 women from the FaSTER trial. Separate likelihood ratios were estimated for significant maternal characteristics and serum markers. Patient-specific risk was calculated by multiplying the incidence of fetal loss by the likelihood ratios for each maternal characteristic and for different serum marker combinations.


RESULTS
Three hundred eighteen women had fetal loss < 24 weeks (early) and 103 > 24 weeks (late). Clinical characteristics evaluated included maternal age, body mass index, race, parity, threatened abortion, previous preterm delivery, and previous early loss. Serum markers studied as possible predictors of early loss included first-trimester pregnancy-associated plasma protein A and second-trimester alpha-fetoprotein, and unconjugated estriol. A risk assessment for early loss based on all of these factors yielded a 46% detection rate, for a fixed 10% false-positive rate, 39% for 5% and 28% for 1%. The only significant marker for late loss was inhibin A. The detection rate was 27% for a fixed 10% false-positive rate and only increased slightly when clinical characteristics were added to the model.


CONCLUSIONS
Patient-specific risk assessment for early fetal loss using serum markers, with or without maternal characteristics, has a moderately high detection. Patient-specific risk assessment for late fetal loss has low detection rates.
Dugoff
Lorraine
L
Department of Obstetrics and Gynecology, University of Colorado at Denver Health Sciences Center, Aurora, CO, USA.
Cuckle
Howard S
HS
Hobbins
John C
JC
Malone
Fergal D
FD
Belfort
Michael A
MA
Nyberg
David A
DA
Comstock
Christine H
CH
Saade
George R
GR
Eddleman
Keith A
KA
Dar
Peer
P
Craigo
Sabrina D
SD
Timor-Tritsch
Ilan E
IE
Carr
Steven R
SR
Wolfe
Honor M
HM
D'Alton
Mary E
ME
D000022:Abortion, Spontaneous / Q000453:epidemiology*; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D004314:Down Syndrome / Q000175:diagnosis; D004964:Estriol / Q000097:blood; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008423:Maternal Age; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D000509:alpha-Fetoproteins / Q000032:analysis
D015415:Biomarkers; D000509:alpha-Fetoproteins; D011266:Pregnancy-Associated Plasma Protein-A; D004964:Estriol