title: First trimester predictors of adverse pregnancy outcomes.
abstract: OBJECTIVE
  To identify first trimester indicators of adverse pregnancy outcomes.
  
  
  METHODS
  Data were obtained from the statewide evaluation of first trimester screening for Down syndrome in Western Australia which included 22,695 pregnancies screened between August 2001 and October 2003. Screening data were linked with pregnancy outcome information from the Hospital Morbidity Database and the Birth Defects Registry. The odds ratios (OR) of adverse outcomes were analysed for combined risk incorporating maternal age, nuchal translucency (NT) and biochemical parameters and then separately for each parameter (pregnancy-associated plasma protein-A (PAPP-A), free beta human chorionic gonadotropin (beta-hCG) and NT).
  
  
  RESULTS
  Risk assessments for first trimester combined screening are derived from maternal age, ultrasound measurement of fetal NT, maternal serum free beta-hCG and PAPP-A. Increased combined risk for Down syndrome was significantly (P < 0.01) associated with spontaneous loss at or before 24 weeks gestation (OR 13.51), birth defects (OR 6.58) and preterm birth at or before 32 weeks gestation (OR 3.2). Maternal serum PAPP-A below the 5th centile was associated with Down syndrome (OR 8.43), spontaneous loss before 24 weeks (OR 5.04) and later than 24 weeks (OR 4.50), preterm delivery before 32 weeks (OR 3.11) and before 37 weeks (OR 2.24). NT above the 95th centile was associated with Down syndrome (OR 43.91), birth defects (OR 4.02) and spontaneous loss before 24 weeks (OR 6.24). Low levels of free beta-hCG and increased NT were less consistently associated with adverse outcomes and high levels of free beta-hCG showed limited use as an indicator. The detection rates for all outcomes other than Down syndrome were less than 40%.
  
  
  CONCLUSIONS
  Biochemical indicators and NT that are measured during first trimester screening for Down syndrome show a number of associations with adverse outcomes, but do not show appropriate performance characteristics for screening tests. These data are consistent with the view that the individual components, specifically low PAPP-A levels alone, do not provide an effective screening tool for adverse pregnancy outcomes.
authors.affiliation: Office of Population Health Genomics, Department of Health, East Perth, Western Australia, Australia. kate.brameld@health.wa.gov.au
authors.forename: Kate J
authors.initials: KJ
authors.lastname: Brameld
authors.forename: Jan E
authors.initials: JE
authors.lastname: Dickinson
authors.forename: Peter
authors.initials: P
authors.lastname: O'Leary
authors.forename: Carol
authors.initials: C
authors.lastname: Bower
authors.forename: Jack
authors.initials: J
authors.lastname: Goldblatt
authors.forename: Beverley
authors.initials: B
authors.lastname: Hewitt
authors.forename: Ashleigh
authors.initials: A
authors.lastname: Murch
authors.forename: Rosanne
authors.initials: R
authors.lastname: Stock
mesh_terms: D000293:Adolescent; D000328:Adult; D000782:Aneuploidy; D015415:Biomarkers / Q000097:blood; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000032:analysis* / Q000097:blood; D004314:Down Syndrome / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005313:Fetal Death / Q000097:blood / Q000235:genetics; D005820:Genetic Testing; D006801:Humans; D016015:Logistic Models; D008423:Maternal Age; D008875:Middle Aged; D048208:Nuchal Translucency Measurement; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First / Q000097:blood*; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis* / Q000378:metabolism; D018570:Risk Assessment; D016216:Ultrasonography, Prenatal / Q000379:methods; D055815:Young Adult
chemical_list: D015415:Biomarkers; D018997:Chorionic Gonadotropin, beta Subunit, Human; D011266:Pregnancy-Associated Plasma Protein-A