Maternal urine and serum steroid measurements to identify steroid sulfatase deficiency (STSD) in second trimester pregnancies.
OBJECTIVE
To document the performance of second trimester maternal urine and serum steroid measurements for detecting fetal steroid sulfatase deficiency (STSD).


METHODS
We studied detection rate and false positive rate (DR, FPR) of analytes in maternal urine [combinations of 16alpha-OH-dehydroepiandrosterone sulfate (16alpha-OH-DHEAS), 11beta-hydroxyandrosterone, total estriol] and serum [combinations of 16alpha-OH-DHEAS, 11beta-hydroxyandrosterone, total estriol, unconjugated estriol (uE3)]. Samples were obtained from pregnancies which were screen positive for Smith-Lemli-Opitz syndrome (SLOS).


RESULTS
Among 1 079 301 pregnancies, 3083 (0.29%) were screen positive for SLOS. Urine and/or serum samples were available from 917 viable pregnancies with known gender. We assigned likelihood ratios (LRs) to steroid measurements from male fetuses with known STSD and unaffected female fetuses. An LR > or = 100 was present in urine from 84 of 86 STSD pregnancies (98% DR, 95% CI 92-99), along with 0 of 198 pregnancies with normal female fetuses (0.0% FPR, CI 0-1.9). LRs were > or = 100 in 4 of 129 female fetuses with major abnormalities (3% FPR). In maternal serum, steroid measurements performed less effectively, achieving a 71% DR for STSD at a 1.6% FPR.


CONCLUSIONS
Maternal urine steroid measurements are effective for detecting STSD, including those with point mutations and those with full deletions.
Marcos
Josep
J
Children's Hospital Oakland Research Institute, Oakland, CA, USA.
Craig
Wendy Y
WY
Palomaki
Glenn E
GE
Kloza
Edward M
EM
Haddow
James E
JE
Roberson
Marie
M
Bradley
Linda A
LA
Shackleton
Cedric H L
CH
D000738:Androsterone / Q000031:analogs & derivatives* / Q000097:blood / Q000378:metabolism / Q000652:urine; D003687:Dehydroepiandrosterone / Q000031:analogs & derivatives* / Q000097:blood / Q000378:metabolism / Q000652:urine; D004964:Estriol / Q000097:blood / Q000378:metabolism* / Q000652:urine; D005189:False Positive Reactions; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D017353:Gene Deletion; D006801:Humans; D016114:Ichthyosis, X-Linked; D008297:Male; D017354:Point Mutation; D011237:Predictive Value of Tests; D011247:Pregnancy; D011262:Pregnancy Trimester, Second / Q000097:blood* / Q000652:urine*; D011296:Prenatal Diagnosis; D019082:Smith-Lemli-Opitz Syndrome / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D043266:Steryl-Sulfatase / Q000378:metabolism
C024368:16-hydroxydehydroepiandrosterone sulfate; D003687:Dehydroepiandrosterone; C002528:11 beta-hydroxyandrosterone; D000738:Androsterone; D043266:Steryl-Sulfatase; D004964:Estriol