title: Effect of mild hepatic or renal impairment on maternal serum screening biochemical measures.
abstract: BACKGROUND
  Integrated maternal serum screening (MSS) is commonly used to screen for fetal trisomies and neural tube defects in early pregnancy. The kidney and liver each play an important role in hormone metabolism, and anecdotal data suggest that MSS biochemical measures may vary with a mother's health status. We examined the correlations between kidney and liver function parameters and MSS markers and the possible association of mild renal or hepatic impairment with MSS measures.
  
  
  METHODS
  We completed a prospective cross-sectional study of 257 consecutive women who underwent integrated MSS at a single hospital. Serum analytes (pregnancy associated plasma protein A [PAPP-A], hCG, creatinine [Cr], and alanine aminotransferase [ALT]) were drawn at approximately 12 weeks' gestation, and alpha-fetoprotein and unconjugated estriol were drawn at 16 weeks' gestation. Creatinine clearance was calculated using the Cockcroft-Gault formula. Abnormally elevated serum Cr and ALT were each defined as ≥ 90th percentile among all women. A low creatinine clearance (CrCl) was set at ≤ 10th percentile.
  
  
  RESULTS
  Serum hCG, PAPP-A, and alpha-fetoprotein were negatively correlated with CrCl, but not after correction for maternal age, weight, and ethnicity. No association between MSS and serum ALT was observed. The median serum concentrations of both PAPP-A (P = 0.04) and alpha-fetoprotein (P = 0.02) were significantly higher among those whose CrCl was ≤ 10th percentile. At the more extreme concentrations of PAPP-A and alpha-fetoprotein, no significant association with a low CrCl or an elevated serum ALT was seen.
  
  
  CONCLUSIONS
  Among a group of apparently healthy pregnant women, mild renal or hepatic impairment had little or no significant correlation with individual MSS markers. Further work should focus on the effect of more severe renal or hepatic dysfunction on MSS measures.
authors.affiliation: Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON.
authors.forename: Ivan
authors.initials: I
authors.lastname: Ying
authors.affiliation: Department of Obstetrics and Gynecology, York Central Hospital, Toronto, ON.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Wyatt
authors.affiliation: Centre for Research on Inner City Health and Applied Health Research Centre, St. Michael's Hospital, University of Toronto, Toronto, ON.
authors.forename: Rosane
authors.initials: R
authors.lastname: Nisenbaum
authors.affiliation: Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON; Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, ON; Department of Health Policy Management and Evaluation, University of Toronto, Toronto, ON.
authors.forename: Joel G
authors.initials: JG
authors.lastname: Ray
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D015415:Biomarkers / Q000097:blood; D006063:Chorionic Gonadotropin / Q000097:blood; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D003951:Diagnostic Errors; D004964:Estriol / Q000097:blood; D005260:Female; D005865:Gestational Age; D006801:Humans; D007674:Kidney Diseases / Q000097:blood*; D008107:Liver Diseases / Q000097:blood*; D009436:Neural Tube Defects / Q000175:diagnosis*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood*; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis; D011296:Prenatal Diagnosis / Q000379:methods*; D011446:Prospective Studies; D014314:Trisomy / Q000175:diagnosis*; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D015415:Biomarkers; D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins; D003404:Creatinine; D000410:Alanine Transaminase; D011266:Pregnancy-Associated Plasma Protein-A; D004964:Estriol