title: Risk of bronchopulmonary dysplasia by second-trimester maternal serum levels of α-fetoprotein, human chorionic gonadotropin, and unconjugated estriol.
abstract: BACKGROUND
  Although maternal serum α-fetoprotein (AFP), human chorionic gonandotropin (hCG), and estriol play important roles in immunomodulation and immunoregulation during pregnancy, their relationship with the development of bronchopulmonary dysplasia (BPD) in young infants is unknown despite BPD being associated with pre- and postnatal inflammatory factors.
  
  
  RESULTS
  We found that these serum biomarkers were associated with an increased risk of BPD. Risks were especially high when AFP and/or hCG levels were above the 95th percentile and/or when unconjugated estriol (uE3) levels were below the 5th percentile (relative risks (RRs) 3.1-6.7). Risks increased substantially when two or more biomarker risks were present (RRs 9.9-75.9).
  
  
  CONCLUSIONS
  Data suggested that pregnancies that had a biomarker risk and yielded an offspring with BPD were more likely to have other factors present that suggested early intrauterine fetal adaptation to stress, including maternal hypertension and asymmetric growth restriction.
  
  
  METHODS
  The objective of this population-based study was to examine whether second-trimester levels of AFP, hCG, and uE3 were associated with an increased risk of BPD.
authors.affiliation: Genetic Disease Screening Program, California Department of Public Health, Richmond, California, USA. Laura.Jelliffe@cdph.ca.gov
authors.forename: Laura L
authors.initials: LL
authors.lastname: Jelliffe-Pawlowski
authors.forename: Gary M
authors.initials: GM
authors.lastname: Shaw
authors.forename: David K
authors.initials: DK
authors.lastname: Stevenson
authors.forename: John W
authors.initials: JW
authors.lastname: Oehlert
authors.forename: Cele
authors.initials: C
authors.lastname: Quaintance
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Santos
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Baer
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Currier
authors.forename: Hugh M
authors.initials: HM
authors.lastname: O'Brodovich
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Gould
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D001997:Bronchopulmonary Dysplasia / Q000097:blood* / Q000175:diagnosis*; D006063:Chorionic Gonadotropin / Q000097:blood*; D004964:Estriol / Q000097:blood* / Q000737:chemistry; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007249:Inflammation; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012044:Regression Analysis; D012306:Risk; D000509:alpha-Fetoproteins / Q000096:biosynthesis*
chemical_list: D015415:Biomarkers; D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins; D004964:Estriol