Prediction of obstetrical risk using maternal serum markers and clinical risk factors.
OBJECTIVE
Abnormal maternal serum analytes (pregnancy associated plasma protein A, total human chorionic gonadotropin, alpha fetoprotein, Inhibin A, and unconjugated estriol) measured as part of aneuploidy screening programs have been associated with adverse obstetrical outcomes in euploid pregnancies. This study aimed to determine if their predictive ability could be enhanced with additional information on obstetrical history.


METHODS
Forty-five thousand two hundred eighty-seven women participated in the screening program and delivered euploid singleton infants between 2010 and 2012 in British Columbia, Canada. A split-sample design was used to develop and validate prognostic models for serious perinatal events (stillbirth, preterm birth <32 weeks, or HELLP syndrome) and severe pre-eclampsia [pre-eclampsia with preterm birth <34 weeks or small for gestational age <10th percentile] using logistic regression.


RESULTS
Three thousand five hundred four women (7.7%) had at least one abnormal marker using standard cut-off values. The combination of serum markers and clinical risk factors improved the ability of statistical models to predict a serious perinatal event [area under the curve (AUC) = 0.62] and severe pre-eclampsia (AUC = 0.78) compared with serum markers or clinical risk factors alone.


CONCLUSIONS
While detection rates are low, the combination of maternal serum markers and obstetrical history helps to identify a small subset of women at higher risk for serious perinatal events and severe pre-eclampsia.
Department of Obstetrics and Gynecology, University of British Columbia and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver, Canada.
Amy
A
Metcalfe
Sylvie
S
Langlois
Julie
J
Macfarlane
Hilary
H
Vallance
K S
KS
Joseph
D000328:Adult; D019540:Area Under Curve; D015415:Biomarkers / Q000378:metabolism*; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000378:metabolism; D004964:Estriol / Q000378:metabolism; D005260:Female; D017359:HELLP Syndrome / Q000453:epidemiology / Q000378:metabolism*; D006801:Humans; D007265:Inhibins / Q000378:metabolism; D016015:Logistic Models; D010298:Parity; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000378:metabolism*; D011247:Pregnancy; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism; D047928:Premature Birth / Q000453:epidemiology / Q000378:metabolism*; D015203:Reproducibility of Results; D017584:Reproductive History; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D050497:Stillbirth / Q000453:epidemiology; D000509:alpha-Fetoproteins / Q000378:metabolism
D015415:Biomarkers; D018997:Chorionic Gonadotropin, beta Subunit, Human; D000509:alpha-Fetoproteins; C422362:inhibin A; D007265:Inhibins; D011266:Pregnancy-Associated Plasma Protein-A; C579283:PAPPA protein, human; D004964:Estriol