First-trimester combined screening for trisomy 21 in women with renal disease.
OBJECTIVE
To evaluate the results of first-trimester combined screening for Down syndrome in women with chronic renal disease.


METHODS
Fifty-five pregnant women with renal disease were compared with 110 patients matched for maternal age, maternal weight, smoking status, and gestational age. Maternal renal function was assayed at the time of the combined screening, and renal insufficiency was defined by serum creatinine >90 µmol/L and renal clearance <80 mL/min. We defined three groups: kidney disease and normal renal function (group 1), kidney disease and renal insufficiency (group 2), and a control group (group 3). The values of nuchal translucency, pregnancy-associated plasma protein A, human β-chorionic gonadotrophin (hCGβ), and false-positive rates for Down syndrome screening were compared.


RESULTS
There were 39 (71%) and 16 (29%) cases in groups 1 and 2, respectively. Nuchal translucency and multiple of the median (MoM) pregnancy-associated plasma protein A were similar in the three groups. However, MoM hCGβ levels were higher in group 2 than in groups 1 and 3 (5.37 vs 1.1 vs 0.98 MoM, p = 0.0001). The resulting screen-positive rate was also higher in group 2 than in groups 1 and 3 (43.7% vs 10.2% vs 5.5%, p = 0.0001).


CONCLUSIONS
Trisomy 21 first-trimester screening using hCGβ is not suitable in the case of maternal renal failure. © 2014 John Wiley & Sons, Ltd.
Department of Obstetrics and Maternal-Fetal Medicine, Necker Enfants Malades Hospital, AP-HP, Paris, France.
Morgane
M
Valentin
Françoise
F
Muller
Marie Paule
MP
Beaujard
Sophie
S
Dreux
Isabelle
I
Czerkiewicz
Valérie
V
Meyer
Marianne
M
Leruez
Yves
Y
Ville
Laurent J
LJ
Salomon
D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D016022:Case-Control Studies; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000378:metabolism*; D015331:Cohort Studies; D003404:Creatinine / Q000378:metabolism*; D004314:Down Syndrome / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005189:False Positive Reactions; D005260:Female; D005865:Gestational Age; D006801:Humans; D008423:Maternal Age; D048208:Nuchal Translucency Measurement; D011247:Pregnancy; D011248:Pregnancy Complications / Q000378:metabolism*; D011261:Pregnancy Trimester, First; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D011296:Prenatal Diagnosis; D051436:Renal Insufficiency, Chronic / Q000378:metabolism*; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal; D055815:Young Adult
D015415:Biomarkers; D018997:Chorionic Gonadotropin, beta Subunit, Human; D003404:Creatinine; D011266:Pregnancy-Associated Plasma Protein-A; C579283:PAPPA protein, human