title: Mid-trimester maternal serum AFP and hCG as markers of preterm and term adverse pregnancy outcomes.
abstract: OBJECTIVE
  To evaluate the predictive values of mid-trimester serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) for preterm and term placenta-mediated adverse pregnancy outcomes (PMAPOs).
  
  
  METHODS
  We extracted data for nulliparous women with a singleton pregnancy without aneuploidy or lethal fetal anomalies from a prospective cohort study. Maternal serum AFP and hCG measured between 13 and 17 weeks of gestation and expressed as multiples of the median (MoM) for gestational age were compared between women who developed a PMAPO (preeclampsia, intrauterine growth restriction, fetal death) before term or at term and women who did not develop any of these complications.
  
  
  RESULTS
  Among 3466 nulliparous women, maternal serum AFP and hCG levels were available in 2110 and 2125 cases, respectively. Women who developed a PMAPO before term had a higher median level of serum AFP (1.4 vs. 1.1 MoM; P < 0.01) and hCG (1.3 vs. 1.1 MoM; P < 0.01) than controls. A serum hCG > 2.0 MoM was associated with a higher risk of PMAPO before term (RR 4.6; CI 95% 2.3 to 9.1) but had no impact on the risk of PMAPO at term (RR 1.1; CI 95% 0.7 to 1.7). Maternal serum AFP > 2.0 MoM was also associated with a significant increase in the risk of preterm PMAPO (RR 3.9; CI 95% 1.6 to 9.8) but not term PMAPO (RR 1.2; CI 95% 0.6 to 2.3).
  
  
  CONCLUSIONS
  Maternal serum AFP or hCG > 2.0 MoM increases the risk of preterm PMAPO but not term PMAPO in our population. We suggest that women with elevated serum AFP or hCG should receive standard pregnancy care once they have reached 37 weeks of gestation if fetal growth is in the normal range.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec City QC.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Tancrède
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec City QC; Centre Hospitalier Universitaire de Québec, Quebec City QC.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bujold
authors.affiliation: Centre Hospitalier Universitaire de Québec, Quebec City QC; Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Quebec City QC.
authors.forename: Yves
authors.initials: Y
authors.lastname: Giguère
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec City QC.
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Renald
authors.affiliation: Centre Hospitalier Universitaire de Québec, Quebec City QC; Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Quebec City QC.
authors.forename: Joel
authors.initials: J
authors.lastname: Girouard
authors.affiliation: Centre Hospitalier Universitaire de Québec, Quebec City QC; Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Quebec City QC.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Forest
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D006063:Chorionic Gonadotropin / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D005313:Fetal Death; D005317:Fetal Growth Retardation / Q000097:blood*; D006801:Humans; D011225:Pre-Eclampsia / Q000097:blood*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second / Q000097:blood*; D047928:Premature Birth; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins
keywords: alpha-fetoprotein; fetus; human chorionic gonadotropin; placenta; preeclampsia; pregnancy