title: Association between isolated abnormal levels of maternal serum unconjugated estriol in the second trimester and adverse pregnancy outcomes.
abstract: OBJECTIVE
  To determine the association between maternal serum unconjugated estriol (uE3) levels in the second trimester and adverse pregnancy outcomes.
  
  
  METHODS
  The prospective database of our fetal Down screening program was assessed and reviewed for maternal serum uE3 levels. Pregnancies with medical diseases, abnormal levels of beta-human chorionic gonadotropin, alpha-fetoprotein and fetal chromosomal or structural abnormalities were excluded. The recruited women were categorized into three groups: high (>95th percentile), normal (5-95th percentile) and low (<5th percentile) uE3 levels.
  
  
  RESULTS
  Of 14 212 screened women, 9183 (high; 455, normal; 8271 and low; 457) levels group, were available for outcome analysis. The rates of most adverse outcomes, including preterm birth, low Apgar scores, fetal death, placental abruption, preeclampsia and gestational diabetes mellitus, of the high and normal groups were comparable. Nevertheless, low uE3 levels increased risk of fetal growth restriction (FGR) (RR: 2.36, 95% CI: 1.79-3.10) and low birth weight (LBW) (RR: 1.87, 95% CI: 1.45-2.39), but not preterm birth. Logistic regression analysis indicated that low uE3 level was an independent risk factor for FGR and LBW.
  
  
  CONCLUSIONS
  High uE3 levels in the second trimester are not associated with poor outcomes, whereas low levels significantly increase risk of FGR and LBW but not other adverse outcomes.
authors.affiliation: a Department of Obstetrics and Gynecology, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Thaniyaporn
authors.initials: T
authors.lastname: Settiyanan
authors.affiliation: a Department of Obstetrics and Gynecology, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Chanane
authors.initials: C
authors.lastname: Wanapirak
authors.affiliation: a Department of Obstetrics and Gynecology, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Supatra
authors.initials: S
authors.lastname: Sirichotiyakul
authors.affiliation: a Department of Obstetrics and Gynecology, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Fuanglada
authors.initials: F
authors.lastname: Tongprasert
authors.affiliation: a Department of Obstetrics and Gynecology, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Kasemsri
authors.initials: K
authors.lastname: Srisupundit
authors.affiliation: a Department of Obstetrics and Gynecology, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Suchaya
authors.initials: S
authors.lastname: Luewan
authors.affiliation: a Department of Obstetrics and Gynecology, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Kuntharee
authors.initials: K
authors.lastname: Traisrisilp
authors.affiliation: a Department of Obstetrics and Gynecology, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Theera
authors.initials: T
authors.lastname: Tongsong
mesh_terms: D000037:Abruptio Placentae / Q000097:blood; D000328:Adult; D015415:Biomarkers / Q000097:blood; D004964:Estriol / Q000097:blood*; D005260:Female; D005313:Fetal Death; D005317:Fetal Growth Retardation / Q000097:blood; D006801:Humans; D007230:Infant, Low Birth Weight / Q000097:blood; D007231:Infant, Newborn; D011225:Pre-Eclampsia / Q000097:blood; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second / Q000097:blood*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D015415:Biomarkers; D004964:Estriol
keywords: Estriol; fetal growth restriction; low birth weight; outcome; pregnancy