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. 2014 Oct;211(4):377.e1-8.
doi: 10.1016/j.ajog.2014.03.026. Epub 2014 Mar 14.

Population-based biomarker screening and the development of severe preeclampsia in California

Véronique Taché  1 , Rebecca J Baer  2 , Robert J Currier  2 , Chin-Shang Li  3 , Dena Towner  4 , L Elaine Waetjen  5 , Laura L Jelliffe-Pawlowski  6
Affiliations

Population-based biomarker screening and the development of severe preeclampsia in California

Véronique Taché et al. Am J Obstet Gynecol. 2014 Oct.

Abstract

Objective: The purpose of this study was to examine the relationship between second-trimester maternal serum biomarkers and the development of early- and late-onset severe preeclampsia in euploid pregnancies.

Study design: Included were 136,139 pregnancies that obtained second-trimester prenatal screening through the California Prenatal Screening Program with live births in 2006-2008. We identified severe preeclampsia diagnoses from hospital discharge records. We used log binomial regression to examine the association between abnormal second-trimester maternal serum biomarkers and the development of severe preeclampsia.

Results: Approximately 0.9% of all women (n = 1208) in our sample experienced severe preeclampsia; 329 women at <34 weeks' gestation and 879 women ≥34 weeks' gestation. High levels of alpha fetoprotein (AFP), human chorionic gonadotropin, inhibin (multiple of the median, ≥95th percentile), and low unconjugated estriol (multiple of the median, ≤5th percentile), were associated with severe preeclampsia (relative risk, 2.5-11.7). Biomarkers were more predictive of early-onset severe preeclampsia (relative risk, 3.8-11.7). One in 9.5 pregnancies with combined high AFP, inhibin, and low unconjugated estriol levels experienced severe early-onset preeclampsia compared with 1 in 680.5 pregnancies without any abnormal biomarkers.

Conclusion: The risk of the development of severe preeclampsia increases for women with high second-trimester AFP, human chorionic gonadotropin, inhibin, and/or low unconjugated estriol; this is especially true for early-onset severe preeclampsia. When abnormal biomarkers co-occur, risk dramatically increases. Although the screening value of second-trimester biomarkers is low, abnormal biomarkers, especially when occurring in combination, appear to indicate placental dysfunction that is associated with the development of severe preeclampsia.

Keywords: biomarker; early-onset severe preeclampsia; screening; serum analyte.

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Conflict of interest statement

The authors report no conflict of interest.

References

    1. Dugoff L, Hobbins JC, Malone FD, et al. Quad screen as a predictor of adverse pregnancy outcome. Obstet Gynecol. 2005;106(2):260–7. - PubMed
    1. Huang T, Hoffman B, Meschino W, Kingdom J, Okun N. Prediction of adverse pregnancy outcomes by combinations of first and second trimester biochemistry markers used in the routine prenatal screening of Down syndrome. Prenat Diagn. 2010;30(5):471–7. - PubMed
    1. Towner D, Gandhi S, El Kady D. Obstetric outcomes in women with elevated maternal serum human chorionic gonadotropin. Am J Obstet Gynecol. 2006;194(6):1676–81. - PubMed
    1. Jelliffe-Pawlowski LL, Baer RJ, Currier RJ. Second trimester serum predictors of preterm birth in a population-based sample of low-risk pregnancies. Prenat Diag. 2010;20:727–33. - PubMed
    1. Jelliffe-Pawlowski LL, Shaw GM, Currier RJ, et al. Association of early-preterm birth with abnormal levels of routinely collected first- and second-trimester biomarkers. Am J Obstet Gynecol. 2013;208(6):492. - PMC - PubMed

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