Technical Update No. 462: Abnormal maternal serum markers and adverse pregnancy outcomes

Abstract

Objective: To review the current data on the association between abnormal first- or second-trimester aneuploidy screening serum markers and adverse pregnancy outcomes, as well as provide health care professionals with recommendations for managing patients with such abnormal serum marker results.

Target population: Health care providers involved in antenatal care for pregnant individuals, including general practitioners, obstetricians, midwives, and maternal-fetal medicine specialists.

Benefits, harms, and costs: Implementation of the recommendations in this technical update should increase clinician competency in managing abnormal maternal serum markers results with respect to preventive interventions and antenatal surveillance. ∗EVIDENCE: Published literature in English was retrieved through searches of PubMed or MEDLINE, CINAHL, and The Cochrane Library through to May 2024 using appropriate controlled vocabulary via MeSH terms (fetal growth retardation, small for gestational age, preeclampsia, preterm birth) and keywords (fetal growth restriction, growth retardation, IUGR, FGR, low birth weight, small for gestational age, Doppler, placenta, preeclampsia, hypertensive disorders of pregnancy, hCG, human chorionic gonadotropin, PAPP-A, pregnancy-associated plasma protein-A, inhibin-A, unconjugated estriol, PlGF, placental growth factor, AFP, alpha-fetoprotein, prenatal screening). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. Grey literature was identified by searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.

Validation methods: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations).

Intended audience: Obstetricians, family physicians, nurses, midwives, maternal-fetal medicine specialists, and other health care providers who provide perinatal care.

Tweetable abstract: Technical update for the interpretation and management of abnormal serum markers SUMMARY STATEMENTS: RECOMMENDATIONS.

Keywords: alpha-fetoprotein (AFP); beta human-choriogonadotropin (bhCG); estriol (uE3); inhibin-A; placenta growth factor (PlGF); pregnancy outcomes; pregnancy-associated plasma protein A (PAPP-A).