Abnormal Biochemical Analytes Used for Aneuploidy Screening and Adverse Pregnancy Outcomes in Twin Gestations

Abstract

Objective The objective of this study was to determine if first- and second-trimester biochemical markers for aneuploidy have an association with adverse pregnancy outcomes in twin gestations.

Study Design A retrospective cohort study of patients who presented with dichorionic diamniotic twin gestations was performed. Patients with first-trimester low pregnancy-associated plasma protein A (PAPP-A) or low free β human chorionic gonadotropin (β-hCG), or second-trimester elevated α-fetoprotein (AFP), elevated inhibin A, elevated hCG, or low unconjugated estradiol were identified. The rates of adverse pregnancy outcomes were compared between patients with or without abnormal analytes with p < 0.05 used as significance.

Results In this study, 340 pregnancies were included. Patients with a low PAPP-A had an increased risk for delivery < 37 weeks. Patients with an elevated second-trimester hCG had an increased risk for spontaneous delivery < 28 weeks and neonatal intensive care unit (NICU) admission. Patients with an elevated inhibin A had an increased risk of spontaneous delivery at < 37 and NICU admission. Patients with an elevated AFP had an increased risk of a NICU admission.

Conclusion Certain abnormal aneuploidy markers are associated with an increased risk of adverse pregnancy outcomes in twin gestations.

Keywords

twins - analytes - adverse outcomes

Note

This study was presented at the 35th Annual Meeting, The Pregnancy Meeting of the Society for Maternal Fetal Medicine, San Diego, CA, February 2–7, 2015.

• References

• 1 Brock DJ, Bolton AE, Monaghan JM. Prenatal diagnosis of anencephaly through maternal serum-alphafetoprotein measurement. Lancet 1973; 2 (7835) 923-924
• 2 Leek AE, Ruoss CF, Kitau MJ, Chard T. Raised alpha-fetoprotein in maternal serum with anencephalic pregnancy. Lancet 1973; 2 (7825) 385
• 3 Merkatz IR, Nitowsky HM, Macri JN, Johnson WE. An association between low maternal serum alpha-fetoprotein and fetal chromosomal abnormalities. Am J Obstet Gynecol 1984; 148 (7) 886-894
• 4 Bogart MH, Pandian MR, Jones OW. Abnormal maternal serum chorionic gonadotropin levels in pregnancies with fetal chromosome abnormalities. Prenat Diagn 1987; 7 (9) 623-630
• 5 Canick JA, Knight GJ, Palomaki GE, Haddow JE, Cuckle HS, Wald NJ. Low second trimester maternal serum unconjugated oestriol in pregnancies with Down's syndrome. Br J Obstet Gynaecol 1988; 95 (4) 330-333
• 6 Wald NJ, Cuckle HS, Densem JW , et al. Maternal serum unconjugated oestriol as an antenatal screening test for Down's syndrome. Br J Obstet Gynaecol 1988; 95 (4) 334-341
• 7 Wald NJ, Cuckle HS, Densem JW , et al. Maternal serum screening for Down's syndrome in early pregnancy. BMJ 1988; 297 (6653) 883-887
• 8 Van Lith JM, Pratt JJ, Beekhuis JR, Mantingh A. Second-trimester maternal serum immunoreactive inhibin as a marker for fetal Down's syndrome. Prenat Diagn 1992; 12 (10) 801-806
• 9 Wald NJ, Densem JW, George L , et al. Inhibin-A in Down's syndrome pregnancies: revised estimate of standard deviation. Prenat Diagn 1997; 17 (3) 285-290
• 10 Wapner R, Thom E, Simpson JL , et al; First Trimester Maternal Serum Biochemistry and Fetal Nuchal Translucency Screening (BUN) Study Group. First-trimester screening for trisomies 21 and 18. N Engl J Med 2003; 349 (15) 1405-1413
• 11 Malone FD, Canick JA, Ball RH , et al; First- and Second-Trimester Evaluation of Risk (FASTER) Research Consortium. First-trimester or second-trimester screening, or both, for Down's syndrome. N Engl J Med 2005; 353 (19) 2001-2011
• 12 Wald N, Barker S, Peto R, Brock DJ, Bonnar J. Maternal serum alpha-fetoprotein levels in multiple pregnancy. BMJ 1975; 1 (5959) 651-652
• 13 Nebiolo LM, Adams WB, Miller SL, Milunsky A. Maternal serum human chorionic gonadotropin levels in twin pregnancies. Prenat Diagn 1991; 11 (7) 463-466
• 14 Wald N, Cuckle H, Wu TS, George L. Maternal serum unconjugated oestriol and human chorionic gonadotrophin levels in twin pregnancies: implications for screening for Down's syndrome. Br J Obstet Gynaecol 1991; 98 (9) 905-908
• 15 Watt HC, Wald NJ, George L. Maternal serum inhibin-A levels in twin pregnancies: implications for screening for Down's syndrome. Prenat Diagn 1996; 16 (10) 927-929
• 16 Spencer K. Screening for trisomy 21 in twin pregnancies in the first trimester using free beta-hCG and PAPP-A, combined with fetal nuchal translucency thickness. Prenat Diagn 2000; 20 (2) 91-95
• 17 Dugoff L ; Society for Maternal-Fetal Medicine. First- and second-trimester maternal serum markers for aneuploidy and adverse obstetric outcomes. Obstet Gynecol 2010; 115 (5) 1052-1061
• 18 Wald NJ, Cuckle H. Maternal serum alpha-fetoprotein and birth weight in twin pregnancies. Br J Obstet Gynaecol 1978; 85 (8) 582-584
• 19 Ghosh A, Woo JS, Rawlinson HA, Ferguson-Smith MA. Prognostic significance of raised serum alpha-fetoprotein levels in twin pregnancies. Br J Obstet Gynaecol 1982; 89 (10) 817-820
• 20 Lepage N, Chitayat D, Kingdom J, Huang T. Association between second-trimester isolated high maternal serum maternal serum human chorionic gonadotropin levels and obstetric complications in singleton and twin pregnancies. Am J Obstet Gynecol 2003; 188 (5) 1354-1359
• 21 Chasen ST, Martinucci S, Perni SC, Kalish RB. First-trimester biochemistry and outcomes in twin pregnancy. J Reprod Med 2009; 54 (5) 312-314
• 22 Laughon SK, Rebarber A, Rolnitzky L, Fink L, Saltzman DH. Decreased first-trimester maternal serum free-beta subunit human chorionic gonadotropin and preterm birth in twin gestations. Am J Perinatol 2009; 26 (7) 491-494