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CC BY-NC-ND 4.0 · AJP Rep 2020; 10(04): e369-e379
DOI: 10.1055/s-0040-1716741
Case Report

Adverse Pregnancy Outcomes by Degree of Maternal Serum Analyte Elevation: A Retrospective Cohort Study

Amanda Yeaton-Massey
1   Department of Obstetrics and Gynecology, Stanford University, Stanford, California
,
Rebecca J. Baer 
2   Department of Pediatrics, University of California San Diego, La Jolla, California
3   California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
,
Larry Rand
3   California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
4   Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California
,
Laura L. Jelliffe-Pawlowski
3   California Preterm Birth Initiative, University of California San Francisco, San Francisco, California
5   Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, California
,
Deirdre J. Lyell
1   Department of Obstetrics and Gynecology, Stanford University, Stanford, California
› Author Affiliations Funding Information This work was supported in part by the University of California, San Francisco California Preterm Birth Initiative. Data from the California Prenatal and Newborn Screening Programs were obtained through the California Biobank Program (Screening Information System request no. 476). Data were obtained with an agreement that the California Department of Public Health is not responsible for the results or conclusions drawn by the authors of this publication.
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Abstract

Objective The aim of this study was to evaluate rates of preterm birth (PTB) and obstetric complication with maternal serum analytes > 2.5 multiples of the median (MoM) by degree of elevation.

Study Design Retrospective cohort study of singleton live-births participating in the California Prenatal Screening Program (2005–2011) examining PTB and obstetric complication for α-fetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3), and inhibin A (INH) by analyte subgroup (2.5 to < 6.0, 6.0 to < 10.0, and ≥ 10.0 MoM vs. < 2.5 MoM).

Results The risk of obstetric complication increased with increasing hCG, AFP, and INH MoM, and were greatest for AFP and INH of 6.0 to <10.0 MoM. The greatest risk of any adverse outcome was seen for hCG MoM ≥ 10.0, with relative risk (RR) of PTB < 34 weeks of 40.8 (95% confidence interval [CI]: 21.7–77.0) and 13.8 (95% CI: 8.2–23.1) for obstetric complication.

Conclusions In euploid, structurally normal fetuses, all analyte elevations > 2.5 MoM confer an increased risk of PTB and, except for uE3, obstetric complication, and risks for each are not uniformly linear. These data can help guide patient counseling and antenatal management.

Keywords

AFP - hCG - estriol - inhibin - adverse pregnancy outcomes

Author Contributions

The authors certify that they have made substantial contributions to the conception and design (AYM, RJB, LR, LJP, DJL), or analysis (RJB, LJP) and interpretation of data (AYM, RJB, LR, LJP, DJL). In addition, they certify their contributions to drafting the article or revising it critically for important intellectual content (AYM, RJB, LR, LJP, DJL). The authors give final approval to the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved (AYM, RJB, LR, LJP, DJL).




Publication History

Received: 08 May 2020

Accepted: 04 June 2020

Article published online:
16 November 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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