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First‐trimester screening biochemical markers (free beta‐subunit human chorionic gonadotropin, pregnancy‐associated plasma protein‐ A ) and risk of early fetal loss
Author(s) -
Valbuena Henar,
Ramis Jordi,
Sagalá Juan,
Sánchez Mª Ángeles,
Aulesa Carlos
Publication year - 2015
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/jog.12490
Subject(s) - medicine , human chorionic gonadotropin , fetus , pregnancy , obstetrics , gestation , gestational age , pregnancy associated plasma protein a , gonadotropin , endocrinology , andrology , first trimester , hormone , biology , genetics
Aim The aim of this work was to assess the risk of early fetal loss (first trimester of pregnancy, 8–13 weeks of gestation) using the results of first‐trimester screening ( FTS ) biochemical markers independently and combined. Methods FTS results of 152 women who suffered early fetal loss were compared to a control group of 150 women with normal pregnancy outcomes. FTS biochemical markers were measured with a D elfia X press 6000 analyzer and biochemical risks for D own's and E dward's syndromes were calculated using P renatal‐ L ifecycle version 3.0 software. Marker levels were standardized by calculating the gestational‐specific multiple of the medians ( MoM ), further adjusted by maternal age, maternal weight, cigarette consumption and pre‐existing type 1 diabetes mellitus. Receiver–operator curves were built to evaluate each marker and its combination. Results Our results show that values of biochemical risk of t21 of more than 1 in 310 have a poor sensitivity to predict early fetal loss (31.4%) with a positive predictive value ( PPV ) for fetal loss of 67.7%. Values of pregnancy‐associated plasma protein A ( PAPP‐A) MoM of less than 0.48 show a sensitivity of 62.1% and a PPV of 84.5% for early fetal loss; whereas for free β‐human chorionic gonadotropin, values of MoM of less than 0.44 have a sensitivity of 66.4% with a PPV of 85.3%. A novel algorithm, consisting in the multiplication of both markers, shows for values of less than 0.48 a sensitivity of 83.1%, a specificity of 78.7% and a PPV of 77.1%. Conclusion Combined analysis of PAPP‐A and free β‐ hCG appears to be a potential candidate to predict early fetal loss.