Prediction of patient-specific risk for fetal loss using maternal characteristics and first- and second-trimester maternal serum Down syndrome markers

Lorraine Dugoff, Howard S. Cuckle, John C. Hobbins, Fergal D. Malone, Michael A. Belfort, David A. Nyberg, Christine H. Comstock, George Saade, Keith A. Eddleman, Peer Dar, Sabrina D. Craigo, Ilan E. Timor-Tritsch, Steven R. Carr, Honor M. Wolfe, Mary E. D'Alton

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Objective: To develop and evaluate a method of estimating patient-specific risk for fetal loss by combining maternal characteristics with serum markers. Study Design: Data were obtained on 36,014 women from the FaSTER trial. Separate likelihood ratios were estimated for significant maternal characteristics and serum markers. Patient-specific risk was calculated by multiplying the incidence of fetal loss by the likelihood ratios for each maternal characteristic and for different serum marker combinations. Results: Three hundred eighteen women had fetal loss < 24 weeks (early) and 103 > 24 weeks (late). Clinical characteristics evaluated included maternal age, body mass index, race, parity, threatened abortion, previous preterm delivery, and previous early loss. Serum markers studied as possible predictors of early loss included first-trimester pregnancy-associated plasma protein A and second-trimester alpha-fetoprotein, and unconjugated estriol. A risk assessment for early loss based on all of these factors yielded a 46% detection rate, for a fixed 10% false-positive rate, 39% for 5% and 28% for 1%. The only significant marker for late loss was inhibin A. The detection rate was 27% for a fixed 10% false-positive rate and only increased slightly when clinical characteristics were added to the model. Conclusion: Patient-specific risk assessment for early fetal loss using serum markers, with or without maternal characteristics, has a moderately high detection. Patient-specific risk assessment for late fetal loss has low detection rates.

Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
Volume199
Issue number3
DOIs
StatePublished - Sep 2008

Fingerprint

Second Pregnancy Trimester
First Pregnancy Trimester
Down Syndrome
Biomarkers
Mothers
Serum
Threatened Abortion
Pregnancy-Associated Plasma Protein-A
Estriol
Maternal Age
alpha-Fetoproteins
Parity
Body Mass Index
Incidence

Keywords

  • alpha-fetoprotein
  • fetal loss
  • inhibin A
  • pregnancy-associated plasma protein A
  • unconjugated estriol

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Prediction of patient-specific risk for fetal loss using maternal characteristics and first- and second-trimester maternal serum Down syndrome markers. / Dugoff, Lorraine; Cuckle, Howard S.; Hobbins, John C.; Malone, Fergal D.; Belfort, Michael A.; Nyberg, David A.; Comstock, Christine H.; Saade, George; Eddleman, Keith A.; Dar, Peer; Craigo, Sabrina D.; Timor-Tritsch, Ilan E.; Carr, Steven R.; Wolfe, Honor M.; D'Alton, Mary E.

In: American Journal of Obstetrics and Gynecology, Vol. 199, No. 3, 09.2008.

Research output: Contribution to journalArticle

Dugoff, L, Cuckle, HS, Hobbins, JC, Malone, FD, Belfort, MA, Nyberg, DA, Comstock, CH, Saade, G, Eddleman, KA, Dar, P, Craigo, SD, Timor-Tritsch, IE, Carr, SR, Wolfe, HM & D'Alton, ME 2008, 'Prediction of patient-specific risk for fetal loss using maternal characteristics and first- and second-trimester maternal serum Down syndrome markers', American Journal of Obstetrics and Gynecology, vol. 199, no. 3. https://doi.org/10.1016/j.ajog.2008.06.099
Dugoff, Lorraine ; Cuckle, Howard S. ; Hobbins, John C. ; Malone, Fergal D. ; Belfort, Michael A. ; Nyberg, David A. ; Comstock, Christine H. ; Saade, George ; Eddleman, Keith A. ; Dar, Peer ; Craigo, Sabrina D. ; Timor-Tritsch, Ilan E. ; Carr, Steven R. ; Wolfe, Honor M. ; D'Alton, Mary E. / Prediction of patient-specific risk for fetal loss using maternal characteristics and first- and second-trimester maternal serum Down syndrome markers. In: American Journal of Obstetrics and Gynecology. 2008 ; Vol. 199, No. 3.
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abstract = "Objective: To develop and evaluate a method of estimating patient-specific risk for fetal loss by combining maternal characteristics with serum markers. Study Design: Data were obtained on 36,014 women from the FaSTER trial. Separate likelihood ratios were estimated for significant maternal characteristics and serum markers. Patient-specific risk was calculated by multiplying the incidence of fetal loss by the likelihood ratios for each maternal characteristic and for different serum marker combinations. Results: Three hundred eighteen women had fetal loss < 24 weeks (early) and 103 > 24 weeks (late). Clinical characteristics evaluated included maternal age, body mass index, race, parity, threatened abortion, previous preterm delivery, and previous early loss. Serum markers studied as possible predictors of early loss included first-trimester pregnancy-associated plasma protein A and second-trimester alpha-fetoprotein, and unconjugated estriol. A risk assessment for early loss based on all of these factors yielded a 46{\%} detection rate, for a fixed 10{\%} false-positive rate, 39{\%} for 5{\%} and 28{\%} for 1{\%}. The only significant marker for late loss was inhibin A. The detection rate was 27{\%} for a fixed 10{\%} false-positive rate and only increased slightly when clinical characteristics were added to the model. Conclusion: Patient-specific risk assessment for early fetal loss using serum markers, with or without maternal characteristics, has a moderately high detection. Patient-specific risk assessment for late fetal loss has low detection rates.",
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AU - Malone, Fergal D.

AU - Belfort, Michael A.

AU - Nyberg, David A.

AU - Comstock, Christine H.

AU - Saade, George

AU - Eddleman, Keith A.

AU - Dar, Peer

AU - Craigo, Sabrina D.

AU - Timor-Tritsch, Ilan E.

AU - Carr, Steven R.

AU - Wolfe, Honor M.

AU - D'Alton, Mary E.

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