Quad screen as a predictor of adverse pregnancy outcome

Lorraine Dugoff, John C. Hobbins, Fergal D. Malone, John Vidaver, Lisa Sullivan, Jacob A. Canick, Geralyn M. Lambert-Messerlian, T. Flint Porter, David A. Luthy, Christine H. Comstoch, George Saade, Keith Eddleman, Irwin R. Merkatz, Sabrina D. Craigo, Ilan E. Timor-Tritsch, Stephen R. Carr, Honor M. Wolfe, Mary E. D'Alton

Research output: Contribution to journalArticle

154 Citations (Scopus)

Abstract

Objective: To estimate the effect of second-trimester levels of maternal serum alpha-fetoprotein (AFP), human chorionic gonadotrophin (hCG), unconjugated estriol (uE3), and inhibin A (the quad screen) on obstetric complications by using a large, prospectively collected database (the FASTER database). Methods: The FASTER trial was a multicenter study that evaluated first- and second-trimester screening programs for aneuploidy in women with singleton pregnancies. As part of this trial, patients had a quad screen drawn at 15-18 6/7 weeks. We analyzed the data to identify associations between the quad screen markers and preterm birth, intrauterine growth restriction, preeclampsia, and fetal loss. Our analysis was performed by evaluating the performance characteristics of quad screen markers individually and in combination. Crude and adjusted effects were estimated by multivariable logistic regression analysis. Patients with fetal anomalies were excluded from the analysis. Results: We analyzed data from 33,145 pregnancies. We identified numerous associations between the markers and the adverse outcomes. There was a relatively low, but often significant, risk of having an adverse pregnancy complication if a patient had a single abnormal marker. However, the risk of having an adverse outcome increased significantly if a patient had 2 or more abnormal markers. The sensitivity and positive predictive values using combinations of markers is relatively low, although superior to using individual markers. Conclusion: These data suggest that components of the quad screen may prove useful in predicting adverse obstetric outcomes. We also showed that the total number and specific combinations of abnormal markers are most useful in predicting the risk of adverse perinatal outcome.

Original languageEnglish (US)
Pages (from-to)260-267
Number of pages8
JournalObstetrics and Gynecology
Volume106
Issue number2
StatePublished - Aug 2005
Externally publishedYes

Fingerprint

Pregnancy Outcome
Second Pregnancy Trimester
Obstetrics
Databases
Pregnancy
Estriol
Pregnancy Complications
Premature Birth
alpha-Fetoproteins
Aneuploidy
Chorionic Gonadotropin
First Pregnancy Trimester
Pre-Eclampsia
Multicenter Studies
Logistic Models
Regression Analysis
Mothers
Elvitegravir, Cobicistat, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination
Growth
Serum

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Dugoff, L., Hobbins, J. C., Malone, F. D., Vidaver, J., Sullivan, L., Canick, J. A., ... D'Alton, M. E. (2005). Quad screen as a predictor of adverse pregnancy outcome. Obstetrics and Gynecology, 106(2), 260-267.

Quad screen as a predictor of adverse pregnancy outcome. / Dugoff, Lorraine; Hobbins, John C.; Malone, Fergal D.; Vidaver, John; Sullivan, Lisa; Canick, Jacob A.; Lambert-Messerlian, Geralyn M.; Porter, T. Flint; Luthy, David A.; Comstoch, Christine H.; Saade, George; Eddleman, Keith; Merkatz, Irwin R.; Craigo, Sabrina D.; Timor-Tritsch, Ilan E.; Carr, Stephen R.; Wolfe, Honor M.; D'Alton, Mary E.

In: Obstetrics and Gynecology, Vol. 106, No. 2, 08.2005, p. 260-267.

Research output: Contribution to journalArticle

Dugoff, L, Hobbins, JC, Malone, FD, Vidaver, J, Sullivan, L, Canick, JA, Lambert-Messerlian, GM, Porter, TF, Luthy, DA, Comstoch, CH, Saade, G, Eddleman, K, Merkatz, IR, Craigo, SD, Timor-Tritsch, IE, Carr, SR, Wolfe, HM & D'Alton, ME 2005, 'Quad screen as a predictor of adverse pregnancy outcome', Obstetrics and Gynecology, vol. 106, no. 2, pp. 260-267.
Dugoff L, Hobbins JC, Malone FD, Vidaver J, Sullivan L, Canick JA et al. Quad screen as a predictor of adverse pregnancy outcome. Obstetrics and Gynecology. 2005 Aug;106(2):260-267.
Dugoff, Lorraine ; Hobbins, John C. ; Malone, Fergal D. ; Vidaver, John ; Sullivan, Lisa ; Canick, Jacob A. ; Lambert-Messerlian, Geralyn M. ; Porter, T. Flint ; Luthy, David A. ; Comstoch, Christine H. ; Saade, George ; Eddleman, Keith ; Merkatz, Irwin R. ; Craigo, Sabrina D. ; Timor-Tritsch, Ilan E. ; Carr, Stephen R. ; Wolfe, Honor M. ; D'Alton, Mary E. / Quad screen as a predictor of adverse pregnancy outcome. In: Obstetrics and Gynecology. 2005 ; Vol. 106, No. 2. pp. 260-267.
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AU - Dugoff, Lorraine

AU - Hobbins, John C.

AU - Malone, Fergal D.

AU - Vidaver, John

AU - Sullivan, Lisa

AU - Canick, Jacob A.

AU - Lambert-Messerlian, Geralyn M.

AU - Porter, T. Flint

AU - Luthy, David A.

AU - Comstoch, Christine H.

AU - Saade, George

AU - Eddleman, Keith

AU - Merkatz, Irwin R.

AU - Craigo, Sabrina D.

AU - Timor-Tritsch, Ilan E.

AU - Carr, Stephen R.

AU - Wolfe, Honor M.

AU - D'Alton, Mary E.

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N2 - Objective: To estimate the effect of second-trimester levels of maternal serum alpha-fetoprotein (AFP), human chorionic gonadotrophin (hCG), unconjugated estriol (uE3), and inhibin A (the quad screen) on obstetric complications by using a large, prospectively collected database (the FASTER database). Methods: The FASTER trial was a multicenter study that evaluated first- and second-trimester screening programs for aneuploidy in women with singleton pregnancies. As part of this trial, patients had a quad screen drawn at 15-18 6/7 weeks. We analyzed the data to identify associations between the quad screen markers and preterm birth, intrauterine growth restriction, preeclampsia, and fetal loss. Our analysis was performed by evaluating the performance characteristics of quad screen markers individually and in combination. Crude and adjusted effects were estimated by multivariable logistic regression analysis. Patients with fetal anomalies were excluded from the analysis. Results: We analyzed data from 33,145 pregnancies. We identified numerous associations between the markers and the adverse outcomes. There was a relatively low, but often significant, risk of having an adverse pregnancy complication if a patient had a single abnormal marker. However, the risk of having an adverse outcome increased significantly if a patient had 2 or more abnormal markers. The sensitivity and positive predictive values using combinations of markers is relatively low, although superior to using individual markers. Conclusion: These data suggest that components of the quad screen may prove useful in predicting adverse obstetric outcomes. We also showed that the total number and specific combinations of abnormal markers are most useful in predicting the risk of adverse perinatal outcome.

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