Maternal serum biochemical markers as a predictor for adverse pregnancy outcome

ABSTRACT

To establish reference values of assaying some maternal serum biochemical markers, namely; MSAFP. MSHCG, uE3 and PAPP-A at 10-20 weeks gestation; among healthy pregnant women and observe the relationship of such markers to predict adverse pregnancy outcome. This is a prospective randomized controlled study conducted in the Obstetrics and Gynecology Departments at AL-Azhar and Cairo University Hospitals during a period of two and half years starting January 2003. Three hundreds healthy pregnant women from those attending the antenatal clinics were participated in this study. Their age ranged between 20-38 years. They all had a spontaneous pregnancy in singleton with gestational age of 10-20 weeks gestation at the time of study. This was confirmed by ultrasonic scanning. Pregnancy outcomes were obtained for all women. The incidence of adverse pregnancy outcome namely miscarnage, preterm delivery, intrauterine growth restriction [IUGR], intrauterine fetal death [IUFD]. pregnancy induced hypertension [PIH] and congenital malformation were evaluated. Blood samples were withdrawn and sera were separated for estimation of levels of maternal serum alpha fetoprotein [MSAFP], unconjugated estriol [uE3], free 3-human chorionic gonadotropin [beta-hCG] and pregnancy associated plasma protein-A [PAPP-A]; using time resolved flouroi mmunoassay technique. Our study showed, unexplained significant elevations of MSAFP and serum 3hCG levels with adverse pregnancy outcome [miscarriage, preterm delivery, IUGR, IUFD]. Low unconjugated estriol levels, was associated with adverse pregnancy outcome except for preterm delivery. Maternal serum levels of PAPP-A were found to be significantly decreased in all adverse pregnancy outcome except in PIH. Combinations of maternal serum markers for prediction of adverse pregnancy outcome were compared. Increased maternal serum AFP and 3hCG were significant only for miscarriage and preterm delivery, whereas increased MSAFP and decreased uE, was significant for all adverse pregnancy outcome except for preterm delivery. Increased levels of MSAFP and decreased levels of PAPP-A was only significant with PIH. Whereas increased levels of beta hCG with decreased uE3 levels was significant for all adverse pregnancy outcome except for preterm delivery and PIH. The combination of increased beta hCG levels and PAPP-A were not significant correlated to adverse pregnancy outcomes. combined maternal serum four markers can be used not only for the detection of fetal structural and chromosomal anomalies but also for early prediction and detection of high risk pregnancies