Top

Published in:

01-09-2015 | Maternal-Fetal Medicine

Introduction of a nomogram for predicting adverse pregnancy outcomes based on maternal serum markers in the quad screen test

Authors: Jung-Joo An, Hyun-Young Ji, Ji Yeon You, Sook-Young Woo, Suk-Joo Choi, Soo-young Oh, Cheong-Rae Roh, Jong-Hwa Kim

Published in: Archives of Gynecology and Obstetrics | Issue 3/2015

Abstract

Purpose

The aim of this study was to develop a nomogram that can calculate a total score, derived from each serum marker in the quad screen test, for systematically predicting adverse pregnancy outcomes (APOs).

Methods

We retrospectively reviewed 3684 singleton pregnant women who underwent a quad screen test and gave birth at a single medical centre from January 2005 to December 2010. The serum marker data from the quad screen test and pregnancy outcomes were used to construct logistic regression models for predicting the risks of APOs. APO was defined as the presence of at least one of the following: preeclampsia, preterm delivery before 34 weeks of gestation, small for gestational age, foetal loss, and foetal demise. A graphic nomogram was generated to represent the scoring model using the regression coefficient of each serum marker.

Results

A nomogram for the prediction of APOs using each serum marker in the quad test was developed based on the logistic regression analysis. The positive predictive values for the subsequent development of an APO were ascended stepwise as the calculated score increases. The area under the receiver operating characteristic curve of this score for the prediction of APO was 0.596 (95 % confidence interval 0.569–0.623).

Conclusions

We here introduced a nomogram for stratifying the risk of APOs in patients with abnormal serum markers in the quad screen test. Although the validity of the nomogram is too weak to be used in clinical routine, but it may provide additional information for practitioners counselling pregnant women and for predicting APOs.

Wald NJ, Rodeck C, Hackshaw AK, Rudnicka A (2004) SURUSS in perspective. BJOG 111:521–531PubMedCrossRef

Committee on Educational Bulletins of the American College of Obstetricians and Gynecologists (1996) ACOG educational bulletin. Maternal serum screening. Number 228, September 1996 (replaces No. 154, April 1991). Int J Gynaecol Obstet 55:299–308CrossRef

ACOG Committee on Practice Bulletins (2007) ACOG Practice Bulletin No. 77: screening for fetal chromosomal abnormalities. Obstet Gynecol 109:217–227CrossRef

Kowalczyk TD, Cabaniss ML, Cusmano L (1998) Association of low unconjugated estriol in the second trimester and adverse pregnancy outcome. Obstet Gynecol 91:396–400PubMedCrossRef

Simpson JL, Palomaki GE, Mercer B, Haddow JE, Andersen R, Sibai B, Elias S (1995) Associations between adverse perinatal outcome and serially obtained second- and third-trimester maternal serum alpha-fetoprotein measurements. Am J Obstet Gynecol 173:1742–1748PubMedCrossRef

Dugoff L (2010) First- and second-trimester maternal serum markers for aneuploidy and adverse obstetric outcomes. Obstet Gynecol 115:1052–1061PubMedCrossRef

Bartha JL, Romero-Carmona R, Escobar-Llompart M, Paloma-Castro O, Comino-Delgado R (2003) Human chorionic gonadotropin and vascular endothelial growth factor in normal and complicated pregnancies. Obstet Gynecol 102:995–999PubMedCrossRef

Dugoff L, Hobbins JC, Malone FD, Vidaver J, Sullivan L, Canick JA, Lambert-Messerlian GM, Porter TF, Luthy DA, Comstock 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. Obstet Gynecol 106:260–267PubMedCrossRef

Krause TG, Christens P, Wohlfahrt J, Lei U, Westergaard T, Norgaard-Pedersen B, Melbye M (2001) Second-trimester maternal serum alpha-fetoprotein and risk of adverse pregnancy outcome. Obstet Gynecol 97:277–282PubMedCrossRef

10.

Waller DK, Lustig LS, Cunningham GC, Golbus MS, Hook EB (1991) Second-trimester maternal serum alpha-fetoprotein levels and the risk of subsequent fetal death. N Engl J Med 325:6–10PubMedCrossRef

11.

Puntachai P, Wanapirak C, Sirichotiyakul S, Tongprasert F, Srisupundit K, Luewan S, Traisrisilp K, Tongsong T (2014) Associations between pregnancy outcomes and unexplained high and low maternal serum alpha-fetoprotein levels. Arch Gynecol Obstet. doi:10.1007/s00404-014-3606-9

12.

Chandra S, Scott H, Dodds L, Watts C, Blight C, Van Den Hof M (2003) Unexplained elevated maternal serum alpha-fetoprotein and/or human chorionic gonadotropin and the risk of adverse outcomes. Am J Obstet Gynecol 189:775–781PubMedCrossRef

13.

Cho SE, Shin YJ, Kim HJ, Ji HY, Kwak HM, Cha HH, Choi SJ, Oh SY, Lee SY, Roh CR, Kim JH (2011) Second trimester maternal serum marker and adverse pregnancy outcome. Korean J Obstet Gynecol 54:651–658CrossRef

14.

Bromley B, Frigoletto FD Jr, Harlow BL, Pauker S, Benacerraf BR (1994) The role of Doppler velocimetry in the structurally normal second-trimester fetus with elevated levels of maternal serum alpha-fetoprotein. Ultrasound Obstet Gynecol 4:377–380PubMedCrossRef

15.

Dugoff L, Cuckle HS, Hobbins JC, Malone FD, Belfort MA, Nyberg DA, Comstock CH, Saade GR, 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. Am J Obstet Gynecol 199:290.e1–290.e6CrossRef

16.

Toal M, Chaddha V, Windrim R, Kingdom J (2008) Ultrasound detection of placental insufficiency in women with elevated second trimester serum alpha-fetoprotein or human chorionic gonadotropin. J Obstet Gynaecol Can 30:198–206PubMed

17.

Aquilina J, Thompson O, Thilaganathan B, Harrington K (2001) Improved early prediction of pre-eclampsia by combining second-trimester maternal serum inhibin-A and uterine artery Doppler. Ultrasound Obstet Gynecol 17:477–484PubMedCrossRef

18.

Salafia CM, Silberman L, Herrera NE, Mahoney MJ (1988) Placental pathology at term associated with elevated midtrimester maternal serum alpha-fetoprotein concentration. Am J Obstet Gynecol 158:1064–1066PubMedCrossRef

19.

Fox H (1970) Effect of hypoxia on trophoblast in organ culture. A morphologic and autoradiographic study. Am J Obstet Gynecol 107:1058–1064PubMed

20.

Florio P, Cobellis L, Luisi S, Ciarmela P, Severi FM, Bocchi C, Petraglia F (2001) Changes in inhibins and activin secretion in healthy and pathological pregnancies. Mol Cell Endocrinol 180:123–130PubMedCrossRef

21.

Florio P, Luisi S, Ciarmela P, Severi FM, Bocchi C, Petraglia F (2004) Inhibins and activins in pregnancy. Mol Cell Endocrinol 225:93–100PubMedCrossRef

22.

Eastham JA, Kattan MW, Scardino PT (2002) Nomograms as predictive models. Semin Urol Oncol 20:108–115PubMedCrossRef

23.

Allouche M, Huissoud C, Guyard-Boileau B, Rouzier R, Parant O (2011) Development and validation of nomograms for predicting preterm delivery. Am J Obstet Gynecol 204:242.e1–242.e8CrossRef

24.

Brown MA, Lindheimer MD, de Swiet M, Van Assche A, Moutquin JM (2001) The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens Pregnancy 20(1):IX–XIVPubMedCrossRef

25.

Bradley Efron B (1986) How biased is the apparent error rate of a prediciton rule? J Am Stat Assoc 82:461–470CrossRef

26.

Harrell FE (2001) Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. Springer, New York, p 251CrossRef

27.

Kwon JY, Park IY, Kwon SM, Kim CJ, Shin JC (2012) The quadruple test for Down syndrome screening in pregnant women of advanced maternal age. Arch Gynecol Obstet 285(3):629–633PubMedCrossRef

28.

Gagnon A, Wilson RD, Audibert F, Allen VM, Blight C, Brock JA, Desilets VA, Johnson JA, Langlois S, Summers A, Wyatt P (2008) Obstetrical complications associated with abnormal maternal serum markers analytes. J Obstet Gynaecol Can 30:918–949PubMed

29.

Poon LC, Nicolaides KH (2014) Early prediction of preeclampsia. Obstet Gynecol Int. doi:10.1155/2014/297397 PubMedCentralPubMed

30.

Kim YJ (2013) Pathogenesis and promising non-invasive markers for preeclampsia. Obstet Gynecol Sci 56:2–7PubMedCentralPubMedCrossRef

31.

Sayin NC, Canda MT, Ahmet N, Arda S, Süt N, Varol FG (2008) The association of triple-marker test results with adverse pregnancy outcomes in low-risk pregnancies with healthy newborns. Arch Gynecol Obstet 277:47–53PubMedCrossRef

Title: Introduction of a nomogram for predicting adverse pregnancy outcomes based on maternal serum markers in the quad screen test
Authors: Jung-Joo An
Hyun-Young Ji
Ji Yeon You
Sook-Young Woo
Suk-Joo Choi
Soo-young Oh
Cheong-Rae Roh
Jong-Hwa Kim
Publication date: 01-09-2015
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 3/2015
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-015-3685-2

At a glance: The STEP trials

Springer Medicine

Introduction of a nomogram for predicting adverse pregnancy outcomes based on maternal serum markers in the quad screen test

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2015

Uptake of non-invasive prenatal testing (NIPT) and impact on invasive procedures in a tertiary referral center

Identification of biological processes and genes for gestational diabetes mellitus

Association between osteocalcin and metabolic syndrome in postmenopausal women

Risk factors predicting an emergency cesarean delivery for the second twin after vaginal delivery of the first twin

Conflicting umbilical artery Doppler findings in fetuses with trisomy 21

Levator avulsion is not associated with symptom bother of female pelvic organ prolapse