Correlation of Second-Trimester Sonographic and Biochemical Markers

Abstract

Objectives. To investigate correlations between sonographic soft markers and biochemical markers (human chorionic gonadotrophin, α-fetoprotein, and estriol) for Down syndrome in the second trimester of pregnancy. Methods. A total of 2183 women with apparently normal singleton fetuses who underwent second-trimester sonography (14-22 weeks) and maternal serum biochemical testing (triple test) were identified. Seven sonographic markers were recorded: nuchal fold thickness, humerus length, femur length, renal pyelectasis, hyperechoic bowel, echogenic intracardiac focus, and choroid plexus cysts. Results. Weak negative but statistically significant correlations were observed between human chorionic gonadotropin (multiples of the median) and both femur length (multiples of the median; Spearman ρ = -0.073; P < .01) and humerus length (multiples of the median; Spearman ρ = -0.083; P < .01). No other correlations significant at the 1% level were observed between femur length (multiples of the median) or humerus length (multiples of the median) and the biochemical markers. There were no significant correlations between nuchal fold thickness and any of the 3 biochemical markers. At the 5% (P < .05) level, the median human chorionic gonadotropin level (multiples of the median) was lower when an echogenic intracardiac focus was detected. Hyperechoic bowel also tended to be associated with higher median human chorionic gonadotropin (multiples of the median) and α-fetoprotein (multiples of the median) levels (P < .05). Conclusions. We found that sonographic and biochemical markers for trisomy 21 are largely independent in unaffected pregnancies. For accurate risk estimation, correlations in both affected and unaffected pregnancies need to be considered. No or minimal correlation between sonographic markers and serum screening tests indicates that they can be used as independent modifiers of the maternal age-specific risk for Down syndrome.

Antenatal Antidepressant Prescription Associated With Reduced Fetal Femur Length but Not Estimated Fetal Weight

“…49,50 This pathway may also include chorionic gonadotropin, 51 the concentrations of which have been negatively associated with femur and humerus length. 52 Therefore, we may hypothesize that femur length differences may be associated with elevated maternal distress, although both groups may have been exposed to maternal distress. The lack of symptom rating scales data does not allow to test this hypothesis.…”

“…Prenatal cortisol levels have been associated with maternal distress underlying unfavorable developmental outcomes 49,50 . This pathway may also include chorionic gonadotropin, 51 the concentrations of which have been negatively associated with femur and humerus length 52 . Therefore, we may hypothesize that femur length differences may be associated with elevated maternal distress, although both groups may have been exposed to maternal distress.…”

Lack of correlation between elevated maternal serum hCG during second‐trimester biochemical screening and fetal congenital anomaly

“…Whether the presence of sonographic 'soft markers' in association with an isolated elevation of MShCG substantially increases Down syndrome risk remains to be determined. It has been demonstrated that MShCG and sonographic 'soft markers' are independent modifiers of Down syndrome risk (Souter et al, 2004), but only limited information on population-based studies to determine the screening efficacy of this approach have been reported to date.…”

Inpatients Disease and Trends

“…The congenital anomaly hospitalization significantly decreased among children, but the prematurity or condition from the perinatal periods did not decrease. The decrease in congenital anomaly may be related to the active screening program or more advanced ultrasound for congenital anomalies in recently [7,8]. In Taiwan, amniocentesis has been encouraged for pregnant women aged ≥ 35 years.…”