First-Trimester Screening for Trisomies 21 and 18

Abstract

Although heavy alcohol use over an extended time is known to impair fetal growth, the effects, if any, of light or moderate consumption are not clear. This study examined drinking patterns on term small-for-gestational-age (SGA) births, with particular attention to binge drinking in the 3 months before pregnancy and the last 3 months of pregnancy. Data on 50,461 women who delivered singleton full-term infants (37-42 weeks gestation) were obtained from the Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Questionnaires were mailed 2 to 6 months after delivery, and nonrespondents were interviewed by phone. The study population was predominantly white, 18 to 34 years of age, had 12 or more years of education, was married, and did not smoke in late pregnancy. Light drinkers took 3 or fewer drinks in an average week, whereas moderate consumption was defined as 4 to 13 drinks and heavy drinking as 14 or more drinks per week on average. Binging was defined as taking 5 or more drinks in one sitting. Close to half the women reported drinking just before pregnancy, 94% of them at a light level. In the last trimester, fewer than 1% of all women and 18% of heavy drinkers binged. SGA births were more common in moderate or heavy prepregnancy drinkers than in light drinkers or nondrinkers. No such association was evident, however, for drinking in the last trimester. Although women who binged at either time were not significantly likelier to deliver an SGA infant, those binging in late pregnancy were 20% more likely to do so. After adjusting for confounding variables, women who were light or moderate drinkers before pregnancy were somewhat less likely to deliver an SGA infant, although the difference was not significant. Women who drank lightly or moderately in late pregnancy were not prone to have an SGA birth. At all levels of alcohol use the risk of an SGA birth was greater for bingers, but this was significant only for heavy drinkers. The lower risk of SGA birth found in some women who drink might be related to vascular effects of alcohol, or to dietary differences between women who drink before pregnancy or in late pregnancy and those who do not. A prospective study would clarify the observations made in this population of parturients. ABSTRACTVaginal bleeding in early pregnancy could be mistaken for menstruation, and it could lead to errors in estimating gestational age, especially in pregnancies that end in miscarriage. This prospective study examined patterns of vaginal bleeding in 151 healthy women whose pregnancies lasted at least 6 weeks beyond the last menstrual period (LMP). The participants collected daily urine samples that were assayed for human chorionic gonadotropin and kept a diary of vaginal bleeding as well as sexual intercourse. Early vaginal bleeding was defined as bleeding lasting a day or longer between conception and follow up, which extended through week 8 after the LMP in nearly all cases. Early vaginal bleeding was described by 9% of women. Typically, it was light and required only 1 or 2 ...

Fetal aneuploidy screening practice in Flanders and Belgium

“…These figures were similar to the results reported from other multicentre studies [19,21,22]. This finding clearly illustrates an advantage of multiple parameter screening algorithms over single or dual parameter algorithms, as already discussed above.…”

Specific detection of type II human chorionic gonadotropin beta subunit produced by trophoblastic and neoplastic cells

“…The measurement of hCG protein or its variants is important for monitoring pregnancy, for prenatal screening for Down syndrome and for the diagnosis or follow-up of tumors [29,30]. Type I hCGβ is preferentially expressed by cells of nontrophoblastic origin, whereas trophoblastic and malignant nontrophoblastic tissues also express type II hCGβ.…”

Épaisseur de la clarté nucale A 11–14SA : courbes et équations françaises

“…Pour permettre un calcul de risque adéquat, différents auteurs ont déve-loppé des méthodes permettant d'exprimer la mesure en multiples (Mom) ou en différence (Delta) [12] par rapport à la médiane attendue pour l'âge gestationnel. À cette valeur en MoM ou en Delta, est rattaché un coefficient de vraisemblance qui modifie le risque initial de la femme [6][7][8][9]. Ces méthodes permettent d'harmoniser les calculs de risque d'aneuploïdie.…”

“…Aujourd'hui, le dépistage de la trisomie 21 basée sur une combinaison de l'âge maternel, de la mesure de la CN et des marqueurs sériques maternels du premier trimestre (freeˇ-human chorionic gonadotropin [␤-hCG] et pregnancy-associated plasma protein-A [PAPP-A]) entre 11 + 0 et 13 + 6 SA représente la méthode de choix à proposer aux femmes [2]. Cette stratégie, proposée par Nicolaides et al avec les one-stop clinic for assessment of risk (Oscar) [6] a confirmée ses bons résultats dans de nombreuses études (BUN [7], SURUSS [8] et FASTER [9]). Son principe est aujourd'hui largement diffusée en France conformément aux dernières recommandations, en particulier de la HAS [2,10].…”