Multiple marker second trimester serum screening for pre-eclampsia

Abstract

Inhibin A, free beta-hCG, and uE3 in combination may be a useful screening test during the second trimester for pre-eclampsia.

Is unexplained elevated maternal serum alpha-fetoprotein still important predictor for adverse pregnancy outcome?

“…The most effective thresholds were 2.0 multiples of the median (MoM) for alpha-fetoprotein (AFP) resulting in a positive likelihood ratio (LR) of 2.36 and a negative likelihood ratio of 0.96 [15]. On the other hand Davidson, Kang and Wald did not find any significant increase in MSAFP levels in preeclamptic women [8,16,17]. We found no significant difference in the rate of preeclampsia between the groups.…”

Pregnancy characteristics and maternal breast cancer risk: a review of the epidemiologic literature

“…Women with pre-eclampsia or only PIH may have altered levels of hormonal factors, such as elevated androgens [22, 23, 36, 37], HCG [31, 38] or AFP [74–76], compared to women with uncomplicated pregnancies.…”

“…However, studies of the associations between maternal estriol and/or estradiol with preeclampsia/PIH have been inconsistent, with several studies reporting no association [21–23, 35, 37, 87–90]. Other hormonal factors found to be altered in preeclamptic pregnancies include higher levels of progesterone [21, 31, 35], androgens [22, 23, 36, 37], and HCG [31, 38]. Lower levels of maternal IGF-I may also play a role [31], but studies of maternal serum IGF-I and preeclampsia/PIH are also inconsistent and associations may depend on severity and/or length of gestation [27, 28, 91–95].…”

“…Lower levels of maternal IGF-I may also play a role [31], but studies of maternal serum IGF-I and preeclampsia/PIH are also inconsistent and associations may depend on severity and/or length of gestation [27, 28, 91–95]. AFP may be elevated in women with preeclamp-sia/PIH, though findings again are inconsistent [38, 74–76]. Finally, given the role of angiogenesis in tumor growth and metastasis [96], a novel biological hypothesis recently proposed [39, 97, 98], is that the antiangiogenic profile [high levels of antiangiogenic factors (e.g., soluble fms-like tyrosine kinase-1 and soluble endoglin) and low levels of proangiogenic factors (e.g., placental growth factor)], which characterizes preeclampsia [99, 100], may help explain the protective effect on later breast cancer.…”

“…These hormonal factors have been implicated in breast cancer etiology and have been proposed to mediate the associations between pregnancy characteristics and maternal breast cancer risk [16, 17, 29–32]. For example, women who deliver twins appear to have increased levels of progesterone and HCG during pregnancy [25, 33, 34] compared to women who deliver singletons, while preeclamptic pregnancies are characterized by higher levels of progesterone [21, 31, 35], androgens [22, 23, 36, 37], and HCG [31, 38]. …”