Screening in early pregnancy for pre‐eclampsia using down syndrome quadruple test markers

Abstract

Adding screening for pre-eclampsia to an existing Down syndrome screening programme using the Quadruple test markers is simple and worthwhile. It will detect over 40% of pregnancies with pre-eclampsia at an acceptable false-positive rate (about 6%) and with minimal additional costs.

Serum markers for predicting pre-eclampsia

“…The data, however, are contradictory: Several studies documented elevated AFP levels in women with subsequent pre-eclampsia (Audibert et al, 2005;Leung et al, 2000), whereas another investigation found no alteration in AFP levels (Wald et al, 2006). The reported moderate sensitivity of AFP is further limiting the clinical use of this marker.…”

“…Additional measurements of serum markers, performed also in the early second-trimester, would be practically and financially justifiable. It has been noted that, in a sample of pregnant women without pre-eclampsia during a previous pregnancy, the quadruple test markers including AFP, unconjugated estriol, HCG and inhibin A reached a sensitivity of 42% in predicting the onset of pre-eclampsia (Wald et al, 2006). In a prospective case-control study including women at high risk for pre-eclampsia development, serum markers such as leptin, placenta growth factor, the plasminogen activator inhibitor (PAI-1)/PAI-2 ratio, uric acid were measured at 20 weeks of gestation.…”

Establishment of cytochrome P450 3A4 and glutathione S-transferase A1-transfected human hepatoma cell line and functional analysis

“…It is often used as the serum marker of fetal defects and tumors to diagnose disease and to monitor disease progression. AFP can perform a lot of important physiological functions, including binding to and transferring numerous receptors (e.g., bilirubin, drugs), maintaining plasma colloid osmotic pressure (Gillespie and Uversky, 2000), performing bilateral regulatory functions as a growth regulatory factor (Li et al, 2002;Dudich et al, 2006;Oertel et al, 2006;Schnater et al, 2006), serving as a sensitive serum marker of primary liver cancer (Leerapun et al, 2007;Montaser et al, 2007), playing a role in the diagnosis of fetal defects or neonatal diseases (Dashe et al, 2006;Odibo et al, 2006;Rozenberg et al, 2006;Wald et al, 2006), and serving as a prognostic marker of acute hepatic failure (Amemiya et al, 2004;Butterfield, 2007). Therefore, AFP may play a positive role in the treatment of hepatic failure.…”

Uterine artery Doppler and adverse pregnancy outcome in women with extreme levels of fetoplacental proteins used for Down syndrome screening

“…For example, women with extremely low levels of first‐trimester pregnancy‐associated plasma protein‐A (PAPP‐A) have an increased risk of small for gestational age (SGA), late miscarriage, pre‐eclampsia, gestational diabetes, preterm delivery and stillbirth1–7. Similar associations exist for extreme second‐trimester levels of other serum feto‐placental proteins used for Down syndrome screening8–16. Screening women for adverse pregnancy outcome using these fetoplacental proteins however, is limited by the low sensitivity and specificity10, 17–19.…”