"Surveillance of Adverse Pregnancy Outcomes and their Causes: Theoretical Considerations"

Abstract

Causes of common Adverse Pregnancy Outcomes (APOs), such as prematurity, fetal demise, and growth restriction, are worth addressing collectively as often non-specific apogens (from the Greek apó [ἀπό] = away from, and génos [γένος] = giving birth to). A rationale is presented for using population distributions of maternal serum markers, such as alpha-fetoprotein from neural tube defect detection programs, for apogen screening. Abnormal distributions can indicate APO risks prior to clinical findings, with skewed distributions with adverse exposures. Temporal or spatial controls are available for widespread effects, and unexposed controls for limited exposures. Alternatively, with apogen related marker skewing, pregnancies with abnormal marker level should be "enriched" for exposures to both known and otherwise unsuspected factors.