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Acta Obstétrica e Ginecológica Portuguesa
versión impresa ISSN 1646-5830
Resumen
MIRANDA, Alexandra; AZEVEDO, Cátia; CADILHE, Alexandra y REIS, Isabel. Association between biochemical screening for fetal aneuploidy in the first trimester and adverse obstetric outcomes. Acta Obstet Ginecol Port [online]. 2017, vol.11, n.1, pp.12-20. ISSN 1646-5830.
Overview: The first trimester screening for fetal aneuploidy includes a combined evaluation of maternal age, obstetric history, ultrasound and biochemical markers. Variations in maternal serum levels of biochemical markers (free b-hCG and PAPP-A) have been associated with adverse obstetric outcomes, even in the absence of aneuploidy. This study aimed to evaluate the association of PAPP-A and free b-hCG with the occurrence of adverse obstetric outcomes, in an obstetric population with negative first trimester screening for chromosomal abnormalities. Study design: Observational, descriptive, analytic and retrospective study that included 1128 pregnancies with a negative first trimester screening, in 2013. Delivery occurred in our Hospital. Methods: The levels of both biochemical markers (free b-hCG and PAPP-A) were compared between groups with a given adverse obstetric outcome and women without any adverse event. Binary logistic regression and multiple linear regression analysis were performed to determine if free b-hCG and PAPP-A were important predictors for adverse outcomes. Results: Maternal serum levels of PAPP-A were significantly lower in women who developed pre-eclampsia compared to women without any adverse obstetric outcome (0.98±0.2 vs. 1.18±0.63 MoM; p=0.027). Maternal serum free b-hCG was significantly lower in pregnant women who had birth before 37 weeks of gestation, compared to pregnant women with a term birth (median; interquartile range: 0.78; 0.39 vs.0.94; 0.75 MoM; p=0.037). Linear regression analysis showed that PAPP-A is an independent predictor of fetal birth weight and that free b- hCG is a predictor of fetal gestational age at birth. Conclusion: Serum PAPP-A and free â-hCG in the first trimester are significantly reduced in pregnancies, with a negative first trimester combined screening for fetal aneuploidy, who developed pre-eclampsia and had a preterm delivery, respectively. In these populations, for a better risk assessment, we suggest to perform pre-eclampsia and preterm labour screening.
Palabras clave : First trimester screening; Pregnancy-associated placental protein A (PAPP-A); Free b-human chorionic gonadotropin (free b-hCG); Pre-eclampsia; Preterm delivery.