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Givens M, Valcheva I, Einerson BD, Rogozińska E, Jauniaux E. Evaluation of maternal serum protein biomarkers in the prenatal evaluation of placenta accreta spectrum: A systematic scoping review. Acta Obstet Gynecol Scand 2024. [PMID: 39004916 DOI: 10.1111/aogs.14918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/29/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024]
Abstract
INTRODUCTION Placenta accreta spectrum (PAS) is an increasingly commonly reported condition due to the continuous increase in the rate of cesarean deliveries (CD) worldwide; however, the prenatal screening for pregnant patients at risk of PAS at birth remains limited, in particular when imaging expertise is not available. MATERIAL AND METHODS Two major electronic databases (MEDLINE and Embase) were searched electronically for articles published in English between October 1992 and January 2023 using combinations of the relevant medical subject heading terms and keywords. Two independent reviewers selected observational studies that provided data on one or more measurement of maternal blood-specific biomarker(s) during pregnancies with PAS at birth. PRISMA Extension for Scoping Review (PRISMA-ScR) was used to extract data and report results. RESULTS Of the 441 reviewed articles, 29 met the inclusion criteria reporting on 34 different biomarkers. 14 studies were retrospective and 15 prospective overall including 18 251 participants. Six studies had a cohort design and the remaining a case-control design. Wide clinical heterogeneity was found in the included studies. In eight studies, the samples were obtained in the first trimester; in five, the samples were collected on hospital admission for delivery; and in the rest, the samples were collected during the second and/or third trimester. CONCLUSIONS Measurements of serum biomarkers, some of which have been or are still used in screening for other pregnancy complications, could contribute to the prenatal evaluation of patients at risk of PAS at delivery; however, important evidence gaps were identified for suitable cutoffs for most biomarkers, variability of gestational age at sampling and the potential overlap of the marker values with other placental-related complications of pregnancy.
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Affiliation(s)
- Matthew Givens
- Department of Obstetrics and Gynecology (Drs Givens and Einerson), University of Utah Health (UUH), Salt Lake City, Utah, USA
| | - Ivaila Valcheva
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Brett D Einerson
- Department of Obstetrics and Gynecology (Drs Givens and Einerson), University of Utah Health (UUH), Salt Lake City, Utah, USA
| | - Ewelina Rogozińska
- The EVIdencE Synthesis and Methodology Group for Women's Health Research (EVIE), Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Eric Jauniaux
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
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Affiliation(s)
- K Spencer
- Endocrine Unit, Clinical Biochemistry Department, Oldchurch Hospital, Romford, Essex, UK
| | - E J Coombes
- Chemical Pathology Department, Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | - A S Mallard
- Clinical Chemistry Department, Royal Cornwall Hospital, Truro, Cornwall, UK
| | - A Milford Ward
- Protein Reference Unit, Northern General Hospital, Sheffield, UK
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Kang JH, Farina A, Park JH, Kim SH, Kim JY, Rizzo N, Elmakky A, Jun HS, Hahn WB, Cha DH. Down syndrome biochemical markers and screening for preeclampsia at first and second trimester: correlation with the week of onset and the severity. Prenat Diagn 2008; 28:704-9. [PMID: 18655226 DOI: 10.1002/pd.1997] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To estimate the combined screening performance of first and early second trimester prenatal serum markers for Down syndrome, in screening for the development of preeclampsia, and analyze the correlation among marker levels, week of onset, and severity of the disease. METHODS A retrospective cohort study was carried out on 32 women with preeclampsia and 3044 controls. Serum samples from these pregnancies were assayed for pregnancy-associated plasma protein-A (PAPP-A), alpha-fetoprotein (AFP), unconjugated estriol (uE3), human chorionic gonadotrophin (hCG), and inhibin-A. A likelihood ratio and the odds of being affected given a positive result (OAPR) of various combinations of markers were calculated and receiver operating characteristic (ROC) curves analysis was performed. RESULTS In the pregnancies that subsequently developed preeclampsia, first trimester PAPP-A concentration was significantly lower and concentrations of early second trimester inhibin-A and hCG significantly elevated. Levels of early second trimester uE3 and AFP were not significantly altered. We also found that inhibin-A correlates with both onset of the disease and the severity. CONCLUSION Down syndrome biochemical markers levels are altered in those patients who subsequently developed preeclampsia and may be a useful screening test for preeclampsia. Inhibin-A is the most predictive marker and correlates with the severity of subsequent preeclampsia and inversely with the week of occurrence of preeclampsia.
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Affiliation(s)
- Jin Hee Kang
- Department of Obstetrics and Gynecology, CHA General Hospital, Pochon CHA University College of Medicine, Seoul, Korea
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Räty R, Koskinen P, Alanen A, Irjala K, Matinlauri I, Ekblad U. Prediction of pre-eclampsia with maternal mid-trimester total renin, inhibin A, AFP and free beta-hCG levels. Prenat Diagn 1999; 19:122-7. [PMID: 10215068 DOI: 10.1002/(sici)1097-0223(199902)19:2<122::aid-pd491>3.0.co;2-r] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We wanted to study if maternal serum mid-trimester total renin, inhibin A, AFP or free beta-hCG levels predict the development of pre-eclampsia. Maternal serum alpha-fetoprotein (AFP) and human chorion gonadotrophin (beta-hCG) were evaluated in the screening programme for Down syndrome in 4356 patients prospectively. Data on pregnancy outcome were available in 1242 women. Pregnancy-induced hypertension (PIH) developed in 69 women, 282 women with uneventful pregnancy outcome were selected for controls. Serum total renin and inhibin A levels were measured retrospectively in the trisomy screening samples of 69 and 30 patients who later developed PIH, and in 282 and 7 patients, respectively, who had an uneventful pregnancy outcome. No significant differences were found in the levels of maternal mid-trimester serum total renin, inhibin A or free beta-hCG levels between PIH and healthy women. The multiples of the median (MoM) of AFP values were significantly higher in the subgroup of patients who later developed severe pre-eclampsia than in patients with mild pre-eclampsia or gestational hypertension and healthy pregnant women. Maternal mid-trimester serum levels of total renin, inhibin A and free beta-hCG are not predictive for development of PIH. High mid-trimester serum AFP values may help in the prediction of severe pre-eclampsia.
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Affiliation(s)
- R Räty
- Department of Obstetrics and Gynaecology, Turku University Central Hospital, Finland
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Spencer K, Carpenter P. Is Prostate-specific Antigen a Marker for Pregnancies Affected by Down Syndrome? Clin Chem 1998. [DOI: 10.1093/clinchem/44.11.2362] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
I have studied the impact of maternal smoking on the levels of maternal serum alpha-fetoprotein (AFP) and free beta human chorionic gonadotrophin (hCG) during the second trimester in a large series (30,727) of self-reported smokers and non-smokers whose pregnancy resulted in the birth of a normal fetus. I have confirmed in a smaller subset of this population that self-reporting is an accurate method of assessing smoking status as confirmed by biochemical (serum cotinine) assessment. In addition, I have investigated marker levels among 195 pregnancies affected by Down syndrome with smoking status confirmed by measurement of serum cotinine. In both unaffected and Down syndrome groups, the incidence of smoking was 19 per cent but a considerable variation was observed with maternal age when the incidence in younger women (under 25) was 32 per cent. AFP median levels in unaffected smokers were 3 per cent higher, whilst in the Down syndrome group smoker medians were increased by 10 per cent compared with the non-smoker group. Free beta hCG levels in unaffected smokers were reduced by 14 per cent, whilst in the Down syndrome group smoker median levels were decreased by 16 per cent. In the smoker group, the Down syndrome detection rate was 10 per cent lower than in the non-smoker group, whilst the false-positive rate was also 2 per cent lower. Correcting for smoking status would redress this inequality and produce an overall 2 per cent increase in the detection rate for a 0.4 per cent increase in the false-positive rate. This increase in screening performance may be worth building into screening programmes, particularly in populations with a high smoking incidence.
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Affiliation(s)
- K Spencer
- Clinical Biochemistry Department, Harold Wood Hospital, Romford, Essex, UK
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Spencer K. Between-pregnancy biological variability of maternal serum alpha-fetoprotein and free beta hCG: implications for Down syndrome screening in subsequent pregnancies. Prenat Diagn 1997; 17:39-45. [PMID: 9021827 DOI: 10.1002/(sici)1097-0223(199701)17:1<39::aid-pd35>3.0.co;2-n] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In women who have an increased Down syndrome risk in a first pregnancy there is a five-fold greater chance of also having an increased Down syndrome risk in a second subsequent pregnancy. Similarly, in women who have a high alpha-fetoprotein (AFP) level in the first pregnancy, suggesting an increased risk of a neural tube defect (NTD), there is also a five-fold greater chance of them also having a high result in a second subsequent pregnancy. Such a biological association of serum marker levels between pregnancies suggests that there are additional maternal or genetic factors influencing the levels of these serum markers, other than the physiological factors which in themselves are poorly understood. In theory, it is possible to correct for high/low marker results in a previous pregnancy and to do so, I estimate, would reduce the overall Down syndrome screening false-positive rate by about 0.2 per cent. There are insufficient data to make any prediction regarding the impact on detection rates. The small reduction in false-positive rate is unlikely to be a feature worth implementing in Down syndrome screening programmes.
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Affiliation(s)
- K Spencer
- Clinical Biochemistry Department, Oldchurch Hospital, Romford, Essex, U.K
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Abstract
Initial studies of immunoreactive inhibin using a commercial assay have shown levels to be increased in three second-trimester series of maternal samples from Down's syndrome-affected pregnancies. This assay detected non-specifically all forms of circulating inhibin, dimeric and free alpha subunits, whether fully or partially processed. More recently, a new specific assay for dimeric inhibin-A has shown elevated results in both a first-trimester and a second-trimester series of cases. In order to assess the value of dimeric inhibin-A as a potential marker in the second trimester, we have analysed 157 Down's syndrome cases and used 367 unaffected cases across the gestational range 14-20 weeks to establish control medians and population parameters. In our series, the median MOM in Down's cases was 1.77, significantly higher than in the controls. At a 5 per cent false-positive rate, dimeric inhibin-A alone identified 37 per cent of cases. When used in conjunction with maternal age and other marker combinations, mathematical modelling showed detection rates rising from 48 per cent (inhibin-A plus age) to 61 per cent (inhibin-A, free beta hCG, age) and 68 per cent (inhibin-A, AFP, free beta hCG, age). Our data suggest that dimeric inhibin-A may have greater potential earlier in gestation when median levels at 14-16 weeks are 1.92 compared with 1.46 at 17-23 weeks. Dimeric inhibin-A may be a valuable addition to screening protocols, particularly in early gestations.
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Affiliation(s)
- K Spencer
- Clinical Biochemistry Department, Oldchurch Hospital, Romford, Essex, U.K
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Abstract
Total human chorionic gonadotropin (hCG) levels have been shown in one previous small study to vary with gravidity. In order to establish if maternal serum free beta hCG was similarly affected, approximately 4500 pregnancies of varying gravidity were analysed. The results indicated that there was a 6 per cent higher median MOM in primigravid compared with multigravid women. The impact of such elevation in Down's syndrome screening programmes will be minimal.
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Affiliation(s)
- K Spencer
- Clinical Biochemistry Department, Oldchurch Hospital, Romford, Essex, U.K
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Spencer K, Aitken DA, Crossley JA, McCaw G, Berry E, Anderson R, Connor JM, Macri JN. First trimester biochemical screening for trisomy 21: the role of free beta hCG, alpha fetoprotein and pregnancy associated plasma protein A. Ann Clin Biochem 1994; 31 ( Pt 5):447-54. [PMID: 7530437 DOI: 10.1177/000456329403100504] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The potential efficacy of screening for trisomy 21 in the first trimester, using maternal serum markers alpha fetoprotein, free beta human chorionic gonadotropin, unconjugated oestriol and pregnancy associated plasma protein A, was studied in an unselected population of women between the seventh and fourteenth week of gestation. Using a combination of alpha fetoprotein and free beta human chorionic gonadotropin, 53% of affected pregnancies could be identified at a false positive rate of 5%. Unconjugated oestriol and pregnancy associated plasma protein A levels were lower in cases of trisomy 21, but their inclusion with other markers did not significantly improve detection rate. Monitoring the same pregnancies also in the second trimester showed that screening in the first trimester identified the same cases as in the second. We conclude that first trimester screening using free beta human chorionic gonadotropin and alpha fetoprotein, is a viable possibility and will lead to detection rates in excess of 50%. Prospective studies are needed to confirm these observations.
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Affiliation(s)
- K Spencer
- Clinical Biochemistry Department, Oldchurch Hospital, Romford, Essex, UK
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Spencer K, Marcri JN. The use of free beta-hCG in antenatal screening for Down's syndrome. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1994; 101:175-6. [PMID: 8166821 DOI: 10.1111/j.1471-0528.1994.tb13091.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Spencer K, Macri JN, Coombes EJ, Ward AM. Antenatal screening for Down's syndrome. BMJ (CLINICAL RESEARCH ED.) 1993; 306:1616. [PMID: 7687179 PMCID: PMC1678001 DOI: 10.1136/bmj.306.6892.1616] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Norcio B. Care for mentally ill in Italy. BMJ (CLINICAL RESEARCH ED.) 1993; 306:1615-6. [PMID: 8329937 PMCID: PMC1678036 DOI: 10.1136/bmj.306.6892.1615-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Andrew SM. Giving up on medicine: Consider all the options first. West J Med 1993. [DOI: 10.1136/bmj.306.6892.1616-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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