Adverse pregnancy outcome after a false-positive screen for down syndrome using multiple markers

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 86; no. 2; pp. 255 - 258
• Main Authors: Pergament, E., Stein, A.K., Fiddler, M., Cho, N.H., Kupferminc, M.J.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.1995; Elsevier Science
• Subjects: Adult; alpha-Fetoproteins - analysis; Amniocentesis; Biological and medical sciences; Case-Control Studies; Chorionic Gonadotropin - blood; Confidence Intervals; Down Syndrome - diagnosis; Estriol - blood; False Positive Reactions; Female; Fetal Diseases - diagnosis; Gynecology. Andrology. Obstetrics; Humans; Management. Prenatal diagnosis; Maternal Age; Medical sciences; Odds Ratio; Predictive Value of Tests; Pregnancy; Pregnancy Outcome - epidemiology; Pregnancy. Fetus. Placenta; Prenatal Diagnosis; Risk Factors; Pregnancy; Human; Fetal diseases; False positive; Biological marker; Down syndrome; Medical screening
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1016/0029-7844(95)00108-4

Objective: To assess the relative risk of an adverse pregnancy outcome in women whose multiple-marker screening (maternal serum alpha-fetoprotein [MSAFP], unconjugated estriol [E3], and hCG levels, and age) indicating an increased risk for Down syndrome (more than 1:250) was not confirmed by amniocentesis. Methods: Fifty-eight women with false-positive screens for Down syndrome were matched with a control group of 116 women whose screens indicated a risk for Down syndrome of less than 1:250. The risk for adverse pregnancy outcome was compared for the two groups, and the roles of MSAFP, unconjugated E3, and hCG as predictors of adverse pregnancy outcome were determined. Results: Women with false-positive screens for Down syndrome were significantly different from their matched controls in the incidence of preterm delivery (20.6 versus 8.6%, respectively), preeclampsia (6.9 versus 0%), small for gestational age newborns (5.2 versus 0%), and fetal demise after 20 weeks' gestation (5.2 versus 0%). An adverse outcome occurred in 19 of 58 pregnancies (32.8%) in the study group and in 14 of 116 matched control pregnancies (12%) (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.6–7.8; P < .01). Unconjugated E3 of 0.75 multiples of the mean (MoM) or less was significantly associated with adverse pregnancy outcome after controlling for the effects of MSAFP and hCG (OR 2.5, 95% CI 1.13–5.55; P < .02). Conclusion: One in three women with a false-positive screen for Down syndrome may experience an adverse pregnancy outcome. In this study, unconjugated E3 of 0.75 MoM or less appeared to be a better predictor of adverse pregnancy outcome than were MSAFP and hCG levels.