Elevated second-trimester maternal serum β-human chorionic gonadotropin and amniotic fluid alpha-fetoprotein as indicators of adverse obstetric outcomes in fetal Turner syndrome

• Published in: The journal of obstetrics and gynaecology research Vol. 41; no. 12; pp. 1891 - 1898
• Main Authors: Alvarez-Nava, Francisco, Soto, Marisol, Lanes, Roberto, Pons, Hector, Morales-Machin, Alisandra, Bracho, Ana
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01.12.2015
• Subjects: adverse pregnancy outcome; alpha-Fetoproteins - analysis; Amniotic Fluid - chemistry; biochemical screening; Chorionic Gonadotropin, beta Subunit, Human - blood; Female; Fetal Diseases; Humans; Pregnancy; Pregnancy Trimester, Second; prenatal diagnosis; ROC Curve; Turner syndrome; Turner Syndrome - complications; adverse pregnancy outcome; Turner syndrome; prenatal diagnosis; biochemical screening
• ISSN: 1341-8076; 1447-0756
• DOI: 10.1111/jog.12813

Aim The objective of this study was to determine the ability of biochemical analytes to identify adverse outcomes in pregnancies with Turner syndrome. Methods Maternal serum and amniotic fluid (AF) marker concentrations were measured in 73 singleton pregnancies with Turner syndrome (10‐22 weeks of gestation). Fetal Turner syndrome was definitively established by cytogenetic analysis. Two subgroups, fetuses with hydrops fetalis versus fetuses with cystic hygroma, were compared. Receiver operating characteristic curves and relative risk were established for a cut‐off multiples of the median ≥3.5 for β‐subunit of human chorionic gonadotropin (hCG) or AF alpha‐fetoprotein (AFP). Results Forty‐nine (67%) of 73 pregnant women had an abnormal maternal serum. While levels of pregnancy‐associated plasma protein‐A and free β‐subunit (fβ)‐hCG were not different to those of the control group, AFP, unconjugated estriol and β‐hCG concentrations were significantly different in the study group (P < 0.05), when compared to those of unaffected pregnancies. Levels of β‐hCG in pregnancies with hydrops fetalis were significantly higher than in those with cystic hygroma (P <0.0001), as were AF‐AFP concentrations (P <0.0015). In addition, abnormalities in both maternal serum β‐hCG and AF‐AFP predicted fetal death. The relative risk of adverse obstetric outcome was 10.667 (P = 0.0004; 95% confidence interval [CI]: 1.554–73.203) for β‐hCG and 2.19 (P = 0.0256; 95% CI: 1.001 to 4.779), for AF‐AFP. Conclusion Maternal serum β‐hCG and AF‐AFP levels may preferentially identify those Turner syndrome pregnancies with the highest risk of fetal death.