Triple marker (α-fetoprotein, unconjugated estriol, human chorionic gonadotropin) versus α-fetoprotein plus free-β subunit in second-trimester maternal serum screening for fetal Down syndrome: A prospective comparison study

• Published in: American journal of obstetrics and gynecology Vol. 173; no. 4; pp. 1306 - 1309
• Main Authors: Kellner, Leonard H., Weiner, Zeev, Weiss, Robert R., Neuer, Marsha, Martin, Gregory M., Mueenuddin, Mian, Bombard, Allan
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01.10.1995; Elsevier
• Subjects: Adolescent; Adult; alpha-Fetoproteins - analysis; Biological and medical sciences; Biomarkers - blood; Chorionic Gonadotropin - blood; Chorionic Gonadotropin, beta Subunit, Human - blood; Down syndrome; Down Syndrome - diagnosis; Estriol - blood; False Positive Reactions; Female; Fetal Diseases - diagnosis; free β-human chorionic gonadotropin; Gynecology. Andrology. Obstetrics; human chorionic gonadotropin; Humans; Management. Prenatal diagnosis; Maternal Age; Medical sciences; Middle Aged; Normal Distribution; Predictive Value of Tests; Pregnancy; Pregnancy Trimester, Second; Pregnancy, High-Risk; Pregnancy. Fetus. Placenta; Prenatal Diagnosis; Prospective Studies; Risk Factors; unconjugated estriol; α-Fetoprotein; Down syndrome; α-Fetoprotein; human chorionic gonadotropin; free β-human chorionic gonadotropin; unconjugated estriol; Chromosomal aberration; Human; Prenatal; Fetal diseases; Trisomy; Pregnancy disorders; Biological marker; Aneuploidy; Female; Diagnosis; Comparative study; Blood plasma
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/0002-9378(95)91376-9

OBJECTIVE: Our purpose was to compare the efficacy of triple-marker screening (α-fetoprotein, unconjugated estriol, human chorionic gonadotropin) with α-fetoprotein plus free β-human chorionic gonadotropin. STUDY DESIGN: Free β-human chorionic gonadotropin was concurrently assayed in 2349 maternal serum samples. Trivariate and bivariate algorithms were used to calculate the risk for fetal Down syndrome by the two protocols. Free β-human chorionic gonadotropin from 12 cases of fetal Down syndrome previously screened with the triple marker was retrospectively assayed. RESULTS: Mean maternal age of our study was 29.8 years (range 14 to 51 years). The initial screen-positive rate with the triple marker was 8.0% compared with 12.8% for α-fetoprotein plus free β-human chorionic gonadotropin. All three cases of fetal Down syndrome ascertained in our prospective study were detected by the triple marker; in contrast, one of three was detected by α-fetoprotein plus free β-human chorionic gonadotropin. By adding 12 additional cases of fetal Down syndrome, 12 of 15 (80%) were screen positive with triple marker and nine of 15 (60%) were screen positive with α-fetoprotein plus free β-human chorionic gonadotropin. CONCLUSION: The detection rate of fetal Down syndrome was greater by use of a triple marker screen than when using α-fetoprotein plus free β-human chorionic gonadotropin. Our data do not support the claims of other studies that suggest that α-fetoprotein plus free β-human chorionic gonadotropin is superior to triple markers.