The relationship between the second trimester screening biochemical markers and complications and anomalies in pregnant women.
Öz
Aim: We aimed to
investigate the relationship between AFP, uE3, beta hCG, maternal age and Down
syndrome, NTD and trisomy 18 risk levels and prenatal maternal or fetal
complications, postnatal chromosomal anomalies, emergence of high or low
birthweight births, in pregnant with triple test.
Method: The pregnancy complications occurred during pregnancy
of 82 patients, whose triple screens were done in our clinic during the years
of 2010-2012, were investigated retrospectively, and post pregnant chromosomal
abnormalities, neural tube defects (NTDs), high and low birth weight cases were
found out by calling the patients and by searching their files. Multiple of
median (MoM) values were calculated by measuring AFP, uE3, and beta hCG levels
with chemiluminescent method via Beckman Coulter UniCelDxI
800 device.
Results: The average age of the women in the study group was
27.7. The risk has been identified, for Down syndrome in 8 patients, for NTD in
10 patients, for trisomy 18 in 3 patients, over 1/250. The number of patients
with preeclampsia was 2; gestational diabetes mellitus (DM) was 8 during
pregnancy. While the number of babies born with low birthweight was 13, high
birthweight infants’ number was 11.
Conclusion:
In order to determine false postivities more properly, further studies
with a higher number of cases are recommended. Advanced clinical trials are
recommended for increasing the safety of pregnancy screening tests.
Anahtar Kelimeler
Kaynakça
- 1. Ogilvie CM. Prenatal diagnosis for chromosome abnormalities: Past, present, future. Pathol Biol (Paris). 2003;51(3):156-60.
- 2. Crandall BF, Robınson , Grau P. Risks associated with an elevated maternal serum alpha-fetoprotein . Am J Obstet Gynecol. 1991;165(3):581-6.
- 3. Carl A. Burtis, Edward R. Ashwood, and David E.Burns. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, Fourth Edition, St. Louis, MO, Elsevier Saunders, 2006; 2167-86.
- 4. Cuckle H. Time for total shift to first trimester Down’s screening.Lancet 2001;358(9294):1658-9
- 5. Evans, Mark I, et al. Alpha-fetoprotein and biochemical screening. Reproductive Risks and Prenatal Diagnosis: Norwalk, Appleton & Lange,1992:233-5.
- 6. Evans MI , Dvorin E , O’Brien JE , Moody JL , Drugan A : Alpha-fetoprotein and biochemical screening In Evans MI (ed): Reproductive risks and prenatal diagnosis Appleton-Lange , Connecticut 1992; 223.
- 7. Aydınlı K, Oral E : Merkezi sinir sistemi anomalileri ve noral tup defektleri . In Aydınlı K (ed) : Prenatal tanı ve Tedavi. Prepektif yayın ve reklam hizmetleri, İstanbul 1992; 108.
- 8. Burton BK. Outcome of pregnancy in patient with unexplained elevated or low levels of maternal serum alpha -fetoprotein. Obstet Gynecol 1988:72:709-13.
- 9. Milunsky A, Jick SS, Brull C. Predictive values, relative risks, and overall benefits of high and low maternal serum alpha-fetoprotein screening in singleton pregnancies: New epidemiologıc data. Am J Obstet Gynecol 1989;161(2):291-7.
- 10. Robinson L, Crau P, Crandell BF. Pregnancy outcome after increasing maternal serum alpha-fetoprotein levels. Obstet Gynecol 1989;74(1):17-20.
- 11. Yaron Y, Cherry M, Kramer R. L, O’Brien J. E, Hallak M, Johnson M. P, Evans M. I, Second-timester maternal serum marker screening: Maternal serum α-fetoprotein, ß-human chorionic gonadotropin, estriol, and their various combinations as predictors of pregnancy outcome. Am J Obstet Gynecol 1999;181(4):968-74.
- 12. Yılmaz NM, Gebelerde üçlü tarama testinin duyarlılığının değerlendirilmesi. Uzmanlık tezi, İstanbul 2005; 5.
- 13. Yılmaz A. Erzurum Bölgesinde Üçlü Tarama Testi Parametrelerinin Medyan Değerlerinin Belirlenmesi. Türk Klinik Biyokimya Derg. 2009;7 (2): 37-41.
- 14. Marteau T M, Cook R, Kidd J, Michie S, Johnston M et. al. The psychological effects of false-positive results in prenatal screening for fetal abnormality: A prospective study. Prenatal Diagnosis. 1992;12(3):205-14.
- 15. Newberger D S. Down Syndrome: Prenatal Risk Assessment and Diagnosis. American Academy of Family Physicians. 2000;62(4):825-32.
- 16. Wenstrom KD, Owen J, Brumfield CG, et al. Significance of a false-positive trisomy 18 multiple-marker screening test. Obstet Gynecol 1997;90(6):938-42.
- 17. Bakır F, Çelik HT, Özdemir Ö, Yıldırımkaya MM. Maternal kanda AFP, hCG ve ankonjuge östriol düzeylerinin gebelik komplikasyonları ile ilişkisi. Turk Hij Den Biyol Derg, 2012;69(4): 213-18.
- 18. Sağol S, Vidinli H, Asena U. The relatıon of false posıtıvıty and obstetrıc complıcatıons in pregnant patıents screened for down syndrome risk by trıple test. Ege Tıp Dergisi 2000;39(2): 121-25.
- 19. Dungan JS, Shulman LP, Philips OP, et al. Positive serum screening for fetal Down syndrome does not predict adverse pregnancy outcome in absence of fetal aneuploidy. J Soc Gynecol Invest, 1994;1(1):55-8.
- 20. Walton DL, Norem CT, Schoen EJ, Ray GT, Colby CJ. Second-trimester serum chorionic gonadotropin concentrations and complications and outcome of pregnancy. N Engl J Med, 1999;341(27):2033–8.
- 21. Saller Jr, Devereux N, Jacob A. Canıck. Current methods of prenatal screening for Down syndrome and other fetal abnormalities. Clinical obstetrics and gynecology, 2008;51(1):24-36.
- 22. Mizejewski GJ. Physiology of Alpha-Fetoprotein as a Biomarker for Perinatal Distress: Relevance to Adverse Pregnancy Outcome. Exp Biol Med (Maywood). 2007;232(8):993-1004.
- 23. Lieppman RE, Williams MA, Cheng EY, et al. An association between elevated levels of human chorionic gonadotropin in the midtrimester and adverse pregnancy outcome. Am J Obstet Gynecol, 1993;168(6 Pt 1):1852-6.
- 24. Hsieh TT, Hung TH, Hsu JJ, et al. Prediction of adverse perinatal outcome by maternal serum screening for Dovvn syndrome in an Asian population. Obstet Gynecol 1997:89(6):937-40.
- 25. Pergament E, Stein AK, Fiddler M, Kupferminc MJ. Adverse pregnancy outcome after a false positive screen for Down Syndrome using multiple markers. Obstet Gynecol,1995;86(2):255-8.
- 26. Haddow JE. Prenatal screening for open neural tube defects, Down’s Syndrome and other major fetal disorders. Semin Perinatol, 1990;14(6):488-503.
Gebelerde ikinci trimester tarama testinde biyokimyasal belirteçler ile gebelik komplikasyonları arasındaki ilişki
Öz
Amaç: Downsendromu, neural tube defects (NTDs), ve
trizomi 18 riskinin ve ayrıca AFP,uE3 ve beta hCG
seviyelerinin her biri ile doğum öncesi maternal veya fetal komplikasyonların
ve doğum sonrası kromozomal anomalilerin, NTD,
yüksek veya düşük ağırlıklı doğumların ortaya çıkması ile ilişkisini araştırmayı
amaçladık.
Yöntem:
Kliniğimizde
2010-2012 yılları arasında üçlü tarama testi yapılmış olan 82 hastada gebelik
sırasında ortaya çıkan komplikasyonlar retrospektif olarak incelenmiş ve
gebelik sonrası kromozomal anomali, NTD, yüksek ve düşük doğum ağırlıklı doğum
olma durumu ise hasta dosyalarından ve telefonla görüşülerek öğrenilmiştir.
AFP, uE3 ve βhCG seviyeleri Beckman Coulter UniCelDxI 800 cihazında,
kemilüminesans yöntemiyle ölçülerek MoM değerleri hesaplanmıştır.
Bulgular:
Çalışma
grubundaki gebelerin yaş ortalaması 27,7’dir. 8 hastada Downsendromu riski, 10
hastada NTD riski, 3 hastada trizomi 18 riski 1/250’nin üzerinde tespit
edilmiştir. Gebelik sırasında preeklampsisi olan hasta sayısı 2,
gestasyoneldiyabetesmellitusu (DM) olan hasta sayısı ise 8 idi. Düşük doğum
ağırlıklı doğan bebek sayısı 13 iken yüksek doğum ağırlıklı doğan bebek sayısı
11’dir.
Sonuç: Yanlış
pozitifliklerin daha doğru belirlenmesi için olgu sayısının daha fazla olduğu
çalışmalar yapılması ve tarama testlerinin güvenirliklerinin artırılması için
gelişmiş klinik araştırmalar yapılması önerilir.
Anahtar Kelimeler
Kaynakça
- 1. Ogilvie CM. Prenatal diagnosis for chromosome abnormalities: Past, present, future. Pathol Biol (Paris). 2003;51(3):156-60.
- 2. Crandall BF, Robınson , Grau P. Risks associated with an elevated maternal serum alpha-fetoprotein . Am J Obstet Gynecol. 1991;165(3):581-6.
- 3. Carl A. Burtis, Edward R. Ashwood, and David E.Burns. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, Fourth Edition, St. Louis, MO, Elsevier Saunders, 2006; 2167-86.
- 4. Cuckle H. Time for total shift to first trimester Down’s screening.Lancet 2001;358(9294):1658-9
- 5. Evans, Mark I, et al. Alpha-fetoprotein and biochemical screening. Reproductive Risks and Prenatal Diagnosis: Norwalk, Appleton & Lange,1992:233-5.
- 6. Evans MI , Dvorin E , O’Brien JE , Moody JL , Drugan A : Alpha-fetoprotein and biochemical screening In Evans MI (ed): Reproductive risks and prenatal diagnosis Appleton-Lange , Connecticut 1992; 223.
- 7. Aydınlı K, Oral E : Merkezi sinir sistemi anomalileri ve noral tup defektleri . In Aydınlı K (ed) : Prenatal tanı ve Tedavi. Prepektif yayın ve reklam hizmetleri, İstanbul 1992; 108.
- 8. Burton BK. Outcome of pregnancy in patient with unexplained elevated or low levels of maternal serum alpha -fetoprotein. Obstet Gynecol 1988:72:709-13.
- 9. Milunsky A, Jick SS, Brull C. Predictive values, relative risks, and overall benefits of high and low maternal serum alpha-fetoprotein screening in singleton pregnancies: New epidemiologıc data. Am J Obstet Gynecol 1989;161(2):291-7.
- 10. Robinson L, Crau P, Crandell BF. Pregnancy outcome after increasing maternal serum alpha-fetoprotein levels. Obstet Gynecol 1989;74(1):17-20.
- 11. Yaron Y, Cherry M, Kramer R. L, O’Brien J. E, Hallak M, Johnson M. P, Evans M. I, Second-timester maternal serum marker screening: Maternal serum α-fetoprotein, ß-human chorionic gonadotropin, estriol, and their various combinations as predictors of pregnancy outcome. Am J Obstet Gynecol 1999;181(4):968-74.
- 12. Yılmaz NM, Gebelerde üçlü tarama testinin duyarlılığının değerlendirilmesi. Uzmanlık tezi, İstanbul 2005; 5.
- 13. Yılmaz A. Erzurum Bölgesinde Üçlü Tarama Testi Parametrelerinin Medyan Değerlerinin Belirlenmesi. Türk Klinik Biyokimya Derg. 2009;7 (2): 37-41.
- 14. Marteau T M, Cook R, Kidd J, Michie S, Johnston M et. al. The psychological effects of false-positive results in prenatal screening for fetal abnormality: A prospective study. Prenatal Diagnosis. 1992;12(3):205-14.
- 15. Newberger D S. Down Syndrome: Prenatal Risk Assessment and Diagnosis. American Academy of Family Physicians. 2000;62(4):825-32.
- 16. Wenstrom KD, Owen J, Brumfield CG, et al. Significance of a false-positive trisomy 18 multiple-marker screening test. Obstet Gynecol 1997;90(6):938-42.
- 17. Bakır F, Çelik HT, Özdemir Ö, Yıldırımkaya MM. Maternal kanda AFP, hCG ve ankonjuge östriol düzeylerinin gebelik komplikasyonları ile ilişkisi. Turk Hij Den Biyol Derg, 2012;69(4): 213-18.
- 18. Sağol S, Vidinli H, Asena U. The relatıon of false posıtıvıty and obstetrıc complıcatıons in pregnant patıents screened for down syndrome risk by trıple test. Ege Tıp Dergisi 2000;39(2): 121-25.
- 19. Dungan JS, Shulman LP, Philips OP, et al. Positive serum screening for fetal Down syndrome does not predict adverse pregnancy outcome in absence of fetal aneuploidy. J Soc Gynecol Invest, 1994;1(1):55-8.
- 20. Walton DL, Norem CT, Schoen EJ, Ray GT, Colby CJ. Second-trimester serum chorionic gonadotropin concentrations and complications and outcome of pregnancy. N Engl J Med, 1999;341(27):2033–8.
- 21. Saller Jr, Devereux N, Jacob A. Canıck. Current methods of prenatal screening for Down syndrome and other fetal abnormalities. Clinical obstetrics and gynecology, 2008;51(1):24-36.
- 22. Mizejewski GJ. Physiology of Alpha-Fetoprotein as a Biomarker for Perinatal Distress: Relevance to Adverse Pregnancy Outcome. Exp Biol Med (Maywood). 2007;232(8):993-1004.
- 23. Lieppman RE, Williams MA, Cheng EY, et al. An association between elevated levels of human chorionic gonadotropin in the midtrimester and adverse pregnancy outcome. Am J Obstet Gynecol, 1993;168(6 Pt 1):1852-6.
- 24. Hsieh TT, Hung TH, Hsu JJ, et al. Prediction of adverse perinatal outcome by maternal serum screening for Dovvn syndrome in an Asian population. Obstet Gynecol 1997:89(6):937-40.
- 25. Pergament E, Stein AK, Fiddler M, Kupferminc MJ. Adverse pregnancy outcome after a false positive screen for Down Syndrome using multiple markers. Obstet Gynecol,1995;86(2):255-8.
- 26. Haddow JE. Prenatal screening for open neural tube defects, Down’s Syndrome and other major fetal disorders. Semin Perinatol, 1990;14(6):488-503.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | İç Hastalıkları |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 23 Nisan 2017 |
| Gönderilme Tarihi | 29 Kasım 2016 |
| Kabul Tarihi | 27 Aralık 2016 |
| Yayımlandığı Sayı | Yıl 2017 Cilt: 1 Sayı: 1 |
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