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Evaluation of different weight correction methods for antenatal serum screening using data from two multi-centre

D M Kennedy¹, V M Edwards, D J Worthington

¹Department of Clinical Chemistry, Birmingham Women's Hospital NHS Trust, Edgbaston, UK. david.kennedy@bham-womens.thenhs.com

Annals of Clinical Biochemistry

|June 22, 1999

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Reciprocal-linear regression offers better weight correction for prenatal screening markers like alpha-fetoprotein (AFP) and human chorionic gonadotrophin (HCG). This method improves the screen positive rate (SPR) for neural tube defects (NTD) without significantly impacting Down

Area of Science:

Prenatal screening
Biochemical markers
Statistical modeling

Background:

Maternal weight influences serum marker concentrations used in prenatal screening.
Weight correction is crucial for accurate screening of Down's syndrome and open neural tube defects (NTD).
Log-linear regression is a common method for weight correction, but reciprocal-linear regression has been proposed as an alternative.

Purpose of the Study:

To compare the effectiveness of log-linear and reciprocal-linear regression for maternal weight correction in prenatal screening.
To evaluate the impact of these correction methods on the detection and screen positive rates (SPR) for Down's syndrome and NTD.
To determine if reciprocal-linear regression offers advantages over log-linear regression, particularly in reducing SPR variability.

Main Methods:

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Comparison of log-linear and reciprocal-linear regression models for weight correction.
Analysis of data from two large prenatal screening programs utilizing alpha-fetoprotein (AFP) with either total human chorionic gonadotrophin (HCG) or free beta-HCG.
Assessment of screen positive rates (SPR) for Down's syndrome and NTD before and after applying different weight correction methods.

Main Results:

The reciprocal-linear method provided a closer fit to the screening data compared to log-linear regression.
Neither correction method significantly altered the detection rates or SPR for Down's syndrome or NTD.
Without weight correction, significant differences in SPR were observed for women at extreme weights.
Both methods reduced SPR variability for Down's syndrome, but reciprocal-linear regression was more effective for NTD screening.

Conclusions:

Reciprocal-linear regression offers a superior fit for maternal weight correction in prenatal screening.
While both methods improve SPR consistency, reciprocal-linear regression is particularly beneficial for reducing variability in NTD screening.
The use of reciprocal-linear regression for weight correction in prenatal screening programs is recommended, especially for NTD detection.