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Published on: February 23, 2011
Serum screening with Down's syndrome markers to predict pre-eclampsia and small for gestational age: systematic
Rachel K Morris1, Jeltsje S Cnossen, Marloes Langejans
1Academic Department of Obstetrics and Gynaecology, University of Birmingham, Birmingham Women's Hospital, Birmingham, B15 2TG, UK. r.k.morris@bham.ac.uk
Insights
Down's serum screening analytes show low accuracy for predicting pre-eclampsia and small for gestational age. Combining these markers with other tests may improve risk assessment for better maternal and perinatal outcomes.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Biochemistry
Background:
- Accurate antenatal prediction of pre-eclampsia and small for gestational age (SGA) is vital for resource allocation and timely intervention.
- Improving maternal and perinatal outcomes relies on effective identification of high-risk pregnancies.
Purpose of the Study:
- To systematically review the accuracy of five serum analytes, commonly used in Down's syndrome screening, for predicting pre-eclampsia and/or SGA.
Main Methods:
- A systematic review of studies published up to February 2007, including Medline, Embase, and Cochrane databases.
- Independent selection and data extraction by two reviewers for studies assessing serum analytes before 25 weeks' gestation.
- Analysis of accuracy metrics, including likelihood ratios, for prediction of pre-eclampsia and SGA.
Main Results:
- Evaluated five serum screening markers across 44 studies (169,637 women) for pre-eclampsia and 86 studies (382,005 women) for SGA.
- Overall predictive accuracy for both conditions was low.
- Inhibin A showed the best predictive value for pre-eclampsia, and AFP for SGA, but with wide confidence intervals due to study heterogeneity and limitations.
Conclusions:
- Serum analytes used in Down's screening possess limited predictive accuracy for pre-eclampsia and SGA individually.
- These markers may serve as a component of risk assessment strategies, particularly when integrated with other predictive tests.
Background:
Reliable antenatal identification of pre-eclampsia and small for gestational age is crucial to judicious allocation of monitoring resources and use of preventative treatment with the prospect of improving maternal/perinatal outcome. The purpose of this systematic review was to determine the accuracy of five serum analytes used in Down's serum screening for prediction of pre-eclampsia and/or small for gestational age.
Methods:
The data sources included Medline, Embase, Cochrane library, Medion (inception to February 2007), hand searching of relevant journals, reference list checking of included articles, contact with experts. Two reviewers independently selected the articles in which the accuracy of an analyte used in Downs's serum screening before the 25th gestational week was associated with the occurrence of pre-eclampsia and/or small for gestational age without language restrictions. Two authors independently extracted data on study characteristics, quality and results.
Results:
Five serum screening markers were evaluated. 44 studies, testing 169,637 pregnant women (4376 pre-eclampsia cases) and 86 studies, testing 382,005 women (20,339 fetal growth restriction cases) met the selection criteria. The results showed low predictive accuracy overall. For pre-eclampsia the best predictor was inhibin A>2.79MoM positive likelihood ratio 19.52 (8.33,45.79) and negative likelihood ratio 0.30 (0.13,0.68) (single study). For small for gestational age it was AFP>2.0MoM to predict birth weight < 10th centile with birth < 37 weeks positive likelihood ratio 27.96 (8.02,97.48) and negative likelihood ratio 0.78 (0.55,1.11) (single study). A potential clinical application using aspirin as a treatment is given as an example.There were methodological and reporting limitations in the included studies thus studies were heterogeneous giving pooled results with wide confidence intervals.
Conclusion:
Down's serum screening analytes have low predictive accuracy for pre-eclampsia and small for gestational age. They may be a useful means of risk assessment or of use in prediction when combined with other tests.
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