Maternal serum analytes as predictors of IUGR with different degrees of placental vascular dysfunction

Abstract

OBJECTIVES: Our primary objective was to determine the association of maternal serum analytes in pregnancies complicated by intrauterine growth restriction (IUGR) stratified by umbilical artery (UA) Doppler versus pregnancies with appropriately grown for gestational age (AGA) and its potential use as screening model. METHODS: Retrospective cohort evaluating first and second trimester maternal serum aneuploidy screening markers in women complicated with IUGR [90 with absent or reversed end diastolic velocity (AREDV), 46 with UA systolic/diastolic ratio ≥95th percentile and 215 with normal UA Doppler] versus 2590 women with AGA fetuses (control). RESULTS: Extreme levels of each analyte were significantly more common in the IUGR/AREDV group than in AGA group: inhibin A >97th percentile [≥2.27 multiples of the median (MoM)], OR: 41 (95% CI: 21-80); unconjugated estriol <3rd percentile (≤0.6 MoM), OR: 17.2 (95% CI: 8.1-42); AFP >97th percentile (≥1.88 MoM), OR: 15 (95% CI: 8.2-27); PAPP-A <3rd percentile (≤0.33 MoM), OR: 13 (95% CI: 6.6-25.5); and free-beta human chorionic gonadotrophin second trimester >97th percentile (≥3.24 MoM), OR: 11.6 (95% CI: 4.2-32). In a subgroup of pregnancies in which all markers were evaluated on each patient, a combination of abnormal markers detected 73% (95% CI: 54-87%) of IUGR/AREDV fetuses. When maternal risk factors were included into the risk calculation, it increased to 91% (95% CI: 76-98%). CONCLUSIONS: Abnormal maternal serum aneuploidy markers preferentially identify those pregnancies at greatest risk of IUGR with AREDV in the UA.