Population-based biomarker screening and the development of severe preeclampsia in California

Veronique Tache, Rebecca J. Baer, Robert J. Currier, Chin-Shang Li, Dena Towner, L Elaine Waetjen, Laura L. Jelliffe-Pawlowski

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective The purpose of this study was to examine the relationship between second-trimester maternal serum biomarkers and the development of early- and late-onset severe preeclampsia in euploid pregnancies. Study Design Included were 136,139 pregnancies that obtained second-trimester prenatal screening through the California Prenatal Screening Program with live births in 2006-2008. We identified severe preeclampsia diagnoses from hospital discharge records. We used log binomial regression to examine the association between abnormal second-trimester maternal serum biomarkers and the development of severe preeclampsia.

Results Approximately 0.9% of all women (n = 1208) in our sample experienced severe preeclampsia; 329 women at <34 weeks' gestation and 879 women ≥34 weeks' gestation. High levels of alpha fetoprotein (AFP), human chorionic gonadotropin, inhibin (multiple of the median, ≥95th percentile), and low unconjugated estriol (multiple of the median, ≤5th percentile), were associated with severe preeclampsia (relative risk, 2.5-11.7). Biomarkers were more predictive of early-onset severe preeclampsia (relative risk, 3.8-11.7). One in 9.5 pregnancies with combined high AFP, inhibin, and low unconjugated estriol levels experienced severe early-onset preeclampsia compared with 1 in 680.5 pregnancies without any abnormal biomarkers.

Conclusion The risk of the development of severe preeclampsia increases for women with high second-trimester AFP, human chorionic gonadotropin, inhibin, and/or low unconjugated estriol; this is especially true for early-onset severe preeclampsia. When abnormal biomarkers co-occur, risk dramatically increases. Although the screening value of second-trimester biomarkers is low, abnormal biomarkers, especially when occurring in combination, appear to indicate placental dysfunction that is associated with the development of severe preeclampsia.

Original languageEnglish (US)
Pages (from-to)377.e1-377.e8
JournalAmerican Journal of Obstetrics and Gynecology
Volume211
Issue number4
DOIs
StatePublished - Oct 1 2014

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Pre-Eclampsia
Biomarkers
Second Pregnancy Trimester
Population
Estriol
alpha-Fetoproteins
Pregnancy
Inhibins
Chorionic Gonadotropin
Prenatal Diagnosis
Mothers
Hospital Records
Live Birth
Serum

Keywords

  • biomarker
  • early-onset severe preeclampsia
  • screening
  • serum analyte

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Population-based biomarker screening and the development of severe preeclampsia in California. / Tache, Veronique; Baer, Rebecca J.; Currier, Robert J.; Li, Chin-Shang; Towner, Dena; Waetjen, L Elaine; Jelliffe-Pawlowski, Laura L.

In: American Journal of Obstetrics and Gynecology, Vol. 211, No. 4, 01.10.2014, p. 377.e1-377.e8.

Research output: Contribution to journalArticle

Tache, Veronique ; Baer, Rebecca J. ; Currier, Robert J. ; Li, Chin-Shang ; Towner, Dena ; Waetjen, L Elaine ; Jelliffe-Pawlowski, Laura L. / Population-based biomarker screening and the development of severe preeclampsia in California. In: American Journal of Obstetrics and Gynecology. 2014 ; Vol. 211, No. 4. pp. 377.e1-377.e8.
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AU - Waetjen, L Elaine

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AB - Objective The purpose of this study was to examine the relationship between second-trimester maternal serum biomarkers and the development of early- and late-onset severe preeclampsia in euploid pregnancies. Study Design Included were 136,139 pregnancies that obtained second-trimester prenatal screening through the California Prenatal Screening Program with live births in 2006-2008. We identified severe preeclampsia diagnoses from hospital discharge records. We used log binomial regression to examine the association between abnormal second-trimester maternal serum biomarkers and the development of severe preeclampsia.Results Approximately 0.9% of all women (n = 1208) in our sample experienced severe preeclampsia; 329 women at <34 weeks' gestation and 879 women ≥34 weeks' gestation. High levels of alpha fetoprotein (AFP), human chorionic gonadotropin, inhibin (multiple of the median, ≥95th percentile), and low unconjugated estriol (multiple of the median, ≤5th percentile), were associated with severe preeclampsia (relative risk, 2.5-11.7). Biomarkers were more predictive of early-onset severe preeclampsia (relative risk, 3.8-11.7). One in 9.5 pregnancies with combined high AFP, inhibin, and low unconjugated estriol levels experienced severe early-onset preeclampsia compared with 1 in 680.5 pregnancies without any abnormal biomarkers.Conclusion The risk of the development of severe preeclampsia increases for women with high second-trimester AFP, human chorionic gonadotropin, inhibin, and/or low unconjugated estriol; this is especially true for early-onset severe preeclampsia. When abnormal biomarkers co-occur, risk dramatically increases. Although the screening value of second-trimester biomarkers is low, abnormal biomarkers, especially when occurring in combination, appear to indicate placental dysfunction that is associated with the development of severe preeclampsia.

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