Research Article

The Relationship of Biochemical Markers used in the First and Second Trimester Screening Tests with Poor Obstetric Results


  • Merve Cellek
  • Ali Turhan Çağlar

Received Date: 15.06.2021 Accepted Date: 02.06.2022 J Ankara Univ Fac Med 2022;75(2):286-294


This study aims to determine the relationship between poor obstetric and perinatal outcomes and maternal serum aneuploidy markers of first and second trimesters.

Materials and Methods:

Five hundred three singleton pregnancies who underwent prenatal screening for aneuploidy were examined. The association between serum aneuploidy markers and poor obstetric and perinatal outcomes was investigated. In the regression analysis, adjusted odds ratio, 95% confidence interval and p-values were found for each marker.


The median Multiple of the Median (MoM) of pregnancy-associated plasma protein A was significantly lower in pregnancies with pregnancy induced hypertension (0.63 vs 0.89, p=0.014). Women with elevated free β human chorionic gonadotropin (hCG) MoM levels were more likely to experience intrauterine growth retardation (p=0.029). By examining low (≤10th percentile) alpha fetoprotein (AFP) MoM levels, we found a 9 fold increase in risk of fetal death at or after 24 weeks of gestation (p=0.036). In case of high AFP levels, 5 fold increase in risk of IUGR was observed (p=0.023). While decreased levels of second-trimester hCG were associated with IUGR (p=0.011), increased risk of pregnancy induced hypertension was significantly associated with elevated hCG levels (p=0.001). Increased risk of abruptio placentae was associated with elevated hCG levels (p=0.023). Low levels of unconjugated estriol (uE3) appeared to be associated with pregnancy induced hypertension and low birth weight, the risks of which increased as depressed levels of uE3 became more extreme. Elevated hCG (31% vs 6%, p<0.001) and low uE3 (16.3% vs 6.2%, p=0.025) levels were associated with more need for neonatal intensive care in newborns. Reduced uE3 levels (at or below 10th percentile) were correlated with lower gestational age at birth (38.4 vs 39, p=0.038).


A relationship was found between abnormal values of markers used in first and second trimester screening tests and poor obstetric results. Triple screening hCG has been determined to be the best marker for predicting pregnancy induced hypertensive diseases.

Keywords: Prenatal Screening Test, Aneuploidy Markers, Adverse Pregnancy Outcomes, Perinatal Outcomes

Full Text (Turkish)