Serum alpha-fetoprotein in the three trimesters of pregnancy: effects of maternal characteristics and medical history
Serum alpha-fetoprotein in the three trimesters of pregnancy: effects of maternal characteristics and medical history
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DOI：
10.1002/uog.14809
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发表时间：
2015-07-01
影响因子：
7.1
通讯作者：
Nicolaides, K. H.
中科院分区：
文献类型：
--
作者：
Bredaki, F. E.;Sciorio, C.;Nicolaides, K. H.
目的探讨影响孕妇血清甲胎蛋白(AFP)测定水平的因素在妊娠并发症筛查中的作用。方法对妊娠11+0~13+6周、19+0~24+6周、30+0~34+6周3次常规就诊的单胎妊娠妇女，记录母体特征和病史，测定血清AFP水平。对孕周为24周的正常活产或死产的孕妇，从多因素线性混合回归分析中筛选出对预测甲胎蛋白有重要意义的因素：孕妇的人口学特征和病史。胎龄、母亲体重、种族来源、分娩时胎龄、上一次妊娠新生儿出生体重Z分数和分娩间隔对血清AFP有显著的独立贡献。吸烟只在妊娠的前三个月对血清AFP有显著影响。用于检测血清AFP的机器也被发现具有显著的效果。采用随机效应多元回归分析确定影响血清AFP测量水平的母体变量的贡献，并将这些值表示为中位数(MOMS)的倍数。该模型对所有协变量的MO值进行了适当的拟合，无论是在发生先兆子痫的孕妇还是在没有妊娠并发症的孕妇中。结论在调整了影响测量的母亲特征和病史的变量后，该模型适用于表达三个妊娠三个月的孕妇的AFP测量结果。版权所有(C)2015 ISUOG。由John Wiley&Sons Ltd.出版。
Objective To define the contribution of maternal variables which influence the measured level of maternal serum alpha-fetoprotein (AFP) in screening for pregnancy complications.Methods Maternal characteristics and medical history were recorded and serum AFP was measured in women with a singleton pregnancy attending for three routine hospital visits at 11+0 to 13+6, 19+0 to 24+6 and 30+0 to 34+6 weeks' gestation. For pregnancies delivering phenotypically normal live births or stillbirths >= 24 weeks' gestation, variables from maternal demographic characteristics and medical history that are important in the prediction of AFP were determined from a linear mixed-effects multiple regression.Results Serum AFP was measured in 17 071 cases in the first trimester, 8583 in the second trimester and 8607 in the third trimester. Significant independent contributions to serum AFP were provided by gestational age, maternal weight, racial origin, gestational age at delivery and birth-weight Z-score of the neonate of the previous pregnancy and interpregnancy interval. Cigarette smoking was found to significantly affect serum AFP in the first trimester only. The machine used to measure serum AFP was also found to have a significant effect. Random-effects multiple regression analysis was used to define the contribution of maternal variables that influence the measured level of serum AFP and express the values as multiples of the median (MoMs). The model was shown to provide an adequate fit of MoM values for all covariates, both in pregnancies that developed pre-eclampsia and in those without this pregnancy complication.Conclusions A model was fitted to express measured serum AFP across the three trimesters of pregnancy as MoMs, after adjusting for variables from maternal characteristics and medical history that affect this measurement. Copyright (C) 2015 ISUOG. Published by John Wiley & Sons Ltd.