Very high CA 125 levels during early first trimester in three cases of spontaneous abortion with chromosomal abnormalities

Biochemical screening for congenital defects

This article discusses biochemical screening for congenital defects. Biochemical screening remains the standard for estimating the risk of aneuploidy in pregnancy. The combination of first and second trimester markers promises to further improve diagnostic accuracy for anomaly detection.

Maternal serum concentrations of CA-125 in second trimester pregnancy complicated by congenital fetal anomalies

OBJECTIVE

The purpose of the study was to determine the value of maternal serum CA-125 concentrations in pregnancies complicated by fetal anomalies with or without hydramnios.

STUDY DESIGN

The study population (n=40) consisted of the following four groups of patients: (1) 10 women with abnormal maternal serum alpha fetal protein (MSAFP) in whom no fetal anomalies were observed; (2) 10 women in whom fetal anomalies were diagnosed in addition to abnormal MSAFP; (3) 10 women with fetal anomalies accompanied by hydramnios and abnormal MSAF, and (4) 10 women had normal MSAFP and were diagnosed with hydramnios without fetal anomaly. The control group consisted of 10 patients who were matched for gestational age with normal MSAFP and normal ultrasonographic examination. In all 50 cases MSAFP and maternal serum CA-125 levels were assessed. CA-125 was measured using OC 125 monoclonal antibody (IMX CA-125, Abott Lab. IL) and a value of >20 U/ml was defined as abnormal.

RESULTS

Maternal serum CA-125 levels were significantly higher in the study group than in the control group, 19.8+/-15.9 U/ml and 9.9+/-4.0 U/ml (P=0.015). The difference was even greater when patients with malformed fetuses and hydramnios were compared to those with fetal anomalies and normal amount of amniotic fluid, 32.4+/-12.7 U/ml and 7.2+/-2.1 U/ml, respectively (P=0.0005). The maternal serum CA-125 levels in patients with hydramnios but without fetal anomalies were significantly lower when compared with those of the malformed fetuses and hydramnios, 9.8+/-2.3 U/ml and 32.4+/-12.7 U/ml, respectively (P=0.002).

CONCLUSION

Maternal serum CA-125 is lacking in value for screening fetal structural anomalies as a significant increase in maternal serum CA-125 levels was found only in patients with fetal anomalies accompanied by hydramnios.

Extremely elevated serum CA125 due to endometriosis

Endometriosis can mimic cancer in a pre-menopausal woman (1). In this case an ultrasound showed a complex ovarian cyst with a low resistance blood flow and the serum CA 125 level was 6,114 iu/mL (normal <35), more than twice the highest level previously reported due to benign disease.

Amniotic fluid and maternal serum levels of CA125 in pregnancies affected by Down syndrome: a re-evaluation of the role of CA125 in Down syndrome screening

In a study of amniotic fluid from 91 Down syndrome cases and 240 controls, we have shown that the median value of CA125 in pregnancies affected by Down syndrome on the whole reflects those observed in the maternal serum from 106 affected cases and 238 controls. The median MOM for CA125 in amniotic fluid from Down syndrome pregnancies was 1.04 and in maternal serum 1.06, neither value being significantly different from that for the control population. We confirm our previous observation that CA125 is not a marker of Down syndrome and conclude that CA125 has no role to play in Down syndrome screening.

Maternal serum CA 125 levels in first trimester abortion

OBJECTIVE

To assess the source of maternal serum CA 125 during the first trimester of pregnancy.

STUDY DESIGN

CA 125 was measured in stored samples from nonviable pregnancies of 8-13 weeks gestation. The study group comprised 19 women with vaginal bleeding and 13 non-bleeders. Only patients in whom chromosome analysis of the products of conception demonstrated a normal caryotype were included. CA 125 levels were expressed in multiples of the median (MoM) for normal pregnancies of the same gestational age.

RESULTS

Median MoM values of CA 125 were significantly higher in women with vaginal bleeding (1.81 MoM) as compared both to non-bleeders (0.82 MoM; p < 0.01-Mann-Whitney U-test) and to the normal pregnancies (1.01 MoM; p < 0.05). No significant difference was found between non-bleeding women and controls.

CONCLUSIONS

The present study indicates that in non-viable pregnancies with euploid fetuses an increase in maternal serum CA 125 levels was found only in presence of decidual disruption associated to vaginal bleeding. These findings are compatible with a prevalent decidual source of this antigen.

Serum CA 125 levels and spontaneous abortion

OBJECTIVE

Previous reports have suggested that serum CA 125 levels in patients who spontaneously abort in the first trimester of pregnancy differ from the levels of patients who successfully complete their pregnancies. Low CA 125 levels have been suggested to predict spontaneous abortion, although an increased rate of first-trimester spontaneous abortion has also been reported in women with elevated CA 125 levels early in pregnancy. The purpose of this study was to prospectively compare serum CA 125 levels of women who abort in the first trimester with levels of those women whose pregnancies progress beyond 12 gestational weeks.

STUDY DESIGN

A total of 188 pregnant patients had weekly serum CA 125 levels obtained after a prepregnancy baseline value was determined. Levels of the antigen in women who ultimately had a first-trimester spontaneous abortion were compared with CA 125 levels from women whose pregnancies continued past the first trimester.

RESULTS

There was no statistically significant difference in the CA 125 levels of patients who aborted compared with those of women whose pregnancies continued. In addition, among patients with CA 125 values > 150 U/ml there was also no statistically significant difference in the proportion of patients who aborted compared with controls.

CONCLUSION

Serum CA 125 levels are not predictive of spontaneous abortion in the first trimester of pregnancy.

Maternal serum CA 125 levels in pregnancies with chromosomally-normal and -abnormal fetuses. Dutch Working Party on Prenatal Diagnosis

We measured the maternal serum cancer antigen 125 (MS-CA 125) levels in 98 nonpregnant women, 765 first- and second-trimester pregnancies with chromosomally-normal fetuses, and 54 chromosomally-abnormal pregnancies. To determine the MS-CA 125 concentration, we used a new automated microparticle enzyme immunoassay with low inter-assay variability. The median MS-CA 125 level decreased from the first to the second trimester of pregnancy and was higher than that in non-pregnant women. We found no difference between normal and Down's syndrome (n = 29) pregnancies (t-test: t = 0.57, p > 0.5). The MS-CA 125 levels in pregnancies with other chromosomal abnormalities showed no difference either, compared with the normals. We conclude that MS-CA 125 is not a useful marker for fetal Down's syndrome, nor for other chromosomal disorders in pregnancy.

Abnormal amniotic fluid levels of CA 125 in second-trimester Down syndrome pregnancies

The aim of this study was to evaluate the concentration of CA 125 in second trimester amniotic fluid from Down syndrome pregnancies. CA 125 was measured in stored amniotic fluid samples from pregnancies of 14-19 weeks' gestation with and without Down syndrome fetuses. CA 125 levels were expressed in multiples of the median (MOM) for normal pregnancies of the same gestational age. Twenty-one pregnancies with Down syndrome fetuses and 63 unaffected controls matched for maternal age, gestational age, and duration of storage were studied. The median MOM values of the affected pregnancies were significantly higher than those of the controls (1.41 MOM versus 0.99 MOM). These findings show that there is an increased concentration of CA 125 in second-trimester amniotic fluid from Down syndrome pregnancies.

Second-trimester cancer antigen 125 and Down's syndrome

This study explores if assay of cancer antigen 125 (CA 125) in maternal serum might aid the detection of Down's syndrome in the second trimester of pregnancy. CA 125 levels were determined retrospectively in stored maternal serum samples from ten Down's syndrome pregnancies and 78 controls matched for gestational and maternal age. In addition, second-trimester amniotic fluid samples from nine Down's syndrome and 109 unaffected pregnancies were analysed for CA 125. Maternal serum CA 125 values for Down's syndrome pregnancies were lower, with the median being 0.72 multiples of the unaffected population median. The medians for affected and unaffected pregnancies did not differ significantly and there was a considerable overlap in the range of values of cases and controls. The distribution of amniotic fluid CA 125 levels for Down's syndrome pregnancies resembled that for controls. From our present results, we could not find an association between Down's syndrome and second-trimester maternal serum or amniotic fluid CA 125 levels.

Maternal serum CA 125 for aneuploidy detection in early pregnancy

Maternal serum CA 125 levels were determined at 9-11 menstrual weeks for 26 cases of trisomy 13 (n = 4), trisomy 18 (n = 7), trisomy 21 (n = 15), and appropriate controls. There were no statistically significant differences between groups.

CA-125 as a maternal serum marker for Down's syndrome in the first and second trimesters

CA-125, alpha-fetoprotein (AFP), and human chorionic gonadotropin (HCG) were determined in maternal serum in the first trimester from 14 women with a Down's syndrome fetus and 61 women with a healthy fetus. In the second trimester, 15 and 60 serum samples were determined from women with a Down's syndrome and a healthy fetus respectively. In both trimesters, maternal serum CA-125 was found to be elevated in Down's syndrome pregnancies compared with controls. Using discrimination functions, our preliminary results indicate that CA-125 is a better marker than AFP and HCG respectively for a Down's syndrome fetus in the first trimester and improves the detection rate in the second trimester.

Amniotic fluid levels of human chorionic gonadotropin and its alpha and beta subunits in second-trimester chromosomally abnormal pregnancies

Amniotic fluid from 135 pregnancies was assayed for human chorionic gonadotropin (hCG) and its free alpha (ahCG) and free beta (bhCG) subunits. Forty-six chromosomally abnormal pregnancies between 14 and 20 weeks' gestation were matched with 89 chromosomally normal samples. Compared with controls, trisomy 21 pregnancies exhibited significantly elevated levels of all three peptides, whereas trisomy 18 gestations gave rise only to significant elevation of ahCG. Female fetuses in both the trisomy 21 and trisomy 18 pregnancies provided significantly elevated levels of hCG and bhCG compared to their male counterparts. On converting the values to multiples of the median, it was determined that 6 of 7 trisomy 18 samples had abnormally elevated alpha/beta ratios, as did 6 of 21 Down's syndrome pregnancies. Further, 11 of 21 trisomy 21 gestations had abnormal amniotic fluid hCG levels. Using only ahCG, bhCG and their ratio, a 61 per cent sensitivity was found for these trisomies, with a 96 per cent specificity.

Extreme elevation of serum CA-125 in two women with severe endometriosis: case report

Two women with elevated preoperative serum CA-125 levels were found to have extensive endometriosis - one, the highest level related to endometriosis ever reported in the English literature. Endometriosis was found to be etiologic as seen by the prompt reduction in serum CA-125 levels following surgical treatment limited to endometriosis. Thus, a very high CA-125 level does not necessarily forebode ovarian malignancy.