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Abstract
Meta-analysis (forest) plots are widely used to show the results from multiple individual randomized trials or observational studies that address the same question, including the assessment of screening markers. They show the between study spread of results and provide a summary estimate of the results from all the studies combined. We here illustrate the advantage of ordering study results by the magnitude of the effect and including a vertical shaded band encompassing the summary 95% confidence interval of the summary estimate to emphasize the uncertainty of the estimate in a way that is more prominent than only displaying a "diamond" around its value.
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Affiliation(s)
- N J Wald
- Wolfson Institute of Preventive Medicine, Barts and the London, School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ
| | - J P Bestwick
- Wolfson Institute of Preventive Medicine, Barts and the London, School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ
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2
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Abstract
Inhibins are gonadal peptide hormones belonging to the transforming growth factor-β (TGF-β) superfamily that regulate the pituitary follicle stimulating hormone (FSH) secretion by negative feedback mechanisms. It is evident that the understanding of inhibins function in the hypothalamic-pituitary-gonadal axis will provide insights into physiology and pathology of the gonadal function. In recent years, a great deal of attention has been focussed on clinical relevance of measuring circulating inhibins in normal and disease state. The past few years also have witnessed the emergence and discovery of extra pituitary action of inhibins that might provide further insights into the underlying diseases like cancer especially in the reproductive axis and various other new endocrine target organs. In this review after systematic analysis of literature, we discuss briefly the known and recent advances in function of these hormones highlighting also its structure, production and mechanisms of signal transduction. Also this review discusses about the physiological relevance of inhibin association in the normal function to the development of reproductive cancers. Finally, we describe evidence from various emerging studies that inhibins make an important contribution to other physiological functions apart from reproduction which reveals new endocrine target organs of inhibins. The emerging view is inhibin participates in multiple ways to regulate the function in different cell types and still complete repertoire of its actions is under investigation.
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Affiliation(s)
- Padmanaban S Suresh
- Centre for Biomedical Research, Vellore Institute of Technology (VIT) University, Vellore, India.
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Complete trisomy 21 vs translocation Down syndrome: a comparison of modes of ascertainment. Am J Obstet Gynecol 2010; 203:391.e1-5. [PMID: 20691415 DOI: 10.1016/j.ajog.2010.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 04/30/2010] [Accepted: 06/07/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the indications for invasive prenatal testing resulting in the detection of translocation Down syndrome and complete trisomy 21. STUDY DESIGN This case control study was based on a large amniocentesis and chorionic villi samples database (n = 534,795). All specimens with translocation Down syndrome (n = 203) comprised the translocation group and were compared with a maternal age-matched group (4 to 1, n = 812) in which complete trisomy 21 was detected. Women with a normal karyotype were randomly selected (n = 812) and served as controls. Indications for invasive testing were compared among the 3 paired groups using χ(2) analysis. RESULTS There were no differences in the incidence of abnormal first- and second-trimester screening tests between the translocation Down syndrome and the complete trisomy 21 groups. History of prior aneuploidy was significantly more frequent in the translocation Down syndrome group, as compared with either complete trisomy 21 fetuses or normal controls. CONCLUSION Fetuses with translocation Down syndrome present with the same screening abnormalities as fetuses with complete trisomy 21.
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Bornstein E, Lenchner E, Donnenfeld A, Kapp S, Keeler SM, Divon MY. Comparison of modes of ascertainment for mosaic vs complete trisomy 21. Am J Obstet Gynecol 2009; 200:440.e1-5. [PMID: 19318154 DOI: 10.1016/j.ajog.2009.01.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 12/29/2008] [Accepted: 01/20/2009] [Indexed: 01/02/2023]
Abstract
OBJECTIVE We sought to compare the indications for amniocentesis leading to the detection of either mosaicism of trisomy 21 (mosaic-T21) or complete trisomy 21 (T21). STUDY DESIGN A retrospective review of a large amniocentesis database (n = 494,163) was conducted. All specimens with mosaic-T21 (n = 124) were compared with a maternal age-matched group of T21 fetuses (n = 496). Samples with normal karyotypes were matched for maternal age and served as normal controls (n = 496). The chi(2) testing was used for statistical analysis. RESULTS The presence of an abnormal first-trimester screen, abnormal sonographic findings, and specifically the single sonographic abnormalities of either a cystic hygroma or a cardiac anomaly were significantly less common in the mosaic-T21 as compared with the T21 group. There were no such differences between the mosaic-T21 and the normal control group. CONCLUSION Fetuses with mosaic-T21, similar to those with normal karyotype, do not present with the same abnormal screening tests as fetuses with T21.
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St-Jacques S, Grenier S, Charland M, Forest JC, Rousseau F, Légaré F. Decisional needs assessment regarding Down syndrome prenatal testing: a systematic review of the perceptions of women, their partners and health professionals. Prenat Diagn 2009; 28:1183-203. [PMID: 19097031 DOI: 10.1002/pd.2059] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify decisional needs of women, their partners and health professionals regarding prenatal testing for Down syndrome through a systematic review. METHODS Articles reporting original data from real clinical situations on sources of difficulty and/or ease in making decisions regarding prenatal testing for Down syndrome were selected. Data were extracted using a taxonomy adapted from the Ottawa Decision-Support Framework and the quality of the studies was assessed using Qualsyst validated tools. RESULTS In all 40 publications covering 32 unique studies were included. The majority concerned women. The most often reported sources of difficulty for decision-making in women were pressure from others, emotions and lack of information; in partners, emotion; in health professionals, lack of information, length of consultation, and personal values. The most important sources of ease were, in women, personal values, understanding and confidence in the medical system; in partners, personal values, information from external sources, and income; in health professionals, peer support and scientific meetings. CONCLUSION Interventions regarding a decision about prenatal testing for Down syndrome should address many decisional needs, which may indeed vary among the parties involved, whether women, their partners or health professionals. Very little is known about the decisional needs of partners and health professionals.
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Affiliation(s)
- Sylvie St-Jacques
- The CanGèneTest Research Consortium on Genetic Laboratory Services and Centre de recherche du CHUQ-HSFA, Québec City, Québec, Canada.
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Odibo AO, Stamilio DM, Nelson DB, Sehdev HM, Macones GA. A Cost-Effectiveness Analysis of Prenatal Screening Strategies for Down Syndrome. Obstet Gynecol 2005; 106:562-8. [PMID: 16135588 DOI: 10.1097/01.aog.0000174581.24338.6f] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate which Down syndrome screening strategy is the most cost-effective. METHODS Using decision-analysis modeling, we compared the cost-effectiveness of 9 screening strategies for Down syndrome: 1) no screening, 2) first-trimester nuchal translucency (NT) only, 3) first-trimester combined NT and serum screen, 4) first-trimester serum only, 5) quadruple screen, 6) integrated screening, 7) sequential screening, 8) integrated serum only, or 9) maternal age. Costs included cost of tests and resources used for raising a child with Down syndrome. One-way and multiway sensitivity analyses were performed for all model variables. The main outcome measures were cost per Down syndrome case detected, rate of delivering a liveborn neonate with Down syndrome, and rate of diagnostic procedure-related pregnancy loss for each strategy. RESULTS Sequential screening detected more Down syndrome cases compared with the other strategies, but it had a higher procedure-related loss rate. Integrated serum screening was the most cost-effective strategy. Sensitivity analyses revealed the model to be robust over a wide range of values for the variables. The addition of the cost of genetic sonogram to the second-trimester strategies resulted in first-trimester combined screening becoming the most cost-effective strategy. CONCLUSION Within our baseline assumptions, integrated serum screening was the most cost-effective screening strategy for Down syndrome. If the cost of nuchal translucency is less than dollars 57 or when genetic sonogram is included in the second-trimester strategies, first-trimester combined screening became the most cost-effective strategy. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anthony O Odibo
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Philadelphia, Pennsylvania 19104, USA.
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Biggio JR, Morris TC, Owen J, Stringer JSA. An outcomes analysis of five prenatal screening strategies for trisomy 21 in women younger than 35 years. Am J Obstet Gynecol 2004; 190:721-9. [PMID: 15042005 DOI: 10.1016/j.ajog.2003.09.028] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study was undertaken to examine the cost-effectiveness and procedural-related losses associated with 5 prenatal screening strategies for fetal aneuploidy in women under 35 years old. STUDY DESIGN Five prenatal screening strategies were compared in a decision analysis model: triple screen: maternal age and midtrimester serum alpha-fetoprotein, human chorionic gonadotropin (hCG), and unconjugated estriol; quad screen: triple screen plus serum dimeric inhibin A; first-trimester screen: maternal age, serum pregnancy-associated plasma protein A and free beta-hCG and fetal nuchal translucency at 10 to 14 weeks' gestation; integrated screen: first-trimester screen plus quad screen, but first-trimester results are withheld until the quad screen is completed when a composite result is provided; sequential screen: first-trimester screen plus quad screen, but the first-trimester screen results are provided immediately and prenatal diagnosis offered if positive; later prenatal diagnosis is available if the quad screen is positive. Model estimates were literature derived, and cost estimates also included local sources. The 5 strategies were compared for cost, the numbers of Down syndrome fetuses detected and live births averted, and the number of procedure-related euploid losses. Sensitivity analyses were performed for parameters with imprecise point estimates. RESULTS In the baseline analysis, sequential screening was the least expensive strategy ($455 million). It detected the most Down syndrome fetuses (n=1213), averted the most Down syndrome live births (n=678), but led to the highest number of procedure-related euploid losses (n=859). The integrated screen had the fewest euploid losses (n=62) and averted the second most Down syndrome live births (n=520). If fewer than 70% of women diagnosed with fetal Down syndrome elect to abort, the quad screen became the least expensive strategy. CONCLUSION Although sequential screening was the most cost-effective prenatal screening strategy for fetal trisomy 21, it had the highest procedure-related euploid loss rate. The patient's perspective on detection versus fetal safety may help define the optimal screening strategy.
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Affiliation(s)
- Joseph R Biggio
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine and Reproductive Genetics, University of Alabama at Birmingham, Ala, USA
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Affiliation(s)
- Stephen Tong
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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Azuma M, Yamamoto R, Wakui Y, Minobe S, Satomura S, Fujimoto S. A novel method for the detection of Down syndrome with the use of four serum markers. Am J Obstet Gynecol 2002; 187:197-201. [PMID: 12114910 DOI: 10.1067/mob.2002.123201] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the use of the Lens culinaris agglutinin-reactive alpha-fetoprotein ratio for the detection of fetal Down syndrome in combination with traditional serum markers. STUDY DESIGN We obtained maternal serum from 530 women with unaffected pregnancies and 31 women who were pregnant with a fetus with Down syndrome at 14 to 20 weeks of gestation. Various combinations of Lens culinaris agglutinin-reactive alpha-fetoprotein ratio, alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol were evaluated by score, without regard for the maternal age-related fetal Down syndrome risk. RESULTS The best combination of serum markers, according to our scoring method, was a combination of all 4 markers. This combination showed a sensitivity of 83.9%, with a 5.1% false-positive rate for Down syndrome. Moreover, in older women, high sensitivity was obtained without increasing the false-positive rate. CONCLUSION The screen using all 4 markers showed high sensitivity in all age groups without increasing the false-positive rate.
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Affiliation(s)
- Masaki Azuma
- Department of Obstetrics and Gynecology, Hokkaido University School of Medicine, Sapporo, Japan
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Reis FM, D'Antona D, Petraglia F. Predictive value of hormone measurements in maternal and fetal complications of pregnancy. Endocr Rev 2002; 23:230-57. [PMID: 11943744 DOI: 10.1210/edrv.23.2.0459] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intrauterine tissues (placenta, amnion, chorion, decidua) express hormones and cytokines that play a decisive role in maternal-fetal physiological interactions. The excessive or deficient release of some placental hormones in association with gestational diseases may reflect an abnormal differentiation of the placenta, an impaired fetal metabolism, or an adaptive response of the feto-placental unit to adverse conditions. This review is focused on the applicability of hormone measurements in the risk assessment, early diagnosis, and management of pregnancies complicated by Down's syndrome, fetal growth restriction, preeclampsia, preterm delivery, and diabetes mellitus. Combined hormonal tests or the combination of hormones and ultrasound may achieve reasonable sensitivity, but research continues to simplify the screening programs without sacrificing their accuracy. Only in a few instances is there sufficient evidence to firmly recommend the routine use of hormone tests to predict maternal and fetal complications, but the judicious use of selected tests may enhance the sensitivity of the risk assessment based solely on clinical and ultrasound examination.
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Affiliation(s)
- Fernando M Reis
- Department of Obstetrics and Gynecology, University of Minas Gerais, Belo Horizonte 30130-100, Brazil
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Florio P, Cobellis L, Luisi S, Ciarmela P, Severi FM, Bocchi C, Petraglia F. Changes in inhibins and activin secretion in healthy and pathological pregnancies. Mol Cell Endocrinol 2001; 180:123-30. [PMID: 11451581 DOI: 10.1016/s0303-7207(01)00503-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Inhibin-related proteins are involved in the control of the feto-maternal communication required to maintain pregnancy. Human placenta, decidua, and fetal membranes are the major sites of production and secretion of activin A, inhibin A and inhibin B in maternal serum, amniotic fluid, and cord blood. The availability of suitable assays developed in the last years has enabled the measurement of inhibins and activin A in their dimeric forms, in order to investigate their role in physiological conditions of pregnancy. The studies conducted on inhibin-related proteins and human pregnancy suggested the possibility of an involvement of inhibin A and activin A in the pathogenesis of gestational diseases. In fact, several lines of evidence underline the potential role and the clinical usefulness of inhibin-related proteins measurement in the diagnosis, prevention, prognosis and follow-up of different gestational pathologies such as early pregnancy viability, Down's syndrome, fetal demise, pre-eclampsia, pregnancy-induced hypertension, preterm delivery and intrauterine growth restriction. The measurement of inhibin A and activin A into the biological fluids of pregnancy will offer in the future, further possibilities in the early diagnosis, prediction, and monitoring diseases of pregnancy.
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Affiliation(s)
- P Florio
- Department of Obstetrics and Gynecology, University of Siena, Policlinico "Le Scotte", Viale Bracci, 53100, Siena, Italy
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Akbas SH, Ozben T, Alper O, Ugur A, Yücel G, Lüleci G. Maternal serum screening for Down's syndrome, open neural tube defects and trisomy 18. Clin Chem Lab Med 2001; 39:487-90. [PMID: 11506458 DOI: 10.1515/cclm.2001.080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Maternal serum screening identifies women at an increased risk of a pregnancy with Down's syndrome or trisomy 18 or an open neural tube defect. The triple test, consisting of maternal serum alpha-fetoprotein, unconjugated estriol and human chorionic gonadotropin was carried out by a chemiluminescence immunoassay method in our laboratory. The study consisted of 373 pregnant women. The gestational range for the study group was 14-22 weeks. The mean maternal age for the study group was 28.53 +/- 5.46 years (range 17.4 to 43.5 years); 9.1% of the women were considered at high risk for Down's syndrome based on the test results. In our study the detection rate for Down's syndrome by prenatal karyotyping was 66.6%. Maternal serum screening allows reduction of the number of women requiring amniocentesis without a significant decrease in the detection rate.
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Affiliation(s)
- S H Akbas
- Department of Biochemistry, Akdeniz University, Faculty of Medicine, Antalya, Turkey
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Wald NJ, Hackshaw AK. Advances in antenatal screening for Down syndrome. Best Pract Res Clin Obstet Gynaecol 2000; 14:563-80. [PMID: 10985931 DOI: 10.1053/beog.2000.0097] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Antenatal screening for Down Syndrome using maternal age alone is no longer an adequate standard of care. Screening in the early second trimester of pregnancy (between 15 and 20 weeks of pregnancy) using the quadruple test can identify 76% of affected pregnancies with a 5% false-positive rate. Screening in the first trimester of pregnancy (between 10 and 13 weeks of pregnancy) is possible using two biochemical markers (PAPP-A and free beta-hCG) together with an ultrasound marker nuchal translucency measurement; using these three markers together with maternal age can identify 85% of affected pregnancies, with a 5% false-positive rate. While there is debate over issues involved in choosing between first and second trimester screening, the most effective screening test for Down Syndrome is the integrated test based on the integration of the first trimester and the second trimester markers. This has a 94% detection rate for a 5% false-positive rate. If the false-positive rate were set at 1%, the detection rate would be 85%. No other screening test for Down Syndrome can detect such a high proportion of affected pregnancies with such a low false-positive rate.
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Affiliation(s)
- N J Wald
- Department of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, St Bartholomew's and The Royal London School of Medicine and Dentistry, Charterhouse Square, London, EC1M 6BQ, UK
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Affiliation(s)
- N P Groome
- School of Biological and Molecular Sciences, Oxford Brookes University, Headington, UK.
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Wenstrom KD, Owen J, Chu DC, Boots L. Prospective evaluation of free beta-subunit of human chorionic gonadotropin and dimeric inhibin A for aneuploidy detection. Am J Obstet Gynecol 1999; 181:887-92. [PMID: 10521748 DOI: 10.1016/s0002-9378(99)70320-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Our goal was to prospectively evaluate the use of the free beta-subunit of human chorionic gonadotropin and dimeric inhibin A for the detection of fetal Down syndrome and other aneuploidies. STUDY DESIGN Women who had a second-trimester multiple-marker screening test (alpha-fetoprotein, unconjugated estriol, human chorionic gonadotropin) and genetic amniocentesis from August 1996 to August 1998 were included. Serum was also analyzed for inhibin and the free beta-subunit of human chorionic gonadotropin. Detection and false-positive rates for 4 analyte combinations at 5 different screening risk cutoff points for Down syndrome were determined and compared. RESULTS We evaluated 1256 patients, including 23 with aneuploidy (13 with Down syndrome, 10 others). The maternal age was 35.9 +/- 4.6 years (mean +/- SD). At the optimal risk cutoff point for Down syndrome detection (1:190; false-positive rate, 19%), the multiple-marker screening test plus inhibin was superior, detecting 85% of Down syndrome cases, in comparison with 69% when the multiple-marker screening test alone was used and 62% when the other 2 combinations were used. The multiple-marker screening test plus inhibin also detected 60% of the other aneuploidies. CONCLUSIONS When evaluated prospectively in a high-risk population, the multiple-marker screening test plus inhibin was superior to the traditional multiple-marker screening test and 2 other analyte combinations, with a lower false-positive rate and increased detection of all aneuploidies in a high-risk population.
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Affiliation(s)
- K D Wenstrom
- Center for Obstetric Research, Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, USA
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Abstract
Case control studies in the Caucasian population showed that maternal serum inhibin-A is elevated in Down syndrome pregnancies and may be a useful second-trimester marker in addition to human chorionic gonadotrophin (hCG) and alpha-fetoprotein (AFP). Data in the Asian population are lacking. We measured inhibin-A levels in the stored maternal sera of 49 Down syndrome pregnancies and 341 controls with a commercially available assay and expressed them as the multiples of the median of the gestational week. The log means and standard deviations for case and control inhibin-A MOMs were 0.209, 0.226, and 0.002 and 0.177, respectively. Median inhibin-A MOM in Down syndrome cases was elevated to 1.62 (95 per cent confidence interval, 1.29-1.82). 36 per cent of Down syndrome cases were expected to be detected at a 5 per cent false-positive rate. However, inhibin-A MOMs were strongly correlated with hCG MOMs in the cases (r=0.73, p<0.001) and the controls (r=0.56, p<0.001). This will diminish the value of adding inhibin-A to the existing hCG and AFP screening protocol.
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Affiliation(s)
- Y H Lam
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Tsan Yuk Hospital, China.
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Abstract
To assess the effect of smoking on maternal serum, second-trimester inhibin A levels, we studied a database of 1277 women undergoing antenatal serum screening. There were 75 smokers, 1008 non-smokers and 194 women in whom smoking status was undetermined. All groups were matched for age, gestation and parity. The median level of inhibin A in smokers was 1.47 multiples of the normal gestation-specific median (MOM) as compared with 1.01 MOM in non-smokers and 0.95 MOM in the undetermined group. The increase was highly statistically significant (p<0.0001, Wilcoxon rank sum test, two-tail). On the basis of these results we conclude that if inhibin A is used as a marker, adjustment for maternal smoking status may be necessary.
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Affiliation(s)
- E L Ferriman
- Department of Feto-Maternal Medicine, Leeds General Infirmary, UK.
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Wenstrom KD, Chu DC, Owen J, Boots L. Maternal serum alpha-fetoprotein and dimeric inhibin A detect aneuploidies other than Down syndrome. Am J Obstet Gynecol 1998; 179:966-70. [PMID: 9790380 DOI: 10.1016/s0002-9378(98)70198-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Our purpose was to determine whether the combination of maternal serum alpha-fetoprotein, free human chorionic gonadotropin-beta, dimeric inhibin A, and maternal age detects aneuploidies other than Down syndrome. STUDY DESIGN We retrieved stored serum from pregnancies complicated by aneuploidies other than Down syndrome from 1988 to 1997 (n = 55, mean maternal age 35.2 +/- 5.6 years). Alpha-fetoprotein levels were obtained from our database, and free human chorionic gonadotropin-beta and dimeric inhibin A levels were measured in the thawed serum with use of commercial assays. Analyte values were used in both 3-analyte and 2-analyte multiple-marker screening tests; detection rates were determined at several different Down syndrome risk-positive cutoff values. RESULTS In the 3-analyte test 58% (32/55) of all aneuploidies were detected with use of both the Down syndrome protocol at a screen-positive risk cutoff value of 1:300 (false-positive rate 17%) and a novel trisomy 18 screening algorithm. However, 67% (37/55) detection was obtained with use of the 2-analyte combination of alpha-fetoprotein and dimeric inhibin A, with both the Down syndrome protocol (screen positive cutoff value 1:300) and the trisomy 18 algorithm: 12 of 13 trisomy 18 (92%), 9 of 17 Turner's syndrome (53%), 10 of 17 other sex chromosome aneuploidies (59%), 1 of 1 trisomy 22 (100%), and 5 of 7 trisomy 13 (71%). CONCLUSIONS The combination of maternal serum alpha-fetoprotein, dimeric inhibin A, and maternal age detects autosomal trisomies other than Down syndrome at a rate superior to that of the traditional analyte combination.
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Affiliation(s)
- K D Wenstrom
- Center for Obstetric Research, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 35233-7333, USA
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Renier MA, Vereecken A, Buytaert P. Inhibins, activins and follistatins: a review of complex regulators of the reproductive system. EUR J CONTRACEP REPR 1998; 3:129-35. [PMID: 9853204 DOI: 10.3109/13625189809051416] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M A Renier
- Department of Obstetrics and Gynecology, University Hospital of Antwerp, Belgium
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