孕早期母体甲胎蛋白与胎盘介导的妊娠并发症

Maternal First-Trimester Alpha-Fetoprotein and Placenta-Mediated Pregnancy Complications.

作者信息

Melamed Nir, Okun Nanette, Huang Tianhua, Mei-Dan Elad, Aviram Amir, Allen Melinda, Abdulaziz Kasim E, McDonald Sarah D, Murray-Davis Beth, Ray Joel G, Barrett Jon, Kingdom John, Berger Howard

机构信息

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre (N.M., N.O., A.A.), University of Toronto, Toronto, Ontario, Canada.

Department of Genetics, North York General Hospital, Toronto, Ontario, Canada (T.H.).

出版信息

Hypertension. 2023 Nov;80(11):2415-2424. doi: 10.1161/HYPERTENSIONAHA.123.21568. Epub 2023 Sep 6.

DOI:10.1161/HYPERTENSIONAHA.123.21568

PMID:37671572

Abstract

BACKGROUND

Maternal serum markers used for trisomy 21 screening are associated with placenta-mediated complications. Recently, there has been a transition from the traditional first-trimester screening (FTS) that included PAPP-A (pregnancy-associated plasma protein-A) and beta-hCG (human chorionic gonadotropin), to the enhanced FTS test, which added first-trimester AFP (alpha-fetoprotein) and PlGF (placental growth factor). However, whether elevated first-trimester AFP has a similar association with placenta-mediated complications to that observed for elevated second-trimester AFP remains unclear. Our objective was to estimate the association of first-trimester AFP with placenta-mediated complications and compare it with the corresponding associations of second-trimester AFP and other first-trimester serum markers.

METHODS

Retrospective population-based cohort study of women who underwent trisomy 21 screening in Ontario, Canada (2013-2019). The association of first-trimester AFP with placenta-mediated complications was estimated and compared with that of the traditional serum markers. The primary outcome was a composite of stillbirth or preterm placental complications (preeclampsia, birthweight less than third centile, or placental abruption).

RESULTS

A total of 244 990 and 96 167 women underwent FTS and enhanced FTS test screening, respectively. All markers were associated with the primary outcome, but the association for elevated first-trimester AFP (adjusted relative risk [aRR], 1.57 [95% CI, 1.37-1.81]) was weaker than that observed for low PAPP-A (aRR, 2.48 [95% CI, 2.2-2.8]), low PlGF (aRR, 2.28 [95% CI, 1.97-2.64]), and elevated second-trimester AFP (aRR, 1.97 [95% CI, 1.81-2.15]). When the models were adjusted for all 4 enhanced FTS test markers, elevated first-trimester AFP was no longer associated with the primary outcome (aRR, 0.77 [95% CI, 0.58-1.02]).

CONCLUSIONS

Unlike second-trimester AFP, elevated first-trimester AFP is not an independent risk factor for placenta-mediated complications.

摘要

背景

用于21三体综合征筛查的母体血清标志物与胎盘介导的并发症相关。最近，已从包含妊娠相关血浆蛋白A（PAPP-A）和β-人绒毛膜促性腺激素（β-hCG）的传统孕早期筛查（FTS）过渡到增加了孕早期甲胎蛋白（AFP）和胎盘生长因子（PlGF）的强化FTS检测。然而，孕早期AFP升高与胎盘介导的并发症之间的关联是否与孕中期AFP升高时观察到的关联相似仍不清楚。我们的目的是评估孕早期AFP与胎盘介导的并发症之间的关联，并将其与孕中期AFP及其他孕早期血清标志物的相应关联进行比较。

方法

对在加拿大安大略省接受21三体综合征筛查的女性进行基于人群的回顾性队列研究（2013 - 2019年）。评估孕早期AFP与胎盘介导的并发症之间的关联，并与传统血清标志物的关联进行比较。主要结局是死产或早产胎盘并发症（子痫前期、出生体重低于第三百分位数或胎盘早剥）的综合情况。

结果

分别有244990名和96167名女性接受了FTS和强化FTS检测筛查。所有标志物均与主要结局相关，但孕早期AFP升高的关联（调整后相对风险[aRR]，1.57[95%CI，1.37 - 1.81]）弱于低PAPP-A（aRR，2.48[95%CI，2.2 - 2.8]）、低PlGF（aRR，2.28[95%CI，1.97 - 2.64]）以及孕中期AFP升高（aRR，1.97[95%CI，1.81 - 2.15]）。当模型针对所有4种强化FTS检测标志物进行调整后，孕早期AFP升高不再与主要结局相关（aRR，0.77[95%CI，0.58 - 1.02]）。