Association between aneuploidy screening analytes and adverse outcomes in twin gestations

Kelly Yamasato; Aiwa Ono

doi:10.1515/jpm-2023-0499

Article

Association between aneuploidy screening analytes and adverse outcomes in twin gestations

Kelly Yamasato and Aiwa Ono

Published/Copyright: April 19, 2024

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From the journal Journal of Perinatal Medicine Volume 52 Issue 6

Abstract

Objectives

To evaluate associations between serum analytes used for genetic screening and obstetric complications among twin pregnancies.

Methods

This cohort included twins delivered at a tertiary care hospital from 2009 to 2017. Abnormal levels of pregnancy associated plasma protein (PAPP-A), first and second trimester human chorionic gonadotropin (hCG), alpha fetoprotein (AFP), estriol, and inhibin, reported as multiples of the median (MoM), were defined as <5 %ile or >95 %ile for our cohort. Associations between abnormal analytes and preterm delivery, small for gestational age, and pregnancy-associated hypertension were calculated using Fisher’s exact test.

Results

A total of 357 dichorionic/diamniotic and 123 monochorionic/diamniotic twins were included. Among dichorionic/diamniotic twins, elevated AFP (>3.70 MoM) was associated with increased preterm delivery <34 weeks (44.4 vs. 16.5 %, p=0.007), while elevated inhibin (>4.95 MoM) was associated with increased preterm delivery<37 weeks (94.1 vs. 58.8 %, p=0.004). For monochorionic/diamniotic twins, elevated inhibin (>6.34 MoM) was associated increased preterm delivery <34 weeks (66.7 vs. 24.8 %, p=0.04) and hypertension (66.7 vs. 21.4 %, p=0.03).

Conclusions

Selected abnormal analyte levels were associated with increased rates of adverse outcomes in twin pregnancies, which differed by chorionicity. Our findings assist providers in interpreting abnormal analyte levels in twin pregnancies and may help to identify those at increased risk for adverse outcomes.

Keywords: alpha fetoprotein; estriol; human chorionic gonadotropin; inhibin; pregnancy-associated plasma protein A; twin pregnancy

Corresponding author: Kelly Yamasato, MD, Department of Obstetrics, Gynecology, and Women’s Health, University of Hawai’i at Manoa John A Burns School of Medicine, 1319 Punahou Street, #824, Honolulu, HI 96816, USA, Phone: (808) 203 6500, Fax: (808) 955 2174, E-mail: kyamasat@hawaii.edu

Current address: Aiwa Ono, New York – Presbyterian Queens.

Research ethics: This study received exemption from Institutional Board review using guidelines set by the Office of Human Research Protection from the Hawaii Pacific Health Research Institute.
Informed consent: Not applicable (requirement for informed consent was waived).
Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: The authors state no conflict of interest.
Research funding: None declared.
Data availability: The raw data can be obtained on request from the corresponding author.

References

1. American College of Obstetricians and GynecologistsCommittee on GeneticsSociety for Maternal-Fetal Medicine. Screening for fetal chromosomal abnormalities: ACOG practice bulletin, number 226. Obstet Gynecol 2020;136:e48–69. https://doi.org/10.1097/aog.0000000000004084.Search in Google Scholar PubMed

2. Dugoff, L, Society for Maternal Fetal Medicine. First- and second-trimester maternal serum markers for aneuploidy and adverse obstetric outcomes. Obstet Gynecol 2010;115:1052–61. https://doi.org/10.1097/aog.0b013e3181da93da.Search in Google Scholar PubMed

3. American College of Obstetricians and Gynecologists. Multifetal gestations: twin, triplet, and higher-order multifetal pregnancies: ACOG practice bulletin, number 231. Obstet Gynecol 2021;137:e145–62.10.1097/AOG.0000000000004397Search in Google Scholar PubMed

4. American College of Obstetricians and Gynecologists. Gestational hypertension and preeclampsia: ACOG practice bulletin, number 222. Obstet Gynecol 2020;135:e237–60.10.1097/AOG.0000000000003891Search in Google Scholar PubMed

5. Talge, NM, Mudd, LM, Sikorskii, A, Basso, O. United States birth weight reference corrected for implausible gestational age estimates. Pediatrics 2014;133:844–53. https://doi.org/10.1542/peds.2013-3285.Search in Google Scholar PubMed

6. Rosner, JY, Fox, NS, Saltzman, D, Klauser, CK, Rebarber, A, Gupta, S. Abnormal biochemical analytes used for aneuploidy screening and adverse pregnancy outcomes in twin gestations. Am J Perinatol 2015;32:1331–5. https://doi.org/10.1055/s-0035-1564428.Search in Google Scholar PubMed

7. Chasen, ST, Martinucci, S, Perni, SC, Kalish, RB. First-trimester biochemistry and outcomes in twin pregnancy. J Reprod Med 2009;54:312–4.Search in Google Scholar

8. Iskender, C, Tarim, E, Cok, T, Yalcinkaya, C, Kalayci, H, Yanik, FB. Obstetrical complications associated with first-trimester screening markers in twin pregnancies. J Obstet Gynaecol Res 2013;39:1495–9. https://doi.org/10.1111/jog.12091.Search in Google Scholar PubMed

9. Lepage, N, Chitayat, D, Kingdom, J, Huang, T. Association between second-trimester isolated high maternal serum maternal serum human chorionic gonadotropin levels and obstetric complications in singleton and twin pregnancies. Am J Obstet Gynecol 2003;188:1354–9. https://doi.org/10.1067/mob.2003.278.Search in Google Scholar PubMed

Received: 2023-11-29

Accepted: 2024-03-19

Published Online: 2024-04-19

Published in Print: 2024-07-26

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Articles in the same Issue

https://doi.org/10.1515/jpm-2023-0499

Keywords for this article

alpha fetoprotein; estriol; human chorionic gonadotropin; inhibin; pregnancy-associated plasma protein A; twin pregnancy