Am J Perinatol 2019; 36(14): 1459-1463
DOI: 10.1055/s-0038-1677017
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Associations between Maternal AFP and β-HCG and Preterm Birth

Xu Wang*
1   Central Lab, Nanjing Medical University Affiliated Wuxi Maternity and Child Health Care Hospital, Wuxi, China
2   State Key Laboratory of Reproductive Medicine, Institute of Toxicology, School of Public Health, Nanjing Medical University, Nanjing, China
3   Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
,
Ying Chen*
1   Central Lab, Nanjing Medical University Affiliated Wuxi Maternity and Child Health Care Hospital, Wuxi, China
,
Hualong Kuang
2   State Key Laboratory of Reproductive Medicine, Institute of Toxicology, School of Public Health, Nanjing Medical University, Nanjing, China
3   Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
,
Rui Yang
1   Central Lab, Nanjing Medical University Affiliated Wuxi Maternity and Child Health Care Hospital, Wuxi, China
,
Daozhen Chen
1   Central Lab, Nanjing Medical University Affiliated Wuxi Maternity and Child Health Care Hospital, Wuxi, China
,
Ailing Chen
1   Central Lab, Nanjing Medical University Affiliated Wuxi Maternity and Child Health Care Hospital, Wuxi, China
,
Yaling Feng
4   Department of Obstetrics and Gynecology, Nanjing Medical University Affiliated Wuxi Maternity and Child Health Care Hospital, Wuxi, China
,
Jianrong Dai
5   Department of Obstetrics and Gynecology, Nanjing Medical University Affiliated Suzhou Hospital, Suzhou, China
,
Ting Wang
5   Department of Obstetrics and Gynecology, Nanjing Medical University Affiliated Suzhou Hospital, Suzhou, China
,
Yun Wang
5   Department of Obstetrics and Gynecology, Nanjing Medical University Affiliated Suzhou Hospital, Suzhou, China
› Author Affiliations
Funding This work was supported by National Natural Science Foundation (81671473), Medical Science and Technology Projects of Jiangsu Province (BE2016633), and Wuxi Medical Talent Project (ZDRC010, CXTDJS003).
Further Information

Publication History

27 October 2018

02 December 2018

Publication Date:
21 January 2019 (online)

Abstract

Objective Preterm birth (PTB) is a significant public health problem. We aimed to explore whether alpha fetal protein (AFP) or β-human gonadotropin (β-HCG) levels during pregnancy were associated with PTB in Chinese population.

Study Design The clinical data collected Nanjing Medical University Affiliated Suzhou Hospital and Wuxi Maternity and Child Health Care Hospital between January 2006 and December 2011 were analyzed retrospectively. A total of 64,999 pregnant women were registered. In addition, 13,828 pregnant women were collected serum from the second trimester. The maternal serum AFP and β-HCG were measured by enzyme immunoassay.

Results In our study, the rate of PTB is 6.23%. With each unit increase of maternal AFP concentration, the adjusted odds of PTB was increased by 69.3% (odds ratio = 1.693, 95% confidence interval: 1.434–1.999, p = 0.00). We set AFP concentrations as high, medium, and low levels. When comparing with low concentration of AFP, high concentration of AFP (≥1.179 M) was positively associated with PTB with adjustment for potential confounders (p < 0.05). Nevertheless, no statistically significant associations were observed between maternal β-HCG and PTB.

Conclusion In this study, maternal AFP concentration was associated with increased risk of PTB.

Authors' Contributions

Data curation: Hualong Kuang and Ailing Chen; Formal analysis: Xu Wang and Hualong Kuang; Funding acquisition: Ying Chen; Investigation: Ying Chen; Methodolog: Daozhen Chen and Jianrong Dai; Project administration: Ying Chen; Resources: Rui Yang, Yaling Feng, Ting Wang, and Yun Wang; Writing—original draft: Ying Chen; Writing—review and editing: Xu Wang.


* These authors contributed equally to this work.


 
  • References

  • 1 Goldenberg RL, Rouse DJ. Prevention of premature birth. N Engl J Med 1998; 339 (05) 313-320
  • 2 Lawn JE, Cousens S, Zupan J. Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: when? Where? Why?. Lancet 2005; 365 (9462): 891-900
  • 3 Sandeva M, Uchikova E. [Frequency and medical social aspects premature birth]. Akush Ginekol (Sofiia) 2016; 55 (02) 27-33
  • 4 Minguet-Romero R, Cruz-Cruz PdelR, Ruíz-Rosas RA, Hernández-Valencia M. [Incidence of preterm births in the IMSS (2007-2012)]. Ginecol Obstet Mex 2014; 82 (07) 465-471
  • 5 Beck S, Wojdyla D, Say L. , et al. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull World Health Organ 2010; 88 (01) 31-38
  • 6 Chen HJ, Wei KL, Zhou CL. , et al. Incidence of brain injuries in premature infants with gestational age ≤ 34 weeks in ten urban hospitals in China. World J Pediatr 2013; 9 (01) 17-24
  • 7 Androutsopoulos G, Gkogkos P, Decavalas G. Mid-trimester maternal serum HCG and alpha fetal protein levels: clinical significance and prediction of adverse pregnancy outcome. Int J Endocrinol Metab 2013; 11 (02) 102-106
  • 8 Tongprasert F, Wanapirak C, Tongsong T. Maternal serum hCG, PAPP-A and AFP as predictors of hemoglobin Bart disease at mid-pregnancy. Prenat Diagn 2011; 31 (05) 430-433
  • 9 Tongprasert F, Srisupundit K, Luewan S, Tongsong T. Second trimester maternal serum markers and a predictive model for predicting fetal hemoglobin Bart's disease. J Matern Fetal Neonatal Med 2013; 26 (02) 146-149
  • 10 Liao S, Wang Y, Ye G. [AFP, uE3, beta-hCG levels applied for prenatal diagnosis of Down's syndrome]. Zhonghua Fu Chan Ke Za Zhi 1997; 32 (11) 655-658
  • 11 Hsieh TT, Hsu JJ, Cheng PJ, Lee CN, Jou HJ, Chen CP. Total hCG versus free beta-hCG combined with alpha-fetoprotein for Down syndrome screening in Taiwan. Taiwan J Obstet Gynecol 2007; 46 (03) 230-235
  • 12 Nour NM. Premature delivery and the millennium development goal. Rev Obstet Gynecol 2012; 5 (02) 100-105
  • 13 Neggers Y, Goldenberg R, Cliver S, Hauth J. The relationship between psychosocial profile, health practices, and pregnancy outcomes. Acta Obstet Gynecol Scand 2006; 85 (03) 277-285
  • 14 Neveux LM, Palomaki GE, Larrivee DA, Knight GJ, Haddow JE. Refinements in managing maternal weight adjustment for interpreting prenatal screening results. Prenat Diagn 1996; 16 (12) 1115-1119
  • 15 Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371 (9606): 75-84
  • 16 Liu L, Oza S, Hogan D. , et al. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet 2016; 388 (10063): 3027-3035
  • 17 Blencowe H, Cousens S, Oestergaard MZ. , et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 2012; 379 (9832): 2162-2172
  • 18 Ponce NA, Hoggatt KJ, Wilhelm M, Ritz B. Preterm birth: the interaction of traffic-related air pollution with economic hardship in Los Angeles neighborhoods. Am J Epidemiol 2005; 162 (02) 140-148
  • 19 Zou L, Wang X, Ruan Y, Li G, Chen Y, Zhang W. Preterm birth and neonatal mortality in China in 2011. Int J Gynaecol Obstet 2014; 127 (03) 243-247
  • 20 Sayin NC, Canda MT, Ahmet N, Arda S, Süt N, Varol FG. The association of triple-marker test results with adverse pregnancy outcomes in low-risk pregnancies with healthy newborns. Arch Gynecol Obstet 2008; 277 (01) 47-53
  • 21 Simpson JL, Palomaki GE, Mercer B. , et al. Associations between adverse perinatal outcome and serially obtained second- and third-trimester maternal serum alpha-fetoprotein measurements. Am J Obstet Gynecol 1995; 173 (06) 1742-1748
  • 22 Tancrède S, Bujold E, Giguère Y, Renald MH, Girouard J, Forest JC. Mid-trimester maternal serum AFP and hCG as markers of preterm and term adverse pregnancy outcomes. J Obstet Gynaecol Can 2015; 37 (02) 111-116
  • 23 Vogel I, Thorsen P, Curry A, Sandager P, Uldbjerg N. Biomarkers for the prediction of preterm delivery. Acta Obstet Gynecol Scand 2005; 84 (06) 516-525
  • 24 Katz VL, Chescheir NC, Cefalo RC. Unexplained elevations of maternal serum alpha-fetoprotein. Obstet Gynecol Surv 1990; 45 (11) 719-726
  • 25 Yuan W, Chen L, Bernal AL. Is elevated maternal serum alpha-fetoprotein in the second trimester of pregnancy associated with increased preterm birth risk? A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2009; 145 (01) 57-64
  • 26 Beta J, Szekeres-Bartho J, Skyfta E, Akolekar R, Nicolaides KH. Maternal serum progesterone-induced blocking factor at 11-13 weeks' gestation in spontaneous early preterm delivery. Fetal Diagn Ther 2011; 29 (03) 197-200
  • 27 Hsieh TT, Hung TH, Hsu JJ, Shau WY, Su CW, Hsieh FJ. Prediction of adverse perinatal outcome by maternal serum screening for Down syndrome in an Asian population. Obstet Gynecol 1997; 89 (06) 937-940
  • 28 Smith GC, Shah I, Crossley JA. , et al. Pregnancy-associated plasma protein A and alpha-fetoprotein and prediction of adverse perinatal outcome. Obstet Gynecol 2006; 107 (01) 161-166
  • 29 Benn PA, Horne D, Briganti S, Rodis JF, Clive JM. Elevated second-trimester maternal serum hCG alone or in combination with elevated alpha-fetoprotein. Obstet Gynecol 1996; 87 (02) 217-222