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Meta-analysis of first trimester Down syndrome screening studies: free beta-human chorionic gonadotropin significantly outperforms intact human chorionic gonadotropin in a multimarker protocol.

AbstractOBJECTIVE:
The purpose of this study was to compare free beta and intact human chorionic gonadotropin in first trimester screening with pregnancy-associated plasma protein-A and nuchal translucency.
STUDY DESIGN:
A Monte Carlo simulation trial was conducted based on a literature review of the PUBMED database (1966 to November 2005).
RESULTS:
In younger patients (< 35 years), detection of Down syndrome increased by 4, 5, 6, and 7 percentage points when free beta was added to pregnancy-associated plasma protein-A and nuchal translucency compared with 0, 0, 2, and 4 percentage points for intact human chorionic gonadotropin at 9-12 weeks' gestation, respectively. In advanced maternal age patients (> or = 35), inclusion of free beta-human chorionic gonadotropin reduced the false-positive rate by 2.5, 3.1, 3.8, and 4.4 percentage points compared with 0.1, 0.3, 1.0, and 2.2 percentage points for intact human chorionic gonadotropin at 9-12 weeks, respectively.
CONCLUSION:
The results of our analysis suggest that in a first-trimester Down syndrome screening protocol free beta-human chorionic gonadotropin achieves higher sensitivity and lower false-positive results than intact human chorionic gonadotropin . Moreover, intact human chorionic gonadotropin does not add substantially to screening performance until the end of the first trimester.
AuthorsMark I Evans, David A Krantz, Terrence W Hallahan, Robert S Galen
JournalAmerican journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 196 Issue 3 Pg. 198-205 (Mar 2007) ISSN: 1097-6868 [Electronic] United States
PMID17346522 (Publication Type: Journal Article, Meta-Analysis)
Chemical References
  • Biomarkers
  • Chorionic Gonadotropin
  • Chorionic Gonadotropin, beta Subunit, Human
  • Pregnancy-Associated Plasma Protein-A
Topics
  • Biomarkers (blood)
  • Chorionic Gonadotropin (blood)
  • Chorionic Gonadotropin, beta Subunit, Human (blood)
  • Clinical Protocols
  • Down Syndrome (diagnosis)
  • Female
  • Humans
  • Pregnancy
  • Pregnancy Trimester, First
  • Pregnancy-Associated Plasma Protein-A (analysis)

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