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Is an elevated maternal serum uE3 MoM value in the second trimester associated with a poor pregnancy outcome?

OBJECTIVE: To determine if a maternal serum uE3 value ≥ 5.00 multiples of the median (MoM) is a useful predictor of a poor pregnancy outcome.METHODS: Between 11/1/93 & 6/1/99, 78,575 women underwent 2nd trimester maternal serum screening using alpha fetoprotein (AFP), human chorionic gonadotropin (hCG) and unconjugated estriol (uE3) levels. After eliminating women who had an increased risk for Down syndrome, open neural tube defects, or Trisomy 18 from the study population, 58 women were identified with an uE3 value ≥ 5.00 MoM. Of these 58 women, 28 women were of more advanced gestational age and 5 women were found to be carrying a multiple gestation. Of the remaining 25 women, 11 women with a maternal serum uE3 value a 5.00 MoM had a normal pregnancy and outcome. Four women were lost to follow-up. Ten women were found to have an abnormal outcome. Abnormal outcomes included preterm delivery (≤ 37 weeks gestation) (n=7), fetal demise (n=2), and birth defects noted at delivery (n=1). The 10 women with abnormal outcomes were matched for race, gestation, and date of screening with women who had a normal 2nd trimester maternal serum screen. A relative risk (RR) for pregnancy complications was determined.RESULTS: A maternal serum uE3 value ≥ 5.00 MoM was associated with a poor pregnancy outcome (RR 53.6 [confidence interval 6.2-463] with a p<0.0001).CONCLUSIONS: Although our sample size is small, maternal serum uE3 values ≥ 5.00 MoM in the 2nd trimester appear to be associated with an increased risk for a poor pregnancy outcome. Due to the limited number of cases reported, this association between an uE3 MoM value ≥ 5.00 and poor pregnancy outcome warrants further investigation.