불량한 임신 결과 예측을 위한 임신중기 산모 혈청 inhibin-A 측정의 연관성 = The association between adverse pregnancy outcomes and the serum inhibin A Levels in mid-trimester of gestation

다국어 초록 (Multilingual Abstract)

Objectives: To investigate the association between abnormal inhibin-A level in Quad test during the 15 and 18 weeks of gestation and adverse pregnancy outcomes. Methods: From January 2005 to March 2007, women who delivered their babies at our institute after Quad test in second trimester of gestation (N=140) were enrolled. We measured inhibin-A levels (MoM) and other serum markers of the Quad test. And we analyzed the incidence of adverse pregnancy outcomes such as preterm birth, fetal growth restriction, pregnancy induced hypertension, fetal loss, and intrauterine fetal death. Results: When the pregnancy outcomes are hypertensive disorders and fetal losses, the inhibin-A levels are is more elevated with statistically significance. Inhibin-A and hCG levels are elevated with significantly at hypertensive disorders and fetal losses. But inhibin-A levels are more significantly associated with abnormal pregnancy outcomes than hCG. Conclusions: Measurement of inhibin-A levels may be the most useful among other serum markers of the Quad test in predicting adverse obstetric outcomes.

참고문헌 (Reference)

1 서용수, "전자간증의 발생 시기와 중등도에 따른임신중기 삼중표지검사 수치의 변화" 대한산부인과학회 49 (49): 1035-1042, 2006

2 이경훈, "임신주수에 따른 신생아 체중 변화" 대한산부인과학회 44 (44): 1851-1856, 2001

3 김현수, "임신성 고혈압의 예측 지표로서 임신중기에 증가된 융모성 성선 자극 호르몬의 임상적 유용성" 42 : 85-89, 1999

4 Jauniaux E, "Trophoblastic oxidative stress in relation to temporal and regional differences in maternal placental blood flow in normal and abnormal early pregnancies" 162 : 115-125, 2003

5 Kim SY, "The prediction of adverse pregnancy outcome using low unconjugated estriol in the second trimester of pregnancy without risk of Down’s syndrome" 41 : 226-229, 2000

6 Muttukrishna S, "Serum inhibin A and activin A are elevated prior to the onset of pre-eclampsia" 15 : 1640-1645, 2000

7 Yaron Y, "Second-trimester maternal serum marker screening: maternal serum alpha-fetoprotein, beta human chorionic gonadotropin, estriol, and their various combinations as predictors of pregnancy outcome" 181 : 968-974, 1999

8 Muttukrishna S, "Role of inhibin in normal and high-risk pregnancy" 22 : 227-234, 2004

9 Sebire NJ, "Raised maternal serum inhibin A concentration at 10 to 14 weeks of gestation is associated with pre-eclampsia" 107 : 795-797, 2000

10 Dugoff L, "Quad screen as a predictor of adverse pregnancy outcome" 106 : 260-267, 2005

11 Wald NJ, "Prenatal screening for Down’s syndrome using inhibin-A as a serum marker" 16 : 143-153, 1996

12 Bersinger NA, "Pregnancy-associated and placental proteins in the placental tissue of normal and preeclamptic women at delivery" 147 : 785-793, 2002

13 Florio P, "Preeclampsia with fetal growth restriction: placental and serum activin A and inhibin A levels" 16 : 365-372, 2002

14 Lockwood GM, "Muttukrishna S. Measurement of inhibin and activin in early human pregnancy: Demonstration of fetoplacental origin and role in prediction of early-pregnancy outcome" 57 : 1490-1494, 1997

15 Silver HM, "Mechanism of increased maternal serum total activin A and inhibin A in preeclampsia" 9 : 308-312, 2002

16 Ledger WL, "Measurement of inhibin A and activin A in pregnancy – possible diagnostic applications" 180 : 117-121, 2001

17 Jauniaux E, "Maternal serum testing for alpha-fetoprotein and human chorionic gonadotropin in high risk pregnancies" 16 : 1129-1135, 1996

18 Simpson JL, "Maternal serum alpha-fetoprotein screening: low and high values for detection of genetic abnormalities" 155 : 593-597, 1986

19 Canick JA, "Low second trimester maternal serum unconjugated oestriol in pregnancies with Down’s syndrome" 95 : 330-333, 1988

20 Casagrandi D, "Inhibin, activin, follistatin, activin receptors and betaglycan gene expression in the placental tissue of preeclampsia patients" 9 : 199-203, 2003

21 Petraglia F, "Inhibin, activin and follistatin in the human placenta – a new family of regulatory proteins" 18 : 3-8, 1997

22 Hung TH, "In vitro ischemia-reperfusion injury in term human placenta as a model for oxidative stress in pathological pregnancies" 159 : 1031-1043, 2001

23 Hustin J, "Histological study of the materno-embryonic interface in spontaneous abortion" 11 : 477-486, 1990

24 Wald NJ, "First and second trimester antenatal screening for Down’s syndrome: the results of the Serum, Urine and Ultrasound Screening Study (SURUSS)" 10 : 56-104, 2003

25 Sorensen TK, "Elevated second trimester human chorionic gonadotropin and subsequent pregnancy induced hypertension" 169 : 834-838, 1993

26 Aquilina J, "Correlation between second trimester maternal serum inhibin-A and human chorionic gonadotropin for the prediction of pre-eclampsia" 21 : 487-492, 2000

27 Lambert-Messerlian GM, "Clinical application of inhibin A measeurement: Prenatal serum screening for Down syndrome" 22 : 235-242, 2004

28 Lepage N, "Association between second-trimester isolated high maternal serum human chorionic gonadotropin levels and obstetric complications in singleton and twin pregnancies" 188 : 1354-1359, 2003

29 Merkatz IR, "An association between low maternal serum alpha-fetoprotein and fetal chromosomal abnormalities" 148 : 886-894, 1984

30 Lieppman RE, "An association between elevated levels of human chorionic gonadotropin in the midtrimester and adverse pregnancy outcome" 68 (68): 1852-1857, 1993

31 Muttukrishna S, "Activin A and Inhibin A as possible endocrine markers for preeclampsia" 349 : 1285-1288, 1997

32 Ilagan JG, "Abnormal multiple marker screens are associated with adverse perinatal outcomes in cases of intrauterine growth restriction" 191 : 1465-1469, 2004

33 Bogart MH, "Abnormal maternal serum chorionic gonadotropin levels in pregnancies with fetal chromosome abnormalities" 7 : 623-630, 1987

34 "ACOG educational bulletin. Maternal serum screening. Number 228, September 1996 (replaces no. 154, April 1991). Committee on Educational Bulletins of the American College of Obstetricians and Gynecologists" 55 : 299-308, 1996