The effect of maternal alcohol and drug abuse on first trimester screening analytes: a retrospective cohort study
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(2020) 20:562
RESEARCH ARTICLE
Open Access
The effect of maternal alcohol and drug abuse on first trimester screening analytes: a retrospective cohort study Anni Lehikoinen1,2*, Raimo Voutilainen1,2, Jarkko Romppanen3 and Seppo Heinonen4,5,6
Abstract Background: The purpose of this study was to determine whether first trimester trisomy screening (FTS) parameters are affected by alcohol and drug use. Methods: A routine combined FTS including measurements of maternal serum levels of free β-human chorionic gonadotropin subunit (free β-hCG) and pregnancy-associated plasma protein A (PAPP-A) were measured at 9–11 weeks of gestation, and fetal nuchal translucency thickness (NTT) at 11–13 weeks of gestation. In total 544 women with singleton pregnancies [71 alcohol and drug abusers, 88 smokers, 168 non-smokers delivering a small for gestational age (SGA) child, and 217 unexposed control women] were assessed. Results: Free β-hCG levels were higher in alcohol and drug abusing than in unexposed pregnant women [mean 1.5 vs. 1.2 multiples of medians (MoM); P = 0.013]. However, stepwise multiple linear regression analyses suggested that smoking could explain increased free β-hCG. Additionally, we observed lower PAPP-A levels in the smoking mothers (0.9 vs. 1.2 MoM; P = 0.045) and in those giving birth to an SGA child compared to the controls (1.1 vs.. 1.2 MoM; P < 0.001). Fetal NTT did not differ significantly between any of the groups. Conclusions: The present study shows increased free β-hCG levels in alcohol and drug abusers, but maternal smoking may explain the result. Maternal serum PAPP-A levels were lower in smoking than non-smoking mothers, and in mothers delivering an SGA child. However, FTS parameters (PAPP-A, free β-hCG and NTT) seem not to be applicable for the use as alcohol biomarkers because of their clear overlap between alcohol abusers and healthy controls. Keywords: First trimester screening, PAPP-A, free β-hCG, nuchal translucency, alcohol, smoking, small for gestational age
Synopsis Higher free β-hCG levels and unaltered PAPP-A levels were found in alcohol-abusing pregnant mothers. Prevalent smoking among the alcohol and drug abusing mothers may explain partly the higher free β-hCG levels. * Correspondence: [email protected] 1 Department of Pediatrics, Kuopio University Hospital, P.O. Box 100, 70029 Kuopio, Finland 2 Department of Pediatrics, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland Full list of author information is available at the end of the article
Background One of the challenges for accurate detection and timely treatment of children with fetal alcohol exposure is the difficulty to confirm alcohol exposure during pregnancy, because we lack a reliable biomarker of alcohol abuse [1–3]. The use of available biomarkers of alcohol consumption are hampered by a number of problems: the time window for detection of alcohol use is not sufficient, the biomarker may be insensitive or unspecific, the use of the biomarker has not been validated, or pregnancy itself affects t
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