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First trimester maternal serum alpha fetoprotein is associated with ischemic placental disease

Dinglas, Cheryl; Afsar, Nur; Cochrane, Elizabeth; Davis, Jay; Kim, Sara; Akerman, Meredith; Wells, Matthew; Chavez, Martin; Herrera, Kimberly; Heo, Hye; Vintzileos, Anthony
BACKGROUND:While elevated second trimester maternal serum alpha fetoprotein (msAFP) has been associated with adverse pregnancy outcomes, the utility of first trimester msAFP in predicting these outcomes is limited. Some laboratories have been including msAFP as part of the first trimester analyte screening for aneuploidy and preeclampsia, offering its potential utility in predicting pregnancy outcomes. OBJECTIVE:Our primary objective was to determine the association between elevated first trimester msAFP and preeclampsia, as well as ischemic placental disease (a composite of preeclampsia, fetal growth restriction and/or placental abruption). Secondary outcomes included early onset preeclampsia requiring delivery at <34 weeks gestation, fetal growth restriction, placental abruption, preterm delivery, fetal demise, and spontaneous abortion. STUDY DESIGN/METHODS:An IRB-approved multi-site retrospective cohort study was performed including all patients with first trimester msAFP as part of routine first trimester aneuploidy screening from April 2015-January 2017. Pregnancies with multiple gestations, known structural or chromosomal abnormalities, known malignancy, and incomplete delivery records were excluded. Delivery records were reviewed for baseline characteristics and adverse pregnancy outcomes. The optimal cut-off point for first trimester msAFP to predict these outcomes was assessed and an elevated msAFP was considered > 2.0 MoM. Fisher exact test and odds ratios were used to determine the association between elevated first trimester msAFP and adverse pregnancy outcomes. Spearman correlation coefficient assessed the relationship between first and second trimester msAFP. RESULTS:Of 1478 patients with first trimester msAFP, 1280 had complete records available for review (86.6%). There was no association demonstrated between elevated first trimester msAFP (> 2.0 MoM) and the primary outcome, overall preeclampsia (5.8% vs. 4.6%, OR 1.29, 95% CI 0.58, 2.91). However, there was an increased incidence of ischemic placental disease, 15.8% vs 7.7% (OR 2.26, 95% CI 1.33-3.87) in those with an elevated AFP. Also, elevated first trimester msAFP was associated with a higher incidence of fetal growth restriction (7.5% vs 2.3%, OR 3.40, 95% CI 1.56-7.42) and preterm birth (18.3% vs 10.3%, OR 1.95, 95% CI 1.18-3.21). Also, a positive correlation between first and second trimester msAFP was demonstrated (rho = 0.46, P< 0.0001). CONCLUSIONS:Elevated first trimester msAFP is associated with ischemic placental disease, fetal growth restriction, and preterm birth. This suggests that elevated msAFP may help to identify high risk pregnancies as early as the first trimester of pregnancy. Future studies are necessary to determine if addition of first trimester msAFP to existing algorithms can improve the early detection of ischemic placental disease.
PMID: 31794723
ISSN: 1097-6868
CID: 4252112

Novel application assessing cervical stiffness in second trimester [Meeting Abstract]

Wells, Matthew; Zavala, Jose; Akerman, Meredith; Vahanian, Sevan; Kinzler, Wendy; Chavez, Martin; Vintzileos, Anthony
ISSN: 0002-9378
CID: 4264712

Novel application assessing cervical stiffness heterogeneity [Meeting Abstract]

Wells, Matthew; Zavala, Jose; Akerman, Meredith; Vahanian, Sevan; Kinzler, Wendy; Chavez, Martin; Vintzileos, Anthony
ISSN: 0002-9378
CID: 4264702

Resolution of intra-amniotic sludge after antibiotic administration in a patient with short cervix and recurrent mid-trimester loss

Dinglas, Cheryl; Chavez, Martin; Vintzileos, Anthony
PMID: 30633916
ISSN: 1097-6868
CID: 3627352

Does educational intervention improve sonographer awareness of ultrasound safety? [Meeting Abstract]

Martinelli, Vanessa T.; Kantorowska, Agata; Murphy, Jean; Chavez, Martin; Kinzler, Wendy; Vintzileos, Anthony
ISSN: 0002-9378
CID: 3574612

Selective laser ablation followed by a delayed Solomon technique for Twin–twin transfusion syndrome may improve dual survival [Meeting Abstract]

Dingals, Cheryl L; Davis, J; Heiselman, C; Chavez, M; Vintzileos, A
ISSN: 0960-7692
CID: 4141022

Is First Trimester Maternal Serum Alpha Fetoprotein Predictive of Adverse Pregnancy Outcomes? [Meeting Abstract]

Dinglas, Cheryl; Afsar, Nur; Davis, Jay; Kim, Sara; Herrera, Kimberly; Chavez, Martin
ISSN: 0029-7844
CID: 4599322

Author's Reply [Letter]

Vahanian, Sevan A; Chavez, Martin R; Murphy, Jean; Vetere, Patrick; Nezhat, Farr; Vintzileos, Anthony M
PMID: 29763653
ISSN: 1553-4669
CID: 3442892

Second trimester marginal cord insertion is associated with adverse perinatal outcomes

Allaf, M Baraa; Andrikopoulou, Maria; Crnosija, Natalie; Muscat, Jolene; Chavez, Martin R; Vintzileos, Anthony M
OBJECTIVES/OBJECTIVE:To determine the feasibility in visualizing placental cord insertion (PCI) during second-trimester fetal anatomical survey and the association between marginal cord insertion (MCI) and preterm delivery (PTD) and low birth weight (LBW). Our secondary objectives were to evaluate the association of MCI with adverse composite obstetrical and neonatal outcomes. METHODS:A prospective cohort study was performed over a 28-month period. Women with singleton pregnancies presenting for routine anatomical survey between 18 and 22 weeks' gestation were included. PCI site was visualized on 2D grayscale and color Doppler and the shortest distance from the sagittal and transverse planes to the placental edge were recorded. MCI was diagnosed when any of measured distances was ≤2 cm. Correlations were assessed via bivariate chi-squared, independent t-test analyses and Fisher's exact tests. Regression models evaluated associations between MCI and adverse composite outcomes. RESULTS:Three hundred one women were included and PCI was feasible in all cases. The incidence of MCI was 11.3% (n = 34). Baseline characteristics between those with and without MCI were similar, except for story of prior PTD, which was greater among those with MCI (17.65 versus 7.17%, p = .04). MCI was associated with increased likelihood of LBW (RR four; 95%CI, 1.46-10.99) and PTD (RR 3.2; 95%CI, 1.53-6.68); in multivariate analysis, we found associations between MCI and composite adverse obstetrical (RR 2.33; 95%CI, 1.30-4.19) and neonatal (RR 2.46; 95%CI, 1.26-4.81) outcomes. CONCLUSIONS:Evaluation of PCI is feasible in all cases. Second-trimester MCI is associated with increased likelihood for LBW, PTD, and composite adverse obstetrical and neonatal outcomes.
PMID: 29544383
ISSN: 1476-4954
CID: 3442882

Ultrasound-Guided Laparoscopic-Assisted Abdominal Cerclage in Pregnancy

Vahanian, Sevan A; Chavez, Martin R; Murphy, Jean; Vetere, Patrick; Nezhat, Farr R; Vintzileos, Anthony M
PMID: 28602787
ISSN: 1553-4669
CID: 3442842