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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter / Tate, Jillian R.

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First trimester biochemistry at different maternal ages

Jenni K. Ranta1, 2 / Jaana Marttala3 / Päivi Laitinen3, 4 / Johanna Kultti5 / Olavi Kauhanen6 / Jarkko Romppanen1, 2 / Esa Hämäläinen7, 8 / Seppo Heinonen6, 9 / Kari Pulkki1, 2 / 3

1Department of Clinical Chemistry, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland

2Eastern Finland Laboratory Centre, Kuopio, Finland

3Department of Obstetrics and Gynaecology, Oulu University Hospital, Oulu, Finland

4Central Ostrobothnia Hospital District, Kokkola, Finland

5Laboratory, Seinäjoki Central Hospital, Seinäjoki, Finland

6Department of Obstetrics and Gynaecology, Kuopio University Hospital, Kuopio, Finland

7Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland

8HUSLAB, Women’s Clinic Laboratory, Helsinki Central University Hospital, Helsinki, Finland

9Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland

Corresponding author: Markku Ryynänen, Department of Obstetrics and Gynaecology, Oulu University Hospital, P.O. Box 24, 90020 Oys, Finland Phone: +358 8 315 3171, Fax: +358 8 315 4310

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 50, Issue 3, Pages 549–555, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: 10.1515/cclm.2011.785, November 2011

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Background: The performance of first trimester biochemical screening was compared at different pregnancy weeks and maternal ages during 2002–2008 in a screened population of 76,949 women.

Methods: The detection rates, as well as the median multiples of a median (MOMs) of free β-human chorionic gonadotropin (free β-hCG) and pregnancy-associated plasma protein-A (PAPP-A), were compared between completed gestational weeks 8–13 and between different maternal ages separated into 5-year groupings.

Results: The number of singleton Down syndrome pregnancies was 221. The median age of the screened women was 30 years and the proportion of women aged ≥35 years 16.9%. The median age of the women with a Down syndrome pregnancy was 37 years. In women aged <35 years, the biochemical markers provided a detection rate of only 38.6%, whereas in women aged ≥35 years, the biochemical markers detected 82.7% of cases (p<0.01).

Conclusions: Biochemical screening works best amongst women aged ≥35 years. For younger mothers aged <35 years, combined screening should be the method of choice.

Keywords: Down syndrome; first trimester; free β-hCG; gestational age; maternal age; PAPP-A; screening

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