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Medians for second-trimester maternal serum markers: geographical differences and variation caused by median multiples-of-median equations


Objectives: To establish gestational age-specific mid-trimester normal medians for the prenatal serum markers α fetoprotein (AFP), human chorionic gonadotropin (HCG) and unconjugated oestriol (uE3) for a Belgian population by using the Beckman Coulter Access chemiluminiscent immunoassays; to compare these data with data obtained from other geographical regions; to propose regression coefficients for regressed medians and analyse variation induced by different regression equations; to evaluate the effect of formulas used for gestation correction on estimating risk in Down’s syndrome.

Design: Data derived from 862 fresh serum samples from women being screened for Down’s syndrome pregnancy, composed of selected pregnancies deemed to be normal, were examined in a retrospective study. Regressed medians were calculated by using a first-degree logarithmic–linear fit of the raw data. Multiples-of-median (MoM) values estimated by using a simple logarithmic–linear equation were compared with those calculated with higher-degree polynomials chosen with a goodness-of-fit analysis. Model-specific variation was estimated and the effect on risk for Down’s syndrome was evaluated.

Results: Regressed medians (Y) for Access serum markers AFP (IU/ml), HCG (IU/ml) and uE3 (nmol/l) for a Belgian population can be estimated with the equation Y = 10(A+BX) with X = decimal weeks. The best fit was obtained with a third-degree and a second-degree polynomial for AFP and uE3, respectively. Differences between the medians and among the slopes of the geographical populations were found to be significant (analysis of covariance, p<0.001).

Conclusions: Belgian marker medians versus gestational time are found to show a pattern that is similar to that in the literature. The log–linear equation is observed to give a good fit and can be suggested as a tool for calculating median MoM values for Belgian laboratories that use Access biochemical prenatal markers.

  • AFP, α fetoprotein
  • ANOVA, analysis of variance
  • HCG, human chorionic gonadotropin
  • uE3, unconjugated oestriol
  • MoM, multiples of median
  • VIF, variance inflation factor

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