Relationship between first trimester maternal TSH levels and Down syndrome screening tests

Yıl 2018, Cilt: 43 Sayı: Ek 1, 94 - 99, 29.12.2018

Gokcen Orgul Devrim Rüzgar Doğan Oytun Portakal M.sinan Beksac

https://doi.org/10.17826/cumj.392260

Öz

Purpose: Down syndrome screening  with first trimester combined test is recommended for all pregnancies. It is unclear, whether thyroid stimulating hormone (TSH) affects secretion of free beta subunit human chorionic gonadotropin (fβ-hcg) and pregnancy-related plasma protein (PAPP-A). We aimed to investigate the effect of serum thyroid stimulating hormone (TSH) levels on the combined test results.

Materials and Methods: First trimester TSH levels together with nuchal translucency (NT(fβ-hcg and PAPP-A results of 297 patients were included in this study. Patients were divided into four groups according to their TSH levels; Group 1 (<0.1 μL / ml), Group 2 (0.1-2.5 μlU / ml), Group 3 (2.5-3.5 μlU / ml) and Group 4 (> 3.5 μlU / ml). Groups were compared in terms of NT, PAPP-A and fβ-hcg levels.

Results: The mean PAPP-A (MoM) value was found to be 0.99 in group 1, 1.12 in group 2, 1.03 in group 3, and 0.95 in group 4. Mean fβ-hcg (MoM) value was 1.36 in group 1, 1.29 in group 2, 1.05 in group 3, and 1.32 in group 4. The mean NT measurement was 1.27 ± 0.25, 1.33 ± 0.38, 1.34 ± 0.33 and 1.32 ± 0.37 mm, from group 1 to group 4, respectively. There was no statistically significant difference between groups in terms of PAPP-A, fβ-hcg and NT.

Conclusion: The present study have shown that first trimester TSH levels do not affect combined test parameters. Prenatal screening by using NT, fβ-hCG and PAPP-A seems to be safe for pregnant women with hypothyroidism or hyperthyroidism.

Gebeliğin ilk üç ayındaki kan TSH düzeyi ile Down sendromu tarama testleri arasındaki ilişki

Öz

Amaç: İlk üç ayda tüm gebelere Down Sendromu taraması amacıyla kombine test yapılması önerilmektedir. Tiroid stimulan hormonun (TSH) serbest beta subünit human koriyonik gonadotropin (fβ-hcg) ve gebelik ile ilişkili plazma protein A (PAPP-A) üretimini etkileyip etkilemediği net değildir. Bu çalışmada serum TSH düzeylerinin kombine test sonuçları üzerine etkisinin olup olmadığını araştırmayı amaçladık.

Gereç ve Yöntem: İlk trimester TSH değeri ile birlikte ense saydamlığı (NT), fβ-hcg ve PAPP-A  sonuçlarına ulaşılabilen 297 hasta çalışmaya dahil edilmiştir. Hastalar TSH değerlerine göre dört gruba ayrılmıştır; Grup 1 (<0.1 uIU/ml), Grup 2 (0.1-2,5 uIU/ml), Grup 3 (2.5-3.5 uIU/ml) ve Grup 4 (>3.5 uIU/ml). Gruplar NT, PAPP-A ve fβ-hcg düzeyleri açısından karşılaştırılmıştır.

Bulgular: Ortalama PAPP-A (MoM) değeri grup 1’de 0.99, Grup 2’de 1.12, Grup 3’de 1,03 ve Grup 4’de 0,95 olarak tespit edilmiştir. Ortalama fβ-hcg (MoM) değeri ise grup 1’de 1.36, Grup 2’de 1.29, Grup 3’de 1.05 ve Grup 4’de 1.32 idi. Ortalama NT ölçümü grup 1’den grup 4’e doğru gittikçe sırasıyla 1.27 ± 0.25, 1.33 ± 0.38, 1.34 ± 0.33 ve 1.32 ± 0.37 mm olarak saptanmıştır. Gruplar arasında PAPP-A, fβ-hcg ve NT açısından istatistiksel olarak anlamlı bir fark olmadığı gösterilmiştir.

Sonuç: İlk trimester TSH düzeylerinin kombine test parametrelerini etkilemediği gösterilmiştir. Hipotiroidisi veya hipertiroidisi olan kadınlarda NT, fβ-hCG and PAPP-A kullanılarak prenatal tarama testi yapılmasının güvenli olduğu düşünülmüştür.

Anahtar Kelimeler

Gebelikle ilişkili plazma protein-A, Nukal saydamlık, Human koriyonik gonadotropin, Tiroid stimulan hormon

Kaynakça

• 1. Egan JF, Kaminsky LM, DeRoche ME, Barsoom MJ, Borgida AF, Benn PA. Antenatal Down syndrome screening in the United States in 2001: a survey of maternal-fetal medicine specialists. American Journal of Obstetrics & Gynecology. 2002;187(5):1230-1234.
• 2. Karadeniz RS, Altay M, Karasu Y, Gelişen O, Haberal A. Comparison of Triple and Qadrupple Test in Second Trimester Down Syndrome Screening. Gynecology Obstetrics & Reproductive Medicine. 2009;15(1).
• 3. Graham L. ACOG releases guidelines on screening for fetal chromosomal abnormalities. AMER ACAD FAMILY PHYSICIANS 8880 WARD PARKWAY, KANSAS CITY, MO 64114-2797 USA; 2007.
• 4. Canick JA, Kellner LH. First trimester screening for aneuploidy: serum biochemical markers. Paper presented at: Seminars in perinatology1999.
• 5. Ehrich M, Deciu C, Zwiefelhofer T, et al. Noninvasive detection of fetal trisomy 21 by sequencing of DNA in maternal blood: a study in a clinical setting. American Journal of Obstetrics & Gynecology. 2011;204(3):205. e201-205. e211.
• 6. Alldred SK, Deeks JJ, Guo B, Neilson JP, Alfirevic Z. Second trimester serum tests for Down's Syndrome screening. The Cochrane Library. 2012.
• 7. Bianchi DW, Platt LD, Goldberg JD, Abuhamad AZ, Sehnert AJ, Rava RP. Genome-wide fetal aneuploidy detection by maternal plasma DNA sequencing. Obstetrics & Gynecology. 2012;119(5):890-901.
• 8. Ökem ZG, Örgül G, Kasnakoglu BT, Çakar M, Beksaç MS. Economic analysis of prenatal screening strategies for Down syndrome in singleton pregnancies in Turkey. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2017;219:40-44.
• 9. Bianchi DW, Parker RL, Wentworth J, et al. DNA sequencing versus standard prenatal aneuploidy screening. New England journal of medicine. 2014;370(9):799-808.
• 10. Shiefa S, Amargandhi M, Bhupendra J, Moulali S, Kristine T. First trimester maternal serum screening using biochemical markers PAPP-A and free β-hCG for down syndrome, patau syndrome and edward syndrome. Indian Journal of Clinical Biochemistry. 2013;28(1):3-12.
• 11. Stenman U-H, Tiitinen A, Alfthan H, Valmu L. The classification, functions and clinical use of different isoforms of HCG. Human reproduction update. 2006;12(6):769-784.
• 12. Ballabio M, Poshyachinda M, Ekins RP. Pregnancy-induced changes in thyroid function: role of human chorionic gonadotropin as putative regulator of maternal thyroid. The Journal of Clinical Endocrinology & Metabolism. 1991;73(4):824-831.
• 13. Maruo T, Matsuo H, Mochizuki M. Thyroid hormone as a biological amplifier of differentiated trophoblast function in early pregnancy. Acta endocrinologica. 1991;125(1):58-66.
• 14. Seven A, Kucur SK, Polat M, Yüksel B, Işıklar Ö, Keskin N. Gebelerde Birinci Trimester Tiroid Fonksiyon Testi Sonuçlarının Değerlendirilmesi. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi/Mugla Medical Journal. 2016;3(2):5-8.
• 15. Nicolaides KH. Nuchal translucency and other first-trimester sonographic markers of chromosomal abnormalities. American Journal of Obstetrics & Gynecology. 2004;191(1):45-
• 16. Malone FD, Canick JA, Ball RH, et al. First-trimester or second-trimester screening, or both, for Down's syndrome. New England Journal of Medicine. 2005;353(19):2001-2011.
• 17. Bakanlığı TS. Doğum Öncesi Bakım Yönetim Rehberi. In: Başkanlığı THSKKvÜSD, ed. Ankara: Sağlık Bakanlığı; 2014.
• 18. Bischof P, Amaudruz M, Weil-Franck C, et al. The disappearance rate of pregnancy-associated plasma protein-A (PAPP-A) after the end of normal and abnormal pregnancies. Archives of gynecology. 1984;236(2):93-98.
• 19. Gagnon A, Wilson RD, Audibert F, et al. Obstetrical complications associated with abnormal maternal serum markers analytes. Journal of Obstetrics and Gynaecology Canada. 2008;30(10):918-932.
• 20. Gravett CP, Buckmaster JG, Watson PT, Gravett MG. Elevated second trimester maternal serum β‐HCG concentrations and subsequent adverse pregnancy outcome. American Journal of Medical Genetics Part A. 1992;44(4):485-486.
• 21. Eldar-Geva T, Hochberg A, DeGroot N, Weinstein D. High maternal serum chorionic gonadotropin level in Downs' syndrome pregnancies is caused by elevation of both subunits messenger ribonucleic acid level in trophoblasts. The Journal of Clinical Endocrinology & Metabolism. 1995;80(12):3528-3531.
• 22. Yoshimura M, Hershman JM. Thyrotropic action of human chorionic gonadotropin. Thyroid. 1995;5(5):425-434.
• 23. Weinans MJ, Pratt JJ, de Wolf BT, Mantingh A. First‐trimester maternal serum human thyroid‐stimulating hormone in chromosomally normal and Down syndrome pregnancies. Prenatal diagnosis. 2001;21(9):723-725.
• 24. Aytan H, Caliskan AC, Demirturk F, Sahin S, Erdogan F, Kuzu Z. Relationship between maternal thyroid hormones and the biochemical markers of the first trimester aneuploidy screening. Archives of gynecology and obstetrics. 2013;287(6):1125-1129.
• 25. Ashoor G, Maiz N, Cuckle H, Jawdat F, Nicolaides KH. Maternal thyroid function at 11–13 weeks of gestation in fetal trisomies 21 and 18. Prenatal diagnosis. 2011;31(1):33-37.
• 26. Dhaifalah I, Salek T, Langova D, Cuckle H. Incorporating thyroid markers in Down syndrome screening protocols. Prenatal diagnosis. 2017;37(5):510-514.