Early first-trimester maternal

serum placental growth factor in

trisomy 21 pregnancies

N. J. COWANS*, A. STAMATOPOULOU*, N. TØRRING† AND K. SPENCER*

*PRENATAL SCREENING UNIT, DEPARTMENT OF CLINICAL BIOCHEMISTRY, KING
GEORGE HOSPITAL, GOODMAYES, UK; †DEPARTMENT OF CLINICAL BIOCHEMISTRY,
AARHUS UNIVERSITY HOSPITAL, AARHUS, DENMARK

PRESENTER_GITHA AYU ASTARIKA

 Most common and
Traditional second
best for women
trimester approach
presenting late

Screning for major

Nucheal
fetal chromosomal
Translucency
anomalies

First trisemester Free-Beta-

approach?? humanchoriogona
drotropin (BhCG)

Pregnancy –
ascosiated plasma
protein A (PAPPA)
 PLASENTAL GROWTH FACTOR (PlGF)

VEGF family Role of PlGF Fetus chromosomal Trisomy 21??

anomalies

•Have similiar •Angiogenis •2 study reports •Unclear

amino acid decrease of PlGF •Previous study
levels on Trisomy shows increasing,
13 and 18 decreasing and
unchanged level
 Objective

 This study aims to test this hypothesis by

examining levels of PlGF in maternal serum
samples from control and trisomy 21 pregnancies
drawn at 8+0 to 10+6 weeks’ gestation.
 PATIENTS & METHODS

STUDY
• Retrospective Case-Control
DESIGN

STUDY
• November 2003-February 2009
PERIOD

• Department of Clinical Biochemistry

INSTITUTION at Aarhus University Hospital, Skejby
 PATIENTS & METHODS

 COMPARATION

 GROUP 1 : 37 sample from case with known Trisomy 21

(November 2003 – January 2009)

 GROUP 2 : 244 euploid control pregnancy

(January 2009- February 2009)

 women with a confirmed
using the FMF algorithm
Draw blood between 8 + pregnancy diagnosis of
as part of the Astraia
0 and 10 + 6 weeks of trisomy 21 were offered
Software database for
pregnancies termination of
risk of aneuploid
pregnancy.

stored at −80◦C and not

Measure biochemically
thawed until PlGF PlGF Analysis
for PAPP A and NT
analysis.

sent to the Department

of Clinical Biochemistry
at Aarhus University Convert to Multiple of
Hospital, Skejby for free- Median
β-hCG and PAPP-A
analysis
PlGF Analysis
Using a solid-phase, two-site fluoroimmunometric
research assay on the 6000 DELFIA® Xpress
random access platform (kit 4083-0010,
PerkinElmer, Turku, Finland).

PlGF analysis was carried out over 2 days with

the kit calibrated at the beginning of the first
day.

The lower limit of detection was given as 7

pg/mL by the kit’s manufacturers, however,
we calculated it to be 3.2 pg/mL (mean of
lowest calibrator + 3 SD of six replicates of
this sample).

Samples were analyzed blinded to

clinical outcome.
Statistical Analysis

Mann whiitney test 

Multiple regression for MoM continous variable
PlGFdetermine influencing
factor for PlGF Pearson Chi Square test 
categorical variables

Pearson,s product moment

test corelation of log 10
screening marker MoM
 RESULT
Table 1 Maternal serum sample storage time and demographic data
in trisomy 21 cases and unaffected controls

Unaffected Trisomi 21
(n = 244) (n = 37)

Storage age (years) 0,96 (0,95-0,97) 2,52 (2,09-3,97)*

Gestational age (days) 66,0 (61,0-70,0) 65,0 (60,3-68,8)

Maternal age (years) 30,0 (28,0-33,0) 37,0 (30,8-40,0)*

Maternal Age (kg) 66,8 (60,0-76,5) 65,0 (57,0-71,5)

Smoker 7,4 2,7

All mothers were Caucasian, information on parity and IVF was not available at the time of the data analysis.
Maternal age and sample storage time were significantly higher in the trisomy 21 cases compared with the
unaffected controls
RESULT
Table 2 Maternal serum placental growth factor levels in unaffected controls and trisomy 21 pregnancies
at each completed week of gestation and at all weeks

GA(weeks) Unaffected Trisomi 21 P*

n PIGF (pg/mL) n PIGF (pg/mL)

8 77 9,1 (7,1-12,5) 12 15,9 (11,9-17,7) <0,0001

9 99 10,6 (8,1-13,0) 18 13,4 (11,4-17,0) <0,01

10 68 12,8 (10,5-17,2) 7 15,0 (10,3-16,3) 0,92

8-10 244 10,8 (8,0-13,7) 37 14,2 (11,1-17,2) <0,0001