{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T08:33:19Z","timestamp":1740126799287,"version":"3.37.3"},"reference-count":34,"publisher":"Georg Thieme Verlag KG","issue":"01","funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100012665","name":"Institute for Clinical Evaluative Sciences","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100012665","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000226","name":"Ontario Ministry of Health and Long-Term Care","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000226","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective\u2003This study aimed to examine whether prenatal biochemical screening analytes are associated with an increased risk of severe maternal morbidity (SMM) or maternal mortality.<\/jats:p><jats:p>\n          Study Design\u2003This population-based cohort study includes all women in Ontario, Canada, who underwent prenatal screening from 2001 to 2011. Increasing fifth percentiles of the multiple of the median (MoM) for alphafetoprotein (AFP), total human chorionic gonadotropin, unconjugated estriol (uE3), dimeric inhibin-A (DIA), and pregnancy-associated plasma protein A were evaluated. An abnormally high concentration (&gt;95th percentile MoM) for each analyte, individually and combined, was also evaluated. The main outcome assessed was the adjusted relative risk (aRR) of SMM or maternal mortality from 20\u2009weeks' gestation up to 26\u2009weeks thereafter.<\/jats:p><jats:p>\n          Results\u2003Among 748,972 pregnancies, 11,177 resulted in SMM or maternal mortality (1.5%). Except for uE3, the aRR of SMM or maternal mortality increased in association with increasing fifth percentiles of the MoM for all analytes. AFP (aRR: 2.10; 95% confidence interval [CI]: 1.97\u20132.25) and DIA (aRR: 2.33; 95% CI: 1.98\u20132.74)\u2009&gt;\u200995th versus\u2009\u2264\u20095th percentile of the MoM were especially associated with SMM or death.<\/jats:p><jats:p>\n          Conclusion\u2003Women with abnormally high concentrations of certain prenatal biochemical analytes may be at a higher risk of SMM or death in pregnancy or postpartum.<\/jats:p>","DOI":"10.1055\/s-0039-1694731","type":"journal-article","created":{"date-parts":[[2019,8,14]],"date-time":"2019-08-14T22:50:14Z","timestamp":1565823014000},"page":"044-059","source":"Crossref","is-referenced-by-count":2,"title":["Risk of Severe Maternal Morbidity or Death in Relation to Prenatal Biochemical Screening: Population-Based Cohort Study"],"prefix":"10.1055","volume":"38","author":[{"given":"Eric J.M.","family":"Lentz","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison L.","family":"Park","sequence":"additional","affiliation":[{"name":"Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alec W.R.","family":"Langlois","sequence":"additional","affiliation":[{"name":"Faculty of Arts and Science, Queen's University, Kingston, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tianhua","family":"Huang","sequence":"additional","affiliation":[{"name":"Genetics Program, North York General Hospital, Toronto, Ontario, Canada"},{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy S.","family":"Meschino","sequence":"additional","affiliation":[{"name":"Genetics Program, North York General Hospital, Toronto, Ontario, Canada"},{"name":"Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel G.","family":"Ray","sequence":"additional","affiliation":[{"name":"Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Medicine, Health Policy Management and Evaluation, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada"},{"name":"Department of Obstetrics and Gynaecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2019,8,14]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"228.e1","DOI":"10.1016\/j.ajog.2012.06.006","article-title":"Abnormal second-trimester serum analytes are more predictive of preterm preeclampsia","volume":"207","author":"R N Olsen","year":"2012","journal-title":"Am J Obstet Gynecol"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"13","DOI":"10.4137\/CMRH.S21865","article-title":"Combination of PAPPA, fhCG\u03b2, AFP, PlGF, sTNFR1, and maternal characteristics in prediction of early-onset preeclampsia","volume":"9","author":"A Yliniemi","year":"2015","journal-title":"Clin Med Insights Reprod Health"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1159\/000458409","article-title":"Predictive value of second-trimester biomarkers and maternal features for adverse pregnancy outcomes","volume":"42","author":"E Yefet","year":"2017","journal-title":"Fetal Diagn Ther"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/S0065-2423(06)43006-7","article-title":"A summary analysis of Down syndrome markers in the late first trimester","volume":"43","author":"G E Palomaki","year":"2007","journal-title":"Adv Clin 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Gynecol"},{"issue":"11","key":"ref8","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/j.kjms.2016.08.011","article-title":"Analysis of first and second trimester maternal serum analytes for the prediction of morbidly adherent placenta requiring hysterectomy","volume":"32","author":"E Oztas","year":"2016","journal-title":"Kaohsiung J Med Sci"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"E236","DOI":"10.9778\/cmajo.20140110","article-title":"Rates of prenatal screening across health care regions in Ontario, Canada: a retrospective cohort study","volume":"3","author":"R Z Hayeems","year":"2015","journal-title":"CMAJ Open"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.1016\/S0140-6736(05)67726-4","article-title":"Cardiovascular health after maternal placental syndromes (CHAMPS): population-based retrospective cohort study","volume":"366","author":"J G Ray","year":"2005","journal-title":"Lancet"},{"issue":"15","key":"ref11","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1136\/heartjnl-2011-301548","article-title":"Heart failure and dysrhythmias after maternal placental syndromes: HAD MPS Study","volume":"98","author":"J G Ray","year":"2012","journal-title":"Heart"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"106.e1","DOI":"10.1016\/j.ajog.2015.08.021","article-title":"Prognosis after maternal placental events and revascularization: PAMPER study","volume":"214","author":"J G Ray","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"S 01","key":"ref13","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1186\/s12978-018-0527-2","article-title":"A global view of severe maternal morbidity: moving beyond maternal mortality","volume":"15","author":"S E Geller","year":"2018","journal-title":"Reprod 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McClure","year":"2007","journal-title":"Int J Gynaecol Obstet"},{"issue":"05","key":"ref23","doi-asserted-by":"crossref","first-page":"e1002307","DOI":"10.1371\/journal.pmed.1002307","article-title":"Maternal age and severe maternal morbidity: a population-based retrospective cohort study","volume":"14","author":"S Lisonkova","year":"2017","journal-title":"PLoS Med"},{"issue":"02","key":"ref24","doi-asserted-by":"crossref","first-page":"135.e1","DOI":"10.1016\/j.ajog.2008.02.046","article-title":"Maternal serum alpha-fetoprotein values in type 1 and type 2 diabetic patients","volume":"199","author":"L L Thornburg","year":"2008","journal-title":"Am J Obstet Gynecol"},{"issue":"01","key":"ref25","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1159\/000020796","article-title":"Renal hemodialysis and maternal serum triple analyte screening","volume":"13","author":"L P Shulman","year":"1998","journal-title":"Fetal Diagn Ther"},{"issue":"10","key":"ref26","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1002\/(SICI)1097-0223(199910)19:10<955::AID-PD670>3.0.CO;2-X","article-title":"Elevated second-trimester maternal serum hCG in patients undergoing haemodialysis","volume":"19","author":"P J Cheng","year":"1999","journal-title":"Prenat Diagn"},{"issue":"08","key":"ref27","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1038\/jp.2015.40","article-title":"Maternal serum markers, characteristics and morbidly adherent placenta in women with previa","volume":"35","author":"D J Lyell","year":"2015","journal-title":"J Perinatol"},{"issue":"06","key":"ref28","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.3889\/oamjms.2018.238","article-title":"Obstetric outcome in pregnant patients with low level of pregnancy-associated plasma protein A in first trimester","volume":"6","author":"V Livrinova","year":"2018","journal-title":"Open Access Maced J Med Sci"},{"issue":"06","key":"ref29","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1001\/jama.2009.113","article-title":"Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis","volume":"301","author":"K J Stothard","year":"2009","journal-title":"JAMA"},{"volume-title":"Perinatal Health Indicators for Canada 2013: A Report of the Canadian Perinatal Surveillance System","year":"2013","author":"Public Health Agency of Canada","key":"ref30"},{"issue":"06","key":"ref31","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1053\/j.semperi.2017.07.007","article-title":"Epidemiology of maternal morbidity and mortality","volume":"41","author":"A Hirshberg","year":"2017","journal-title":"Semin Perinatol"},{"issue":"06","key":"ref32","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/j.tjog.2017.10.017","article-title":"Maternal serum placental growth factor combined with second trimester aneuploidy screening to 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