Age-specific risk of fetal loss observed in a second trimester serum screening population

doi:10.1016/j.ajog.2004.06.099

American Journal of Obstetrics and Gynecology

Volume 192, Issue 1, January 2005, Pages 240-246

https://doi.org/10.1016/j.ajog.2004.06.099 Get rights and content

Objective

The purpose of this study was to investigate age-specific spontaneous fetal loss rates of pregnancies without known chromosomal or structural abnormalities from mid-second trimester onward.

Study design

The study consisted of 264,653 women screened between October 1995 and September 2000 with available pregnancy outcomes. Pregnancies associated with fetal chromosomal or structural abnormalities, insulin dependent diabetes mellitus, and multiple pregnancies were excluded. Spontaneous fetal losses at or after 15 weeks of gestation were identified. Women were grouped according to maternal age at expected date of delivery. Spontaneous fetal loss rates in each group were evaluated after adjusting fetal losses associated with amniocentesis and identifiable ethnic groups.

Results

Fetal loss rates increased in both younger and older women. The lowest rate was seen in women at mid-20s. Compared with Caucasian and Asian women, black women had higher fetal loss rate at nearly every age group.

Conclusion

The results of the study provided a baseline age-specific spontaneous fetal loss rate of pregnancies at a specified gestational window.

Section snippets

Material and methods

The Ontario Maternal Serum Screening Program (MSS) was funded by the Ministry of Health of the Province of Ontario in July 1993. The screening program used 3 biochemical markers—alpha-fetoprotein (MSAFP), unconjugated estriol (MSuE3), and human chorionic gonadotrophin (MShCG), in combination with maternal age to estimate a woman's risk at term of having a fetus with Down syndrome and/or trisomy 18.It also estimates a woman's risk of having a fetus with open neural tube defects (ONTDs) based on

Results

Between October 1995 and September 2000, 264,653 women were screened for Down syndrome and/or ONTDs in the Ontario MSS program and had the pregnancy outcome available from CIHI. Among these pregnancies, there were 1040 spontaneous miscarriages (15-21 weeks of gestation) and 592 intrauterine fetal deaths (≥22 weeks of gestation), given an overall fetal loss rate of 0.62%. After excluding pregnancies with fetal chromosomal or structural abnormalities, IDDM, and multiple pregnancies, 250,011 women

Comment

The associations between maternal age and spontaneous fetal loss have been the subjects of many previous studies. Most of the studies reported a increased risk of fetal loss in older women.6., 10., 11., 12., 13., 14. Higher risks of fetal loss in both young and older women were also reported in a number of studies.¹⁵ Different from previous studies, however, this study estimated fetal loss rate from mid-second trimester to term based on fetuses without known chromosomal or structural

Acknowledgments

The authors would like to thank all members of the Ontario MSS consultative committee and participating MSS centers for their contributions to the Ontario MSS program. In addition, the data entry by Ms Mandy Lee was a key component in the collection of data. The authors would also like to thank the women of Ontario.

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General Obstetrics and Gynecology: ObstetricsAge-specific risk of fetal loss observed in a second trimester serum screening population

Objective

Study design

Results

Conclusion

Section snippets

Material and methods

Results

Comment

Acknowledgments

Lancet

Early Hum Dev

Am J Obstet Gynecol

Lancet

Lancet

Fertil Steril

Eur J Obstet Gynecol Reprod Biol

Lancet

Survival probability of human conceptions from fertilization to term

Int J Fertil

General Obstetrics and Gynecology: Obstetrics
Age-specific risk of fetal loss observed in a second trimester serum screening population