Exploring potential mid-trimester maternal serum biomarkers for fetal congenital heart disease: a retrospective case-control study.

OBJECTIVE

To assess potential associations between maternal serum alpha-fetoprotein (AFP) and free human chorionic gonadotropin beta subunit (free β-hCG) levels during the mid-trimester and the occurrence of fetal congenital heart disease (CHD).

METHODS

A retrospective case-control study was carried out, analyzing data from 303 pregnant women. Of these, 101 cases were diagnosed with fetal CHD (CHD group), and 202 cases were diagnosed with healthy fetuses (control group). The multiple of median (MoM) of AFP and free β-hCG were measured using time-resolved fluorescence immunoassay during the second trimester, respectively. Binary logistic regression was applied to compare the CHD and control groups, analyze relevant risk factors, and calculate the odds ratio (OR) for each variable. Risk models incorporating AFP, free β-hCG, and other factors, either individually or in combination, were formulated. Receiver operating characteristic (ROC) curve and area under the curve (AUC) analyses were performed to evaluate the diagnostic performance of these models.

RESULTS

The AFP MoM, hCG MoM, and maternal age in the CHD group were significantly higher than those in the control group. Binary logistic regression analysis revealed that fetal CHD was associated with AFP, β-hCG, and maternal age, with OR values of 4.057 (95% confidence interval (CI): 2.221-7.409, p < .001), 1.978 (95% CI: 1.412-2.772, p < .001), and 1.223 (95% CI: 1.136-1.317, p < .001), respectively. The combining AFP MoM, free β-hCG MoM, maternal age, and gestational days demonstrated a higher diagnostic value compared to single biomarkers, yielding an AUC of 0.794, with a sensitivity of 0.782 and specificity of 0.683 for detecting fetal CHD.

CONCLUSIONS

This study presents an evidence from a domestic Chinese cohort demonstrating that elevated maternal serum AFP and free β-hCG levels during mid-trimester pregnancy are significantly associated with fetal CHD. These biomarkers show promise as potential candidates for noninvasive CHD screening. Further investigation and validation are necessary to confirm these findings.