About the Multiple Marker Test
Between the 15th and 20th weeks of pregnancy, expectant mothers
typically are offered a blood test called the multiple marker test.
It can sometimes be called a triple screen or a quad screen,
depending on the number of things measured.
For the screening, a sample of blood is drawn from the mother to
measure the levels of hCG (human chorionic gonadotropin) and
estriol, which are produced by the placenta, and alpha-fetoprotein
(AFP), which is produced by the fetus. Sometimes the level of
inhibin-A, which is made by the placenta, also is measured. The
levels of these substances can help doctors identify a fetus at
risk for certain birth defects, including neural tube defects (like
) and chromosomal abnormalities (like
In determining the results of the test, doctors take into
- the mother's age, weight, and ethnicity
- whether she has diabetes
- if she is having twins or other multiples
- the gestational age of the fetus
Many of these factors affect the levels of the substances being
measured and the interpretation of the test results, so the
accuracy of this information is vital. If any of the information is
inaccurate, the results from the screening may be as well.
Receiving Abnormal Results
If you have undergone the multiple marker test and received
abnormal results, there is no need to worry yet. Just because the
test is abnormal doesn't mean that your child has a birth
defect. Rather, an abnormal screen indicates that the fetus should
be evaluated further.
Usually, when a pregnant woman's results show high levels of
AFP, pointing to a possible risk of spina bifida or other neural
tube defects, her doctor will order a detailed ultrasound to
examine the fetus, including the fetal skull and spine. In
addition, an ultrasound can confirm the age of the fetus and
whether the woman is carrying multiples. The doctor also may offer
amniocentesis, which is the withdrawal of amniotic fluid from the
uterus for further testing.
If a woman's multiple marker screen results reveal low
levels of AFP and estriol and high levels of hCG and inhibin-A, she
has an increased risk of having a baby with Down syndrome. The next
step is usually an ultrasound to confirm the baby's due date
and to look for any obvious abnormalities. Unfortunately,
ultrasound is not a very good test for detecting Down syndrome. For
this reason, patients are offered amniocentesis so chromosome
testing can be done on the fetal cells found in the amniotic
In general, remember that the multiple marker test is just a
screen. It can identify many fetuses that are at risk for certain
birth defects, but will not identify them all. A positive screen
does not necessarily mean that there is a birth defect, but that
there is a need for more evaluation.
If you have any questions or concerns about multiple marker
testing, talk to your doctor or seek the advice of a
Larissa Hirsch, MD
Date reviewed: February 2007
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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