Pregnancy: Should I Have the Maternal Serum Triple or Quadruple Test?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Pregnancy: Should I Have the Maternal Serum Triple or Quadruple Test?
Get the facts
Key points to remember
- Before you have any tests for birth defects, talk about
possible outcomes with your partner and your doctor or nurse-midwife. You also
need to discuss whether a known birth defect would change your medical,
birthing, or parenting plans.
- The triple and quad tests are
screening tests. They can't be used to diagnose a birth defect. They only
estimate the chance that your fetus has a birth defect.
If one of these tests shows a higher-than-normal chance of a birth defect, you
would then decide whether to have another test, such as
amniocentesis, to find out for sure if there is a
problem.
- The triple and quad tests may show a chance of a problem when
there isn't one (false-positive result). The quad test is less likely
than the triple test to show a false-positive result.
- If you plan to have an amniocentesis, you can skip
screening tests.
- A triple or quad test can cost a lot. And some
insurance may not pay for it.
FAQs
The maternal serum triple
screen, sometimes called the triple test or MSAFP+ test, measures the amounts
of three substances in a pregnant woman's blood:
-
Alpha-fetoprotein (AFP)
-
Human chorionic gonadotropin (hCG)
-
Estriol (uE3)
The levels of these substances help your doctor estimate
the chance that your
fetus may have
Down syndrome,
neural tube defects, or certain rare genetic problems.
Other things are considered along with the test results to estimate the chance
of a problem. For example, your doctor will look at your age, weight, and race, and
how far along your pregnancy is.
The quadruple (or quad) test
combines the triple screen and a test for the
hormone inhibin A, which is produced by the fetus and
the
placenta. The quad test is a little more accurate than
the triple screen, but it might not be available everywhere.
The
triple and quad tests are screening tests. They can't be used to diagnose a
birth defect.
If your test result shows that your risk of having a
fetus with Down syndrome is higher than average for your age, you can decide
whether to have another test, such as
amniocentesis, that can show for sure if there is a
problem.
The American College of Obstetricians and Gynecologists
recommends that all women be offered a screening test for Down syndrome. The
risk of having a fetus with a genetic problem increases as a woman gets older.
Many doctors use 35 and older as the age when risk increases.
The triple or quad screen finds 80 out of 100 fetuses with
neural tube defects, such as spina bifida, and about 90 out of 100 with
anencephaly.1 The test misses
finding 20 out of 100 fetuses with spina bifida and 10 out of 100 with
anencephaly.
The quad test finds
Down syndrome almost 81 out of 100 times. It doesn't
find it 19 out of 100 times.2 The quad test is more
likely to find Down syndrome and may be less likely to be
false-positive than the triple screen.
A triple or quad screen usually gives accurate
results when it is done between 15 and 20 weeks of pregnancy. This is why your
doctor might use a
fetal ultrasound to find out for sure how far along
your pregnancy is.
Normal results tell you that there is no need for more tests
unless you have another concern, such as a known genetic disease in your
family.
Positive results tell you that
there is a higher-than-average chance of a birth defect. But if the average
risk for your age is very low, or if your risk is above average but still very
low, you may choose not to have more tests.
- If your screening test is positive (and your risk is above average) you may choose to have a
fetal ultrasound as soon as possible to check the
fetal age and number of fetuses. (The wrong fetal age or pregnancy with twins
or more can lead to a false-positive result.) An ultrasound can find
neural tube defects up to 99 out of 100 times.1 It won't find these problems 1 time out of 100. But
ultrasound isn't as good at finding
Down syndrome or genetic diseases.
- If your screening test is positive but the ultrasound shows no problems, you can have an
amniocentesis. This test finds Down syndrome about 99
out of 100 times.1 The test doesn't find it about 1
time out of 100. In most cases, the amniocentesis results are
normal.
- If your screening test is positive and the ultrasound suggests a possible genetic problem, you may choose to have
an amniocentesis.
If a birth defect is found, you decide where to go from
there. You may choose to learn all you can about raising a child with Down
syndrome or a birth defect. Or you may decide to end the pregnancy.
A triple or quad test is a blood test, so there is little or no physical
risk.
The most common risk of the tests is needless worry. There
is a chance that the test could show that there's a problem when there isn't
one. This is called a
false-positive test result. The quad test is less
likely than the triple test to show a problem when there isn't one.
But most women have normal test results. Even when the test is positive,
most pregnancies turn out to have no problems.
If you don't have a triple or quad test or a test to diagnose a birth
defect, your fetus could have a problem that you don't find out about until
birth.
- The birth could be higher-risk for the baby
if your doctor is not expecting a newborn with health problems.
- You
could give birth in a hospital that does not have a neonatal intensive care
unit (NICU) for sick newborns.
- A fetus with a rare, severe defect
sometimes dies before delivery.
- You might not be emotionally ready
for a sick baby or one with
Down syndrome.
Your doctor might recommend a triple or quad test if:
- You have a family history of Down syndrome or
birth defects.
- You want a test for birth defects, but you aren't
sure if you want to have an
amniocentesis.
- You might change your birth
or parenting plans if you knew your fetus had a serious problem.
Compare your options
|
|
|
|
What is usually involved?
|
|
|
|
What are the benefits?
|
|
|
|
What are the risks and side effects?
|
|
|
Have a triple or quad
test Have a triple or quad
test
- You have a blood test.
- Based on the result, you decide whether to have more tests, such
as
fetal ultrasound or
amniocentesis.
- You can find out if there is a chance of a problem with your
fetus.
- The tests are good at finding a problem if there is
one.
- You may have peace of mind if the test is negative.
- The tests have a high chance of showing a problem when there
isn't one. This could make you worry.
- The tests can't diagnose a
problem, so you might need other tests if the triple or quad test is
positive.
Don't have either test
Don't have either test
- You may decide not to have any tests for birth
defects.
- You may have a
fetal ultrasound to check for
problems.
- You may decide to skip screening tests and have an
amniocentesis. This can find out for sure if there is
a problem.
- You won't have the worry of a test that may show a problem when
there isn't one.
- You can avoid the cost of a screening test and go right to
amniocentesis to find out for sure if there is a problem.
- If you don't have any tests for birth defects, your fetus could
have a problem that you don't find out about until birth.
- There are no known side effects of fetal
ultrasound.
- Amniocentesis has about a 1 out of 400 risk of
miscarriage.3 It doesn't lead
to a miscarriage 399 out of 400 times. The test also has a risk of bleeding and
infection.
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
I know that
I'm at a bit higher risk of having a baby with Down syndrome because of my age.
My husband and I don't have any risk factors for having a child with other
birth defects. If the screening tests weren't available, I would probably have
an amniocentesis even though it has some risks. But since I can have the
screening tests, I've decided to start with that and then make a decision about
amniocentesis based on the results.
I'm not
really worried about things like birth defects that might or might not happen.
I don't have any risk factors for having a baby with a birth defect, and I know
a lot of women who have had amniocentesis and other tests who spent a lot of
time worrying, only to have healthy, normal babies. I feel like the best thing
I can do is take good care of myself, stay alert for any signs that there is a
problem, and enjoy my pregnancy.
My neighbor
had her first baby at our rural community hospital. The baby had spina bifida,
and they rushed her by ambulance to the nearest city and then by helicopter to
a center that treats babies with this problem. My neighbor had to follow her
later on and so was away from her baby at a really traumatic time. It was such
a scary experience for her. I am definitely going to have the screening tests
and find out my risk of having a baby that needs special care so we can plan
ahead.
My husband and I want to have the most
definitive information possible to make decisions about my pregnancy, so we are
going to start with the chorionic villus sampling. I know it's a little more
risky, but we feel like we need as much information as early as we can get it.
It took us a little longer than we expected to become pregnant. If there is any
chance that the fetus has a birth defect, we want to know that as soon as we
can so we can make the best decision for us about whether to continue this
pregnancy or end it and give ourselves a chance to try again.
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have a triple or quad test
Reasons to not have the test
I want to know if there's a chance that there could be a problem.
Knowing that there's a problem wouldn't change my birth or parenting plans.
More important
Equally important
More important
I'm not worried that the test could show a problem when there isn't one.
I'm worried that the test could show a problem when there isn't one.
More important
Equally important
More important
I want to just have the blood test.
I'd rather have an amniocentesis to find out for sure if there's a problem.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having a triple or quad test
NOT having the test
Leaning toward
Undecided
Leaning toward
What else do you need to make your decision?
1.
A triple or quad blood test can tell me for sure if there's a problem with my fetus.
2.
These tests could show that there is a chance of a problem with my fetus when there isn't one.
3.
If a triple or quad test shows no problem, I probably won't need to have more tests for birth defects.
1.
How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
2.
Check what you need to do before you make this decision.
3.
Use the following space to list questions, concerns, and next steps.
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Key concepts that you understood
Key concepts that may need review
Credits
| Credits |
Healthwise Staff |
| Primary Medical Reviewer |
Sarah Marshall, MD - Family Medicine |
| Specialist Medical Reviewer |
Siobhan M. Dolan, MD, MPH - Reproductive Genetics |
References
Citations
- Cunningham FG, et al. (2010). Prenatal diagnosis and
fetal therapy. In Williams Obstetrics, 23rd ed., pp.
287–311. New York: McGraw-Hill Medical.
- American College of Obstetricians and Gynecologists
(2007, reaffirmed 2008). Screening for fetal chromosomal abnormalities. ACOG Practice Bulletin
No. 77. Obstetrics and Gynecology, 109(1): 217–227.
- Caughey AB, et al. (2006). Chorionic villus sampling compared with amniocentesis and the difference in the rate of pregnancy loss. Obstetrics and Gynecology, 108(3): 612–616.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Pregnancy: Should I Have the Maternal Serum Triple or Quadruple Test?
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the facts
Key points to remember
- Before you have any tests for birth defects, talk about
possible outcomes with your partner and your doctor or nurse-midwife. You also
need to discuss whether a known birth defect would change your medical,
birthing, or parenting plans.
- The triple and quad tests are
screening tests. They can't be used to diagnose a birth defect. They only
estimate the chance that your fetus has a birth defect.
If one of these tests shows a higher-than-normal chance of a birth defect, you
would then decide whether to have another test, such as
amniocentesis, to find out for sure if there is a
problem.
- The triple and quad tests may show a chance of a problem when
there isn't one (false-positive result). The quad test is less likely
than the triple test to show a false-positive result.
- If you plan to have an amniocentesis, you can skip
screening tests.
- A triple or quad test can cost a lot. And some
insurance may not pay for it.
FAQs
What are these tests?
The maternal serum triple
screen, sometimes called the triple test or MSAFP+ test, measures the amounts
of three substances in a pregnant woman's blood:
-
Alpha-fetoprotein (AFP)
-
Human chorionic gonadotropin (hCG)
-
Estriol (uE3)
The levels of these substances help your doctor estimate
the chance that your
fetus may have
Down syndrome,
neural tube defects, or certain rare genetic problems.
Other things are considered along with the test results to estimate the chance
of a problem. For example, your doctor will look at your age, weight, and race, and
how far along your pregnancy is.
The quadruple (or quad) test
combines the triple screen and a test for the
hormone inhibin A, which is produced by the fetus and
the
placenta. The quad test is a little more accurate than
the triple screen, but it might not be available everywhere.
The
triple and quad tests are screening tests. They can't be used to diagnose a
birth defect.
If your test result shows that your risk of having a
fetus with Down syndrome is higher than average for your age, you can decide
whether to have another test, such as
amniocentesis, that can show for sure if there is a
problem.
The American College of Obstetricians and Gynecologists
recommends that all women be offered a screening test for Down syndrome. The
risk of having a fetus with a genetic problem increases as a woman gets older.
Many doctors use 35 and older as the age when risk increases.
How well do these tests work to find birth defects?
The triple or quad screen finds 80 out of 100 fetuses with
neural tube defects, such as spina bifida, and about 90 out of 100 with
anencephaly.1 The test misses
finding 20 out of 100 fetuses with spina bifida and 10 out of 100 with
anencephaly.
The quad test finds
Down syndrome almost 81 out of 100 times. It doesn't
find it 19 out of 100 times.2 The quad test is more
likely to find Down syndrome and may be less likely to be
false-positive than the triple screen.
A triple or quad screen usually gives accurate
results when it is done between 15 and 20 weeks of pregnancy. This is why your
doctor might use a
fetal ultrasound to find out for sure how far along
your pregnancy is.
What's next after you get the test results?
Normal results tell you that there is no need for more tests
unless you have another concern, such as a known genetic disease in your
family.
Positive results tell you that
there is a higher-than-average chance of a birth defect. But if the average
risk for your age is very low, or if your risk is above average but still very
low, you may choose not to have more tests.
- If your screening test is positive (and your risk is above average) you may choose to have a
fetal ultrasound as soon as possible to check the
fetal age and number of fetuses. (The wrong fetal age or pregnancy with twins
or more can lead to a false-positive result.) An ultrasound can find
neural tube defects up to 99 out of 100 times.1 It won't find these problems 1 time out of 100. But
ultrasound isn't as good at finding
Down syndrome or genetic diseases.
- If your screening test is positive but the ultrasound shows no problems, you can have an
amniocentesis. This test finds Down syndrome about 99
out of 100 times.1 The test doesn't find it about 1
time out of 100. In most cases, the amniocentesis results are
normal.
- If your screening test is positive and the ultrasound suggests a possible genetic problem, you may choose to have
an amniocentesis.
If a birth defect is found, you decide where to go from
there. You may choose to learn all you can about raising a child with Down
syndrome or a birth defect. Or you may decide to end the pregnancy.
What are the risks of having a triple or quad test?
A triple or quad test is a blood test, so there is little or no physical
risk.
The most common risk of the tests is needless worry. There
is a chance that the test could show that there's a problem when there isn't
one. This is called a
false-positive test result. The quad test is less
likely than the triple test to show a problem when there isn't one.
But most women have normal test results. Even when the test is positive,
most pregnancies turn out to have no problems.
What are the risks of NOT having a triple or quad test?
If you don't have a triple or quad test or a test to diagnose a birth
defect, your fetus could have a problem that you don't find out about until
birth.
- The birth could be higher-risk for the baby
if your doctor is not expecting a newborn with health problems.
- You
could give birth in a hospital that does not have a neonatal intensive care
unit (NICU) for sick newborns.
- A fetus with a rare, severe defect
sometimes dies before delivery.
- You might not be emotionally ready
for a sick baby or one with
Down syndrome.
Why might your doctor recommend a triple or quad test?
Your doctor might recommend a triple or quad test if:
- You have a family history of Down syndrome or
birth defects.
- You want a test for birth defects, but you aren't
sure if you want to have an
amniocentesis.
- You might change your birth
or parenting plans if you knew your fetus had a serious problem.
2. Compare your options
| |
Have a triple or quad
test |
Don't have either test
|
| What is usually involved? |
- You have a blood test.
- Based on the result, you decide whether to have more tests, such
as
fetal ultrasound or
amniocentesis.
|
- You may decide not to have any tests for birth
defects.
- You may have a
fetal ultrasound to check for
problems.
- You may decide to skip screening tests and have an
amniocentesis. This can find out for sure if there is
a problem.
|
| What are the benefits? |
- You can find out if there is a chance of a problem with your
fetus.
- The tests are good at finding a problem if there is
one.
- You may have peace of mind if the test is negative.
|
- You won't have the worry of a test that may show a problem when
there isn't one.
- You can avoid the cost of a screening test and go right to
amniocentesis to find out for sure if there is a problem.
|
| What are the risks and side effects? |
- The tests have a high chance of showing a problem when there
isn't one. This could make you worry.
- The tests can't diagnose a
problem, so you might need other tests if the triple or quad test is
positive.
|
- If you don't have any tests for birth defects, your fetus could
have a problem that you don't find out about until birth.
- There are no known side effects of fetal
ultrasound.
- Amniocentesis has about a 1 out of 400 risk of
miscarriage.3 It doesn't lead
to a miscarriage 399 out of 400 times. The test also has a risk of bleeding and
infection.
|
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These
personal stories
may help you decide.
Personal stories about deciding to have the triple or quad screen
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I know that I'm at a bit higher risk of having a baby with Down syndrome because of my age. My husband and I don't have any risk factors for having a child with other birth defects. If the screening tests weren't available, I would probably have an amniocentesis even though it has some risks. But since I can have the screening tests, I've decided to start with that and then make a decision about amniocentesis based on the results."
"I'm not really worried about things like birth defects that might or might not happen. I don't have any risk factors for having a baby with a birth defect, and I know a lot of women who have had amniocentesis and other tests who spent a lot of time worrying, only to have healthy, normal babies. I feel like the best thing I can do is take good care of myself, stay alert for any signs that there is a problem, and enjoy my pregnancy."
"My neighbor had her first baby at our rural community hospital. The baby had spina bifida, and they rushed her by ambulance to the nearest city and then by helicopter to a center that treats babies with this problem. My neighbor had to follow her later on and so was away from her baby at a really traumatic time. It was such a scary experience for her. I am definitely going to have the screening tests and find out my risk of having a baby that needs special care so we can plan ahead."
"My husband and I want to have the most definitive information possible to make decisions about my pregnancy, so we are going to start with the chorionic villus sampling. I know it's a little more risky, but we feel like we need as much information as early as we can get it. It took us a little longer than we expected to become pregnant. If there is any chance that the fetus has a birth defect, we want to know that as soon as we can so we can make the best decision for us about whether to continue this pregnancy or end it and give ourselves a chance to try again."
"Even though I wouldn't choose to end my pregnancy if I found out the baby had a birth defect, I still want to know ahead of time if possible. I would like to have the time to learn as much as I could about what to expect, where to have the baby, and what sort of special care it might need after it is born."
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have a triple or quad test
Reasons to not have the test
I want to know if there's a chance that there could be a problem.
Knowing that there's a problem wouldn't change my birth or parenting plans.
More important
Equally important
More important
I'm not worried that the test could show a problem when there isn't one.
I'm worried that the test could show a problem when there isn't one.
More important
Equally important
More important
I want to just have the blood test.
I'd rather have an amniocentesis to find out for sure if there's a problem.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
4. Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having a triple or quad test
NOT having the test
Leaning toward
Undecided
Leaning toward
5. What else do you need to make your decision?
Check the facts
1.
A triple or quad blood test can tell me for sure if there's a problem with my fetus.
You're right. These tests can only tell you if there is a chance of a problem. They can't be used to diagnose a problem.
2.
These tests could show that there is a chance of a problem with my fetus when there isn't one.
That's right. These tests may show a chance of a problem when there isn't one.
3.
If a triple or quad test shows no problem, I probably won't need to have more tests for birth defects.
That's right. You probably won't need more tests if the triple or quad test shows no problem.
Decide what's next
1.
Do you understand the options available to you?
2.
Are you clear about which benefits and side effects matter most to you?
3.
Do you have enough support and advice from others to make a choice?
Certainty
1.
How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
2.
Check what you need to do before you make this decision.
3.
Use the following space to list questions, concerns, and next steps.
Credits
| By |
Healthwise Staff |
| Primary Medical Reviewer |
Sarah Marshall, MD - Family Medicine |
| Specialist Medical Reviewer |
Siobhan M. Dolan, MD, MPH - Reproductive Genetics |
References
Citations
- Cunningham FG, et al. (2010). Prenatal diagnosis and
fetal therapy. In Williams Obstetrics, 23rd ed., pp.
287–311. New York: McGraw-Hill Medical.
- American College of Obstetricians and Gynecologists
(2007, reaffirmed 2008). Screening for fetal chromosomal abnormalities. ACOG Practice Bulletin
No. 77. Obstetrics and Gynecology, 109(1): 217–227.
- Caughey AB, et al. (2006). Chorionic villus sampling compared with amniocentesis and the difference in the rate of pregnancy loss. Obstetrics and Gynecology, 108(3): 612–616.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
Last Revised:
April 4, 2012
Cunningham FG, et al. (2010). Prenatal diagnosis and
fetal therapy. In Williams Obstetrics, 23rd ed., pp.
287–311. New York: McGraw-Hill Medical.
American College of Obstetricians and Gynecologists
(2007, reaffirmed 2008). Screening for fetal chromosomal abnormalities. ACOG Practice Bulletin
No. 77. Obstetrics and Gynecology, 109(1): 217–227.
Caughey AB, et al. (2006). Chorionic villus sampling compared with amniocentesis and the difference in the rate of pregnancy loss. Obstetrics and Gynecology, 108(3): 612–616.
