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Quadruple screen test

Definition

The quadruple screen test is a blood test done during pregnancy to determine whether the baby is at risk for certain birth defects.

How the Test is Performed

This test is most often done between the 15th and 22nd weeks of the pregnancy. It is most accurate between the 16th and 18th weeks.

A is taken and sent to the lab for testing.

The test measures levels of 4 pregnancy hormones:

Alpha-fetoprotein (AFP), a protein produced by the baby

Human chorionic gonadotropin (hCG), a hormone produced in the placenta

Unconjugated estriol (uE3), a form of the hormone estrogen produced in the fetus and the placenta

Inhibin A, a hormone released by the placenta

If the test does not measure levels of inhibin A, it is called the triple screen test.

To determine the chance of your baby having a birth defect, the test also factors in:

Your age

Your ethnic background

Your weight

Your baby's (measured in weeks from the day of your last period to the current date)

How to Prepare for the Test

No special steps are needed to prepare for the test. You can eat or drink normally before the test.

How the Test will Feel

You may feel slight pain or a sting when the needle is inserted. You may also feel some throbbing at the site after the blood is drawn.

Why the Test is Performed

The test is done to find out if your baby might be at risk for certain birth defects, such as Down syndrome and birth defects of the spinal column and brain (called neural tube defects). This test is a screening test, so it does not diagnose problems.

Certain women are at greater risk of having a baby with these defects, including:

Women who are over 35 years old during pregnancy

Women taking insulin to treat diabetes

Women with a family history of birth defects

Normal Results

Normal levels of AFP, hCG, uE3, and inhibin A.

Normal value ranges may vary slightly among different laboratories. Talk to your health care provider about the meaning of your specific test results.

What Abnormal Results Mean

An abnormal test result does NOT mean that your baby definitely has a birth defect. Often, the results can be abnormal if your baby is older or younger than your provider had thought.

If you have an abnormal result, you will have another ultrasound to check the age of the developing baby.

More tests and counseling may be recommended if the ultrasound shows a problem. However, some people choose not to have any more tests done, for personal or religious reasons. Possible next steps include:

, which checks the AFP level in the amniotic fluid surrounding the baby. Genetic testing can be done on the amniotic fluid removed for the test.

Tests to detect or rule out certain birth defects (such as Down syndrome).

Genetic counseling.

Ultrasound to check the baby's brain, spinal cord, kidneys, and heart.

Prenatal cell-free DNA screening, which uses cell-free DNA from the placenta and the fetus in the mother's bloodstream. A normal result might help avoid needing amniocentesis.

During pregnancy, increased levels of AFP may be due to a problem with the developing baby, including:

Absence of part of the brain and skull (anencephaly)

Defect in the baby's intestines or other nearby organs (such as )

Death of the baby inside the womb (usually results in a )

(spinal defect)

(heart defect)

(genetic defect)

High AFP can also mean that you are carrying more than 1 baby.

Low levels of AFP and estriol and high levels of hCG and inhibin A may be due to a problem such as:

Down syndrome (trisomy 21)

(trisomy 18)

Considerations

The quadruple screen can have false-negative and false-positive results (although it is slightly more accurate than the triple screen). More tests are needed to confirm an abnormal result.

If the test is abnormal, you may need to talk to a genetic counselor.

References

ACOG Practice Bulletin No. 162: Prenatal diagnostic testing for genetic disorders. Obstet Gynecol. 2016;127(5):e108-e122. PMID: 26938573 pubmed.ncbi.nlm.nih.gov/26938573/.

Driscoll DA, Simpson JL. Genetic screening and prenatal genetic diagnosis. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe's Obstetrics: Normal and Problem Pregnancies. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 10.

Wapner RJ, Dugoff L. Prenatal diagnosis of congenital disorders. In: Resnik R, Lockwood CJ, Moore TR, Greene MF, Copel JA, Silver RM, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 32.

Williams DE, Pridjian G. Obstetrics. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier; 2016:chap 20.

Review Date: 1/10/2022

Reviewed By: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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