Pregnancy: Should I have the maternal serum triple or quadruple test?

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

Your options

Have the triple or quad test.
Don't have either test. You may decide instead to have a fetal ultrasound or an amniocentesis.

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 risk of this happening increases with the mother's age. The quad test is less likely than the triple test to show a false-positive result.
These tests usually are accurate when they show there is no problem. So if your test result is normal, you probably won't need more tests, such as a fetal ultrasound or amniocentesis, to look for birth defects.
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:

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, 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 screen finds 80 out of 100 fetuses with open spina bifida and 97 out of 100 with anencephaly.¹ The test misses finding 20 out of 100 fetuses with open spina bifida and 3 out of 100 with anencephaly.

One large study showed that the quad test finds Down syndrome almost 86 out of 100 times. It doesn't find it 14 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.²

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.

For more information, see:

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.³ 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.³ 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 chance of a false-positive test increases with the mother's age. 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 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 in 400 risk of miscarriage.⁴ 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.

For more information about prenatal tests, see:

If you need more information, see the topics:

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."

— Rachel, age 37

"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."

— Yvonne, age 31

"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."

— Candace, age 26

"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."

— Elena, age 37

3. Your Feelings

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:

More important

Equally important

More important

4. Your Decision

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. Quiz Yourself

Check the facts

1. A triple or quad blood test can tell me for sure if there's a problem with my fetus.

True
False
I'm not sure

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.

True
False
I'm not sure

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.

True
False
I'm not sure

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.

I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

References

Citations

Genetic Disease Branch, California Department of Health Services (2007). The California Expanded AFP Screening Program. Richmond, CA: California Department of Health Services. Also available online: http://www.dhs.ca.gov/pcfh/GDB/html/PS/PSSEDMATold2.htm.
Benn PA, et al. (2003). Incorporation of inhibin-A in second-trimester screening for Down syndrome. Obstetrics and Gynecology, 101(3): 451–454.
Cunningham FG, et al. (2005). Prenatal diagnosis and fetal therapy. In Williams Obstetrics, 22nd ed., pp. 313–339. New York: McGraw-Hill.
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.