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Quadruple Marker Test

Dr. Pravallika Devisetti Last Updated on 11th February 2022

Quadruple Marker or Quad screen is a type of screening test used to identify any risk of chromosomal/genetic birth defects of an unborn child (fetus). It is usually done in the second trimester of pregnancy around (15-22 weeks of pregnancy). It is most accurate between the 16th and 18th weeks of pregnancy. This blood test checks the levels of various proteins and hormones (secreted by the carrying mother and/or Fetus) which helps to determine the risk of the fetus having any defects or genetic abnormalities. The components included in the quad test are

Alpha-fetoprotein (AFP); a protein produced by the fetus’s liver.
Human chorionic gonadotropin (hCG); a hormone produced by the placenta (this is a structure that provides nutrients to your baby)
Inhibin A; a hormone produced by the placenta and ovaries of the mother
Unconjugated Estriol (UE); a hormone produced by the baby and placenta

The above-mentioned proteins and hormones change as the pregnancy progresses. Hence, it’s essential to correlate results with the stage of the pregnancy.

What is the Quadruple Marker test used for?What is included in the Quadruple Marker test?Procedure for Quadruple Marker test How to prepare for the Quadruple Marker test?Things to consider after the Quadruple Marker test is complete How much does the Quadruple Marker test cost?What do abnormal Quadruple Marker test results indicate? Is Quadruple Marker a definitive test?Why book a Quadruple Marker test?Frequently Asked Questions

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What is the Quadruple Marker test used for?

The test is performed to find out if your baby might be at risk for certain birth defects or if the mother has certain pregnancy-related issues, such as:

Down syndrome
Birth defects of the spinal column and brain (called neural tube defects).
Trisomy 18 (Edwards Syndrome)
Abdominal wall defects

To diagnose multiple/twin pregnancies
To diagnose causes for miscarriage

What is included in the Quadruple Marker test?

A quad screen checks for the following components in your blood:

Alpha-fetoprotein (AFP): AFP is a protein that is produced in a developing fetus. Higher levels of this protein can indicate neural tube defects or seen in twin pregnancy and lower than normal levels can indicate a high risk of having Down syndrome in the baby.

Unconjugated estriol (UE): The Fetus and placenta produce this hormone. The lower levels might mean a high risk for having a baby with Down syndrome.

Human chorionic gonadotropin (hCG): The placenta makes a hormone called hCG. Levels that are higher than expected could mean an increased risk of a baby having Down syndrome.

Inhibin-A: The placenta and ovaries produce this protein. A higher level of this means having a baby with Down syndrome.

Procedure for Quadruple Marker test

A healthcare professional will draw a small sample of blood from your(mother’s) arm.
Then the Phlebotomist cleans the skin with the disinfectant on the elbow and then applies a band around the arm to make the vein visible.
Then the phlebotomist inserts a needle into the vein to draw blood into a small tube.
The process is quick and typically causes little pain or discomfort.
The blood sample taken is sent to the lab for testing.

Book a Quadruple Marker to check for any type of chromosomal birth defect risk for your unborn child!

How to prepare for the Quadruple Marker test?

No special preparation is needed for this test. You can eat or drink normally before the test.

Things to consider after the Quadruple Marker test is complete

After the test is completed, get some rest. It is always better to eat or drink something because some people feel weak or faint after drawing blood. You should be able to go back home and can resume your regular day-to-day activities.

*What types of Disorders or conditions can the Quadruple Marker test detect?

Down syndrome (trisomy 21). Down syndrome is a genetic disorder where the baby born may have certain facial deformities and heart disorders, immune system disorders, can have intellectual disabilities, developmental delays etc. This condition happens due to some defects involving chromosome 21.
Trisomy 18. Also referred to as Edward’s Syndrome, it is a chromosomal abnormality and might lead to stillbirth or early death.
Spina bifida. A birth defect occurs when the spine and spinal cord do not form properly. This is a neural tube defect.
Abdominal wall defects. An abdominal wall defect is an opening in the abdomen through which various abdominal organs can protrude.

How much does the Quadruple Marker test cost?*

The cost of the Quadruple Marker Test in India varies from INR 1600-2690 in 24 cities of India. Here are the costs of a few cities.

City	Test Price
Quadruple Marker Test Cost in Chennai	₹ 1600.0
Quadruple Marker Test Cost in Hyderabad	₹ 1600.0
Quadruple Marker Test Cost in Gurgaon	₹ 1800.0
Quadruple Marker Test Cost in Delhi	₹ 2000.0
Quadruple Marker Test Cost in Mumbai	₹ 2380.0
Quadruple Marker Test Cost in Bangalore	₹ 2690.0
Quadruple Marker Test Cost in Kolkata	₹ 2690.0

*Disclaimer: The value varies based on location, time, and your preferred lab partner.

How long does it take to get the results for the Quadruple Marker test?

You can expect to get the results for the Quadruple Marker test within 24 to 48 hours after the sample is collected. However, in certain cases, depending on the location, medical advice, and preferred lab partner, it may take longer.

What do abnormal Quadruple Marker test results indicate?

Abnormality	Cut off	Detection rate	False-positive rate
Neural tube defects	≥ 2.5 MoM (Multiples of median)	70-75 %	2-4 %
Down Syndrome (Trisomy 21)	1: 270	75 -80 %	4 %
Edwards Syndrome (Trisomy 18)	1:100	60 %	0.3 %

Quadruple marker screen results that are not in the normal range do not necessarily mean there is a problem with your baby. However, results are interpreted as follows:

Higher than normal AFP levels could mean that your baby has an open neural tube defect such as spina bifida or anencephaly.
Lower than normal AFP, Unconjugated estriol levels could mean that you have a higher chance of having a baby with Down syndrome.
Higher than normal range of hCG, Inhibin A levels may indicate a high risk of having a baby with Down syndrome.

Your doctor interprets these results based on your gestational age etc. Please consult your doctor for better interpretation and management.

If the quad marker screen results are in the abnormal range, your doctor might advise for further tests such as an ultrasound or amniocentesis.

Disclaimer: Please consult with your doctor for interpreting the test reports.

Is Quadruple Marker a definitive test?

No. This test is a screening test only and is not a definitive test for diagnosis.
The test can approximately detect 75 percent of Down syndrome cases in women below 35 years and 85 to 90 percent of Down syndrome cases in women aged 35 years and older.
It can also detect approximately 75 percent of open neural tube defects.
If the quad screen test is negative, there’s still a possibility that your baby could be born with one of these conditions.
About 50 women out of every 1,000 will have a result on the quad screen that indicates an increased risk of a birth defect, but only one to two of those women will actually have a baby with an open neural tube defect.

How to read the Quadruple Marker test report?

Biological reference in healthy pregnant women (Normal value)

Pregnancy Weeks	AFP	HCG	Estriol	Inhibin A
14	27.20 ng/mL	40370 mIU/mL	0.37 ng/mL	208.75 pg/mL
15	32.01 ng/mL	32200 mIU/mL	0.55 ng/mL	222.90 pg/mL
16	37.67 ng/mL	25690 mIU/mL	0.76 ng/mL	194.20 pg/mL
17	44.33 ng/mL	20490 mIU/mL	1.00 ng/mL	201.30 pg/mL
18	52.16 ng/mL	16340 mIU/mL	1.25 ng/mL	196.20 pg/mL
19	61.38 ng/mL	13040 mIU/mL	1.50 ng/mL	226.90 pg/mL
20	72.33 ng/mL	10400 mIU/mL	1.76 ng/mL	253.70 pg/mL
21	85.08 ng/mL	8295 mIU/mL	1.99 ng/mL	282.10 pg/mL
22	100.02 ng/mL	6620 mIU/mL	2.30 ng/mL	292.30 pg/mL

Reference ranges may vary from lab to lab.

Normal levels of AFP, estriol, hCG, and Inhibin-A strongly indicate that you have a healthy pregnancy and a healthy baby. In over 98% of pregnancies, normal quad marker screen results predict healthy babies and births without major complications. However, there are no prenatal tests that can guarantee your baby and pregnancy will be completely healthy or without complications.

Book a Quadruple Marker test to check your Quadruple Marker level!

Why book a Quadruple Marker test?

Your doctor may recommend this test if you have any of the following reasons:

Age more than or equal to 35 years
Previous history of having a baby with birth defects
Family history of having a baby with birth defects
History of exposure to radiation in the past
On treatment for type 1 diabetes

It determines if a woman is at higher or lower risk of carrying a baby with a birth defect like

Down syndrome.
Neural tube defects.
Failure of closure of the abdominal wall in the fetus.
Multiple/twin pregnancies.
To diagnose causes of miscarriage or ectopic pregnancy in the mother.

Quadruple Marker test at home – how does it work?

The Quadruple Marker test is just like any other blood test. A lab technician visits your home when you book your tests through the MFine app. The lab technician first cleans the arm and then inserts a needle into a vein. The required amount of blood is then taken into a vacutainer. The lab technician then removes the needle and places cotton wool or a bandage over the prick.

Are there any risks involved with the Quadruple Marker test?

No. The quad marker screen is a safe and useful screening test for families concerned about birth defects or genetic diseases of the baby. The test carries no risk to the baby since a blood sample is taken only from the mother. As this is a simple blood test there is no risk for the mother as well.

What can affect the results of the Quadruple Marker test?

Factors that can affect the levels of components measured by a quad screen include:

A miscalculation of weeks or months of pregnancy
Maternal race
Maternal weight
Pregnancy with more than one baby i.e, twin or multiple pregnancies
Diabetes
In vitro fertilization
Smoking during pregnancy

Book a Quadruple Marker test to check your Quadruple Marker level!

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Frequently Asked Questions | FAQs

Is fasting required for the quadruple test?

No. Fasting is not needed. The quad screen test is a routine screening prenatal test wherein a blood sample is taken from the mother to assess the health and well-being of the baby.. It is a simple blood test and there are no specific steps to be followed prior to the test unless your doctor advises otherwise. The Mother can eat and drink normally.

When can a quadruple test be done?

Ideally, the quad screen is done between the 16th and 18th weeks of pregnancy during the second trimester. However, the procedure can be done from the 15th week to the 22nd week of pregnancy.

What if the quadruple test is negative?

If the result is negative, or normal, it means that your baby probably does not have a birth defect. However, it does not guarantee that you will have a normal pregnancy or baby.

How is the quad marker screen done, and is it safe?

The quad screen involves drawing a little blood. A lab technician gets enough of a blood sample from one of your veins to run the screen. It is safe for your baby and only requires a needle poke for the mother.

Why is the test called the quad screen test?

The quad screen test derives its name from the fact that it measures the levels of four hormones/proteins found in pregnant women:

Alpha-fetoprotein (AFP)
Human chorionic gonadotropin (hCG)
Unconjugated Estriol (UE)
Inhibin A

Disclaimer: The content is uniquely informative and is meant for educational use. Kindly use the content only in consultation with an appropriate certified or registered healthcare provider.

Is the lab technician coming for Quadruple Marker test sample collection vaccinated?

Yes. Our lab technicians are fully vaccinated. Further, they also ensure safety throughout by wearing a mask, gloves, and frequently sanitizing themselves during the sample collection.

Does MFine provide the interpretation for the results along with the reports?

Yes, MFine provides the interpretation for the result along with the reports. You can also avail a free medical consultation with a doctor to understand your reports accurately. The doctor will also advise and prescribe medicines, if required, based on the results.

How can I download my Quadruple Marker test report?

Login to MFine
Go to your profile
Click on Attachment and Reports
Click on Lab Report
Download the report

Are there any discount offers running on the Quadruple Marker test?

Usually, you can avail of up to a 50% discount on the Quadruple Marker through MFine. However, the discount and test price may vary based on lab partner and location.

Is a quad screen necessary?

This test is strongly recommended by doctors for women who are 35 years or older, those who have a past history or family history of birth defects, if a mother is having Type 1 Diabetes In some cases it is recommended in other women who do not meet above criteria as well if the doctor feels there is a need for this test based on clinical findings.

Are there any other reasons for the high levels of the four substances- hCG, AFP, Inhibin A, and UE in the blood, in case of a positive result?

There can be multiple reasons for high levels of these components in the blood. Some key reasons are listed below.

Death of the unborn baby inside the mother’s womb.
If any part of the skull or brain is missing. (Anencephaly).
Intestines or any surrounding organs are defective (Duodenal atresia).
Neural tube defects it’s a serious problem or a condition where the baby’s brain is abnormally developed or there is a problem in the spine.
Genetic abnormality like Turner’s syndrome is a condition where there is a developmental delay as well as there are intellectual disabilities.
Multiple pregnancies or Twin pregnancies.