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Quadruple screen test

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 blood sample 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 gestational age (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.

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:

  • Amniocentesis, which checks the AFP level in the amniotic fluid surrounding the baby
  • 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

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

High AFP can also mean that you're 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:


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 want to talk to a genetic counselor.

Alternative Names

Quad screen; Multiple marker screening; AFP plus; Triple screen test; AFP maternal; MSAFP; 4-marker screen; Down syndrome - quadruple; Trisomy 21 - quadruple; Turner syndrome - quadruple; Spina bifida - quadruple; Tetralogy - quadruple; Duodenal atresia - quadruple; Genetic counseling - quadruple; Alpha-fetoprotein quadruple; Human chorionic gonadotropin - quadruple; hCG - quadruple; Unconjugated estriol - quadruple; uE3 - quadruple; Pregnancy - quadruple; Birth defect - quadruple


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

Driscoll DA, Simpson JL, Holzgreve W, Otano L. Genetic screening and prenatal genetic diagnosis. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 10.

Wapner RJ. Prenatal diagnosis of congenital disorders. In: Creasy RK, Resnick R, Iams JD, Lockwood CJ, Moore TR, Greene MF, eds. Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice. 7th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 30.

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

Review Date 4/5/2016

Updated by: Irina Burd, MD, PhD, Associate Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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