Blood tests are a standard diagnostic tool during pregnancy. It is a safer option which provides a clear picture about the factors affecting the growing fetus, and allows the would-be parents and the doctors to stay informed about the fetal growth, development, and associated anomalies.

The Quadruple marker test, otherwise known as the quad marker screening, is a type of blood test done during pregnancy. During the second trimester, the procedure is prescribed to find potent anomalies or complications associated with the baby’s growth and development.

The quad marker test results also flag if there is a possibility of severe developmental complications in the baby, requiring further testing. Given how important the test is, knowing about it in detail enables the parents to make informed decisions during their pregnancy.

This article will explore more about the Quadruple Marker test procedure and explain the test results.

What is a Quadruple Marker test?

The Quadruple marker test is a definitive blood test prescribed during the second trimester of the pregnancy. As the name suggests, the screening looks into four (quad) factors.

These include: Alpha-fetoprotein (AFP), Human chorionic gonadotropin (HCG), Estriol, and Inhibin A.

Your healthcare provider (OBGYN) will likely prescribe the test during 15-18 weeks gestation. The procedure can be prescribed up to 22 weeks gestation too.

The screening helps identify the fetus’ risks of being born with developmental issues, neural tube defects like Spina Bifida, or chromosomal defects like Down syndrome.

Depending on the analysis of quadruple test results low risk or high risk, the doctors will suggest additional testing to confirm their suspicions.

Why is the Test Done?

The prevalence of quad marker screening has been around for a long time. It is part of prenatal care and is an important test that prepares the would-be parents for any complications that could affect the baby after their delivery.

The quad-marker screening analyzes and helps estimate four conditions:

Condition/Diagnosis for What is it?
Down syndrome It is a Chromosomal disorder that alters the development and intellectual ability of the newborn.
Trisomy 18 Fatal chromosomal disorder that alters the structural development in the body. It often claims the lives of the newborn by the age of 1.
Spina bifida A type of neural tube defect that results in underdevelopment of the spinal cord and the bones of the spine.
Abdominal wall defects It results in external protrusion of the abdominal organs through an opening in the abdomen.


Besides testing for these anomalies, your OBGYN will also prescribe a Quad marker screening if:

  • You are 35 years and older
  • You have previous history with delivering babies with congenital defects
  • You have diabetes and insulin-related complications
  • You contracted a viral infection during gestation
  • You are on certain harmful medications or have been abusing drugs while pregnant

Based on these factors, the healthcare provider will assess the complications and then address the problems accordingly.

What factors does the Quadruple Marker Test Check?

As mentioned before in brief, the quad marker screen addresses four distinct factors. The low and high levels of these individual factors depict the risks of the birth defects in the developing fetus during pregnancy.

Factor Produced from Quad Marker Results
Alpha-fetoprotein (AFP)

Normal levels: 10-150 ng/mL (15-18 weeks)

Baby’s liver -High levels indicate risks of neural tube defects in the baby.

-Low levels indicate possibilities of Down syndrome.

-Could also indicate the possibility of multiple pregnancies.

Human chorionic gonadotropin (hCG)

Normal levels: 13,300–254,000 mIU/mL (13–16 weeks) to 4,060–165,400 mIU/mL (17–24 weeks)

Placenta -High levels indicate possibilities of Down syndrome.
Unconjugated estriol (UE)

Normal levels: ≤2.50 ng/mL (first trimester) and ≤9.60 ng/mL (second trimester)

Baby and the placenta -Low levels indicate possibilities of Down syndrome.

Normal levels: 180 pg per milliliter (15 weeks)

Placenta and ovaries -High levels indicate possibilities of Down syndrome.

Remember that the quadruple test normal values, low or high values aren’t a definitive diagnosis for any of the mentioned conditions. These results allow the doctors to go for further screening to determine the estimated risks.

Much like how a positive quad screening doesn’t ascertain that a baby would suffer from Down syndrome or neural tube defects, a negative screening doesn’t guarantee that the baby would be completely safe from these complications too.

Only further testing can give additional information about the associated risks and finalize a diagnosis.

How is the Quadruple Marker Test Done?

The quad marker screening is a simple blood test. The lab technician draws the blood sample from the patient’s veins and sends it for further testing.

The procedure is 100% safe and doesn’t impose any kinds of risks to the mother’s or the baby’s health.

Also, there are no specific requirements needed for preparing for the test. The mother can get their blood drawn after eating or even following their medication. There are no imposed restrictions on the timing of the test too.

What can I expect from an abnormal Quadruple Marker Test?

A normal quadruple marker test means that your fetus is less likely to be born with congenital disabilities. However, a quadruple marker test low risk means higher chances of chromosomal defects, developmental defects, and other associated complications.

If the results are abnormal, the doctor will suggest further genetic screening and laboratory testing to rule out the potential risks of birth defects in the developing fetus.

Sometimes, an abnormal quad marker screening report indicates that the fetus is older than the estimated gestation. Depending on the levels of the reports, the doctor might suggest an ultrasound, prenatal cell-free DNA screening, or amniocentesis to determine the complications in the baby before their birth.

What is the cost of the Quadruple Marker Test in India?

The quadruple marker test cost in India typically starts from INR 1600. The prices can be higher depending on the city or the laboratory in which you are getting the test done.


Being pregnant is a roller-coaster ride for the parents. However, it is better to be informed about possible risks during the pregnancy to better prepare before the baby’s arrival. A quad marker screening allows the parents and the doctors to rule out every possible risk and complication that could affect the newborn’s quality of life. If your OBGYN has prescribed a quadruple marker test, get it done for your safety and your baby’s well-being as well.

Prekshi Garg is a young, dynamic, energetic, and meritorious professional biotechnologist. She is a merit rank holder in her post-graduation and a skilled bioinformatician with great zeal to do her best in neurosciences. She is currently working in the area of Neurotranscritomics dealing with neurodevelopmental and neurodegenerative disorders. She has presented many papers at different scientific forums and is awarded ‘Representing the Institution in Scientific Events’ citation by Amity University Uttar Pradesh and Top position in Student Assistantship Program held at Amity University in addition to awards won for oral presentations in different scientific deliberations. Prekshi has published a good number of papers and book chapters during the start of her academic career itself. Her tremendous skills and knowledge make her a good blend of biotechnology and bioinformatics.

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