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[Prematurity and methods of its screening]
Insights
Maternal serum alpha-fetoprotein (MS-AFP) screening in early pregnancy can identify women at higher risk for premature delivery. Elevated MS-AFP levels between 15-20 weeks gestation indicate a significantly increased likelihood of preterm birth.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Epidemiology
Context:
- Premature delivery is a significant global health concern with substantial neonatal morbidity and mortality.
- Current screening methods for high-risk pregnancies have limitations in early detection.
- Identifying at-risk pregnancies early allows for timely intervention and improved outcomes.
Purpose:
- To investigate the association between maternal serum alpha-fetoprotein (MS-AFP) levels and the risk of premature delivery.
- To evaluate MS-AFP as a potential screening marker for identifying pregnancies at high risk for preterm birth.
- To establish a predictive cut-off value for MS-AFP in early pregnancy.
Summary:
- A retrospective study analyzed data from 2368 pregnant patients screened between 15-20 weeks gestation.
- Higher MS-AFP levels (≥1.8 MOM) were significantly correlated with an increased risk of premature delivery (odds ratio 3.8).
- The study demonstrated a sensitivity of 25% and specificity of 92% for MS-AFP in predicting preterm birth.
Impact:
- MS-AFP screening, typically used for hereditary diseases, can be extended to include premature delivery risk assessment.
- Early identification of high-risk pregnancies enables targeted interventions, potentially reducing rates of preterm birth.
- This approach offers an extension of classical screening techniques, enhancing prenatal care and obstetrical management.
Objective:
Premature delivery is an essential problem in the modern obstetrics. Revealing and marking the high-risk group of pregnant women in time could be used as one of the methods of its prevention.
Design:
Retrospective epidemiological study of the aggregated data of pregnant patients.
Setting:
OBGYN Clinic of the 1st and 3rd Faculty of Medicine, Prague, FNB, FNKV.
Method:
A routine database of pregnant patients was generated. In our study was included the group of 2368 patients who underwent the screening and fulfilled the condition of completion the data in the period from the 15th to the 20th week of pregnancy, during and after the birth. Database is a component of a lager database generated in the last 15 years. The group of premature delivery patients was marked as those who delivered before the beginning of the 10th month of pregnancy. MS-AFP (maternal serum AFP) screening values of pregnants were measured and transformed to the multiples of medians (MOM), corresponding to the particular week of pregnancy for enabling the comparison during the whole period of screening. Statistical investigation was performed using data analysis advanced methods.
Results:
A significant statistical correlation between higher values of MS-AFP, during the period from the 15th to the 20th week of pregnancy, and premature deliveries were found. The cut-off value of 1.8 MOM MS-AFP was included to determine the higher risk group of patients. Women with equal or higher values of AFP were 3.8 times more likely to have premature delivery than those with lower AFP values (95% CI: 2.2;6.3). Sensitivity of 25% and specificity of 92% were proven.
Conclusion:
According to our opinion, MS-AFP could not only be used for the hereditary diseases screening, but as well for performing the premature delivery screening at the beginning of the 2nd trimester. Cut-off value of 1.8 MOM for marking the higher risk group was used for marking the high-risk group. Thus the extension of the classical screening technique of hereditary diseases could yield also in other areas of the obstetrical care.
