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Risks associated with an elevated maternal serum alpha-fetoprotein level.

B F Crandall1, L Robinson, P Grau

  • 1Division of Medical Genetics, University of California, Los Angeles.

American Journal of Obstetrics and Gynecology
|September 1, 1991
PubMed
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Elevated maternal serum alpha-fetoprotein (MSAFP) levels indicate a higher risk of pregnancy complications. Higher MSAFP multiples of the median correlate with increased risks of fetal abnormalities and adverse outcomes.

Area of Science:

  • Prenatal screening and diagnostics
  • Maternal-fetal medicine
  • Reproductive health

Background:

  • Maternal serum alpha-fetoprotein (MSAFP) screening is a key component of prenatal care.
  • Elevated MSAFP levels prompt further investigation for fetal abnormalities and adverse pregnancy outcomes.

Purpose of the Study:

  • To evaluate the association between elevated maternal serum alpha-fetoprotein (MSAFP) levels and the risk of serious fetal abnormalities and adverse pregnancy outcomes.
  • To stratify risks based on MSAFP multiples of the median (MoM).

Main Methods:

  • Analysis of data from 58,187 women undergoing MSAFP screening.
  • Stratification of women with MSAFP ≥ 2.5 MoM into three groups based on MoM levels.
  • Correlation of MSAFP levels with ultrasonography, amniocentesis findings, and pregnancy outcomes.

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Main Results:

  • The risk of serious abnormalities detected by imaging or amniocentesis increased significantly with higher MSAFP MoM levels (7% in 2.5-2.9 MoM, 18% in 3.0-5.0 MoM, 71% in >5.0 MoM).
  • Even with normal imaging and amniocentesis, elevated MSAFP was associated with increased risks of adverse outcomes like fetal death, prematurity, and preeclampsia.
  • The overall risk for abnormality or adverse outcome ranged from 24% to 91% across the three MSAFP MoM groups.

Conclusions:

  • Elevated maternal serum alpha-fetoprotein levels are a significant predictor of both fetal abnormalities and adverse pregnancy outcomes.
  • Risk stratification based on MSAFP MoM is crucial for appropriate prenatal management and counseling.
  • Further investigation is warranted for women with elevated MSAFP, regardless of initial imaging results.