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Maternal serum alpha-fetoprotein screening: benefits, risks, and costs
1Department of Family Medicine, University of Rochester School of Medicine and Dentistry, New York.
The Journal of Family Practice
|November 1, 1987
Summary
Maternal serum alpha-fetoprotein screening for neural tube defects offers benefits that outweigh risks. However, current data is insufficient to recommend screening for Down's syndrome using this method.
Area of Science:
- Prenatal screening
- Maternal serum alpha-fetoprotein analysis
- Medical diagnostics
Background:
- Maternal serum alpha-fetoprotein (MSAFP) screening is a common prenatal diagnostic tool.
- Evaluating the benefits, risks, and cost-effectiveness of MSAFP screening is crucial for clinical practice.
- Previous reports provide a basis for analyzing screening outcomes in a hypothetical population.
Purpose of the Study:
- To analyze the benefits and risks of MSAFP screening for 10,000 women.
- To review the cost-benefit of MSAFP screening.
- To assess the utility of MSAFP screening for neural tube defects and Down's syndrome.
Main Methods:
- Analysis of previously published reports.
- Hypothetical population study of 10,000 women.
- Review of cost-benefit of MSAFP screening.
Main Results:
- Screening identified all anencephalic and most spina bifida cases.
- Elevated MSAFP caused anxiety in 500 women; 150 underwent amniocentesis with one resulting abortion.
- Screening identified twins, underestimated gestational age, and pregnancies at risk for adverse outcomes.
Conclusions:
- Benefits of prenatal screening for neural tube defects outweigh the risks.
- Current cost-effectiveness of MSAFP screening for neural tube defects is neutral, but requires reevaluation if incidence declines.
- Insufficient data exists to support MSAFP screening for Down's syndrome; it should be discouraged.