Clinical interpretation of maternal serum alpha-fetoprotein concentrations

Concentrations of maternal serum alpha-fetoprotein provide the basis for decisions to proceed to ultrasonography and amniocentesis in the multistaged screening/diagnostic process used for the prenatal detection of open neural tube defects, abdominal wall defects, and twins. The concentration of maternal serum alpha-fetoprotein at or above which women should be advised that amniocentesis is available (cutoff levels for amniocentesis) varies, depending upon a number of factors, such as maternal weight, race, residence, and gestational age. We briefly describe a methodology for computing the predicted risks of fetal conditions associated with a given concentration of maternal serum alpha-fetoprotein adjusted for important variables. This adjustment methodology provides a straightforward means for clinical laboratories to report results of assays of maternal serum alpha-fetoprotein in terms of predicted risks, to facilitate understanding by the physician and patient of the clinical meaning of the results of maternal serum alpha-fetoprotein testing.