Particulate acetylcholinesterase in amniotic fluid and its implications for neural tube defect screening

Acetylcholinesterase activity in mid-trimester amniotic fluid has been determined by a quantitative spectrophotometric method and a qualitative electrophoretic technique in a limited (76 samples) retrospective study. Differential centrifugation studies on amniotic fluid from normal pregnancies demonstrated the presence of particle-associated acetylcholinesterase sedimenting only at relatively high centrifugal forces. It is postulated that this particle-associated activity was a contributory factor to an observed false-positive incidence of 6.6% when quantitative acetylcholinesterase measurement was used to discriminate between normal pregnancies and those associated with neural tube defects. Discrimination on the basis of electrophoretic analysis of acetylcholinesterase resulted in no misclassification of pregnancies. Particulate acetylcholinesterase would not be expected to influence the interpretation of the electrophoretic pattern due to its size-related exclusion from gel pores. The implication of these observations in the accurate prenatal diagnosis of neural tube defects is discussed.