Maternal serum alpha-fetoprotein screening

Article Abstract:

Alpha-fetoprotein is a glycoprotein, or compound consisting of carbohydrates and protein, that is produced by the fetus. The levels of alpha-fetoprotein are highest in the fetal blood and amniotic fluid in the 13th week of pregnancy and in the mother's blood at 30 weeks of pregnancy. Increased maternal blood levels of alpha-fetoprotein have been associated with fetal defects and poor outcome of pregnancy. Screening for increased maternal blood levels of alpha-fetoprotein was shown to be effective in detecting defects of the neural tube, the tissue from which the brain and spinal cord develop. A recent study showed that low maternal alpha-fetoprotein levels were associated with abnormalities of the fetal chromosomes, the structures that carry the genetic information of the cell. The measurement is repeated in women with alpha-fetoprotein levels that are 2.5 times the normal value. Those with abnormal alpha-fetoprotein levels can be further assessed by ultrasonography, which uses sound waves to visualize the fetus, and by amniocentesis. This procedure involves obtaining a sample of amniotic fluid through a needle inserted into the amniotic sac. Among women who undergo follow-up amniocentesis, 1 in 10 women will have a fetus with a neural tube defect and 1 in 40 will have a fetus with a chromosomal abnormality. The cost-effectiveness and accuracy of initial tests for measuring alpha-fetoprotein levels were areas of earlier concern. Screening for elevated alpha-fetoprotein levels is not mandatory and many women refuse to be tested. However, women with elevated alpha-fetoprotein levels, but no evidence of fetal defects, were shown to have an increased risk of poor outcome of pregnancy. A recent study showed that elevated maternal alpha-fetoprotein levels were associated with an increased risk of fetal death, which could occur late in pregnancy. These findings support the usefulness of measuring alpha-fetoprotein levels in pregnant women to detect neural tube defects, fetal chromosomal abnormalities, and an increased risk of fetal death. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Cases, Measurement, Fetus, Alpha fetoproteins

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Prevention of preeclampsia - a reality?

Article Abstract:

Preeclampsia, or toxemia during pregnancy, is a condition unique to pregnant women which usually occurs between the 20th week of gestation (pregnancy) and one week after birth. Symptoms include hypertension (high blood pressure), edema (fluid retention in the legs and feet), and protein in the urine. If this condition goes untreated eclampsia may develop (in 1 out of 200 cases), which is a serious condition characterized by coma and convulsive seizures leading to death. The cause is unknown but it has been observed that women with hypertension or kidney irregularities have a stronger tendency to develop preeclampsia. Other complications associated with preeclampsia are neutropenia in infants (low levels of white blood cells) and higher rates of nosocomial infections (i.e. infections acquired during hospitalization) in the first three weeks after birth. In several studies, women with a higher risk of developing pregnancy-induced hypertension have been treated daily with low doses of aspirin which has shown favorable results. In one case, a small group of high-risk women were treated with low dosages of aspirin early in their pregnancies. When compared with a control group that was given placebos and with their own previous pregnancies, the aspirin-supplemented pregnancies were more successful. Longer terms, higher birth weights, and fewer complications, including preeclampsia, were noted. However, it was concluded that routine use of low-dosage aspirin treatment in pregnant women is premature. The potential adverse and overall long-term effects upon both the mother and the infant are unknown. Therefore, the questions of how to define high-risk and to what degree must it be present to indicate treatment must be examined. Although aspirin therapy in the treatment of preeclampsia shows promise, further study is recommended.

Prevention, Preeclampsia, Aspirin, editorial

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Childbearing among older women - the message is cautiously optimistic

Article Abstract:

Pregnant women over the age of 35 are more likely to have complications than younger pregnant women, but the outlook for older pregnant women has improved significantly. Pregnant women over 35 are more susceptible to bleeding complications and disorders of the kidneys, the cardiovascular system, the nervous system, and the lungs. These older women are also more likely to have spontaneous abortions, still birth, and fetal malformations. Many of these complications are caused by disorders such as diabetes and hypertension that occur with aging. A 1995 study showed that from the 1960s to the 1990s the overall rate of fetal death decreased by over 70%, though it remained higher among older mothers. In comparison to the 1960s, more women over the age of 35 are having children in the 1990s. For these older mothers who receive fetal screening early in pregnancy, the likelihood that they will deliver a living child is 994 in 1,000.

Risk factors, Pregnant women, Maternal age

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