Risks associated with an elevated maternal serum alpha-fetoprotein level

Article Abstract:

Screening of pregnant women's blood for alpha-fetoprotein (AFP), a protein made by the fetus, was initially used to identify abnormalities such as spina bifida. Other problems such as fetal death may also be detected, and pregnant women with high levels of AFP, but normal results from ultrasound and amniocentesis, have a higher tendency toward adverse outcomes. The difference in frequencies of abnormalities and poor pregnancy outcomes, according to blood levels of AFP, were evaluated in 58,187 women. Of these women, 102 had two episodes of elevated AFP and 900 had a single reading in which AFP was higher than normal. These 1,002 women were divided into three groups according to AFP level, with 393 women having levels from 2.5 to 2.9 times greater than average; 473 having levels from 3.0 to 4.9 times greater than average; and 136 women with levels more than 5.0 times the average. After 281 women were excluded due to incorrect dating of the pregnancy, detection of twins, or other reasons, the three groups contained 267, 328, and 126 women, respectively. Group two had the greatest number of spina bifida cases and group three had more cases of anencephaly (lack of brain and spinal cord). The overall risks for these neural tube detects were 1.8, 3.2, and 24.3 percent in groups one, two, and three, respectively. The groups had a risk of 1.3, 2.5, and 12.5 percent for other serious problems such as abnormal or absent kidneys; and the risk of fetal death was 1.0, 6.1, and 24.3 percent for groups one, two, and three. Of all 721 women with high AFP levels, 556 had normal ultrasound or amniocentesis results, and a 27 percent risk of adverse pregnancy outcome including late fetal or newborn death, low volume of amniotic fluid, prematurity or low birth weight, placental separation, or preeclampsia (a serious condition associated with high blood pressure.) The overall risk for abnormality or adverse outcome were 24 (group one), 41 (group two), and 91 percent (group three). (Consumer Summary produced by Reliance Medical Information, Inc.)

Pregnancy, Complications of, Pregnancy complications

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Maternal serum alpha-fetoprotein levels in pregnancies complicated by diabetes: implications for screening programs

Article Abstract:

Alpha-fetoprotein (AFP) is a protein made by the fetus that can be measured in the mother's blood. Elevated levels of AFP correlate to a certain degree with the presence of fetal abnormalities such as spina bifida. Lower AFP levels have been found in pregnant women who are diabetic, and correction factors have been proposed so that AFP levels of diabetic mothers are not misinterpreted. However, the decreased levels may alternatively be reflecting real deficits in growth retardation, which occurs in pregnancies complicated by poorly controlled glucose and fat metabolism due to diabetes. The relationship of AFP levels in early pregnancy to the degree of diabetic control and to fetal growth was evaluated in 93 pregnant patients with diabetes. AFP levels from 4,674 nondiabetic pregnant women were used as standards. Diabetic women had significantly lower levels of AFP, but when adjusted for weight, the distribution of AFP levels among the group of women more closely resembled that among nondiabetic women. AFP levels were below average in all diabetic women who had poorly controlled diabetes early in gestation, indicated by high levels of a glucose-modified protein in the blood between 4 and 12 weeks. This was not true when the protein was measured closer to the time when AFP was sampled, 14 to 24 weeks. Among 41 diabetic patients who underwent ultrasonography and in whom fetal size could be estimated, there was an insignificant trend for those with lower AFP levels and higher glucose-linked protein levels to have delayed fetal growth. Further research is needed to support the idea that measurements of AFP, glucose-modified protein, and ultrasonography considered together provide the best prediction of fetal growth abnormalities in pregnancies complicated by diabetes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diabetes in pregnancy, Gestational diabetes

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Isolated hyperechoic fetal bowel: significance and implications for management

Article Abstract:

An ultrasound finding in the second or third trimester of pregnancy of a fetus with an abnormally formed bowel may indicate other significant disorders such as cystic fibrosis or growth retardation. Researchers detected bowel abnormalities in 45 fetuses with the use of ultrasound. Thirty-four of these fetuses (76%) were born alive without any other apparent defects. Three of the remaining fetuses died in utero due to infection or severe growth retardation. Two infants were found to have cystic fibrosis, two with congenital infections, two with calcified growths in the abdomen, and one with fetal alcohol syndrome. Women with fetuses diagnosed with bowel abnormalities before birth may want further analysis to detect congenital infections, abnormal fetal chromosomes, and cystic fibrosis.

Usage, Abnormalities, Fetus, Intestines, Prenatal diagnosis

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