Although high concentrations of maternal serum a-fetoprotein (MSAFP) are predictive of adverse pregnancy outcomes, 4 and the risk increases directly with the a-fetoprotein (AFP) level,5 it is unclear whether this association is useful in obstetric care and whether any proposed treatment strategy reduces the incidence of pregnancy complications. Raised Subjects and Methods because of unexplained elevation of MSAFP. These women were divided into 2 groups: permanent smokers (>5 cigarettes per day; n = 123) and nonsmokers (n = 471). (We excluded 52 women who stopped smoking during pregnancy.) A control group was formed of permanent smokers with normal MSAFP (n = 827). The rationale of the study was to compare pregnancy outcomes in the 2 study groups and the control group with those of a true reference group, which consisted of nonsmokers with normal MSAFP (n = 12 596) giving birth to single infants at Kuopio University Hospital during the same time period (1991)(1992)(1993)(1994)(1995).Basic maternal and clinical data were collected at prenatal visits and at delivery. We defined preterm birth as delivery before 37 completed weeks of pregnancy; preeclampsia as repeated blood pressure measurements higher than 149/90 mm Hg with proteinuria higher than 0.5 g per day; and low birthweight as a birthweight of less than 2500 g. A child was considered small for gestational age when the sex-and age-adjusted birthweight was below the normal 10th percentile.If a subject had 2 abnormalities, such as low birthweight and preterm delivery, each was considered an independent outcome and the subject was included in both tallies.Maternal blood samples drawn between 15 and 18 weeks' gestation were obtained, with the subjects' consent, from women in maternity care units in the area of Kuopio University Hospital. As described elsewhere, AFP concentrations were assayed at the Clinical Chemistry Laboratory of Kuopio University Hospital.13 The assay has a detection limit of 0.3 kU/L and interassay and intraassay variations of 3.5% and 2.9%, respectively. Quality was assessed regularly with commercially available control samples (Lyphocheck Immunoassay Control Serum, Bio-Rad Laboratories, Anaheim, Calif). Gestational age was truncated to the nearest whole week. Subject-specific results wereIn the district of Kuopio University, 35 971 pregnant women were screened by way of MSAFP assay over a 5-year period (1991)(1992)(1993)(1994)(1995). The study group with elevated MSAFP was derived from 646 (1.8%) of these women whose chromosomally normal, singleton pregnancies were firther evaluated at a university-based tertiary care clinic

Objective: This study was designed to investigate the association between the concentrations of maternal serum hCG and amniotic fluid erythropoietin during the second trimester of pregnancy. Methods: In a prospective case-control study, 42 consecutive singleton pregnancies showing unexplained elevated serum hCG concentrations (>2.0 multiples of the median, MoM) in Down’s syndrome screening and 27 control pregnant women undergoing midtrimester amniocentesis because of a previous cytogenetic abnormality were studied. Results: The mean amniotic fluid erythropoietin concentration in the study group was 1.8 (range 0.61–8.7) MoM, whereas it was 1.1 (range 0.71–3.96) MoM in the controls (p = 0.035). A significantly increasing relationship (p < 0.05) was found between the concentrations of maternal serum hCG and amniotic fluid erythropoietin. Conclusions: The results of the current study revealed in vivo the association between elevated hCG and amniotic fluid erythropoietin levels which, in turn, supports the concept of early placental damage. The underlying pathology seems to be sufficient to cause an erythroblastic response.

Objective: A combination of low concentrations of maternal serum alpha fetoprotein (MSAFP) and human chorionic gonadotropin (hCG) was used to screen for trisomy 18 in early 2nd-trimester pregnancies in a low-risk child-bearing population. Methods: Women less than 37 years of age were offered screening between 15 and 20 weeks of gestation. Those pregnancies showing low concentrations of MSAFP (<0.75 multiples of the median) and hCG (<0.5 multiples of the mean) were considered positive. If gestational age was confirmed, genetic counselling and invasive prenatal diagnosis were offered. Results: Between January 1995 and December 1996, 19,491 women were screened, of whom 252 were found to be positive (1.25%). 145 invasive procedures were carried out, and 3 cases were detected. The odds of a fetus being affected after a positive screen result were 1 in 36. Conclusions: Measurement of low concentrations of MSAFP and hCG in pregnant women less than 37 years of age is an effective screening test for Edward’s syndrome, but with regard to the natural history of this genetic condition, it can result in overuse of invasive tests which in turn can harm chromosomally normal pregnancies. This stresses the need to evaluate these pregnancies further with detailed ultrasonographic assessment and selective fetal karyotyping only.

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