Maternal serum alpha‐fetoprotein at 12, 22 and 32 weeks' gestation in screening for pre‐eclampsia

Bredaki, Foteini E.; Mataliotakis, Michalis; Wright, Alan; Wright, David; Nicolaides, Kypros H.

doi:10.1002/uog.15818

Cited by 30 publications

(24 citation statements)

References 19 publications

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“…The results were in general agreement with other studies on second-trimester MS-AFP and APOs [6,[9][10][11][12]. A case-control study on MS-AFP and preeclampsia also revealed that MS-AFP was elevated in both the first and the second trimesters in pregnancies that developed preeclampsia, but the performance of second-trimester MS-AFP combined with maternal factors for preeclampsia screening was better than that of first-trimester MS-AFP [23]. Taking others' and our findings together, we can conclude that first-trimester MS-AFP is less predictive of APOs than second-trimester MS-AFP.…”

Section: Discussionsupporting

confidence: 90%

First-trimester maternal serum alpha-fetoprotein is not a good predictor for adverse pregnancy outcomes: a retrospective study of 3325 cases

Zhang

et al. 2020

BMC Pregnancy Childbirth

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Background: It is well known that second-trimester maternal serum alpha-fetoprotein (MS-AFP) is a predictor for adverse pregnancy outcomes (APOs), such as preterm birth, stillbirth, preeclampsia and small for gestational age (SGA). However, it is unknown whether first-trimester MS-AFP is also predictive of APOs. Methods: We retrospectively reviewed the data on the first-trimester MS-AFP levels and pregnancy outcomes of 3325 singleton pregnant women. The cutoff value of 2.5 multiple of the median (MoM) was used to evaluate the risks of APOs regarding MS-AFP. The receiver operating characteristic (ROC) curves were used to evaluate the predictive efficiencies of MS-AFP to these disorders. Results: A total of 181 pregnancies resulted in preterm birth, 32 in stillbirth, 81 in preeclampsia, and 362 in SGA. Compared to women with MS-AFP < 2.5MoM, those with MS-AFP ≥ 2.5MoM had increased risks (odds ratio, 95% confidence interval) of preterm birth (2.53, 1.65~3.88), preeclampsia (3.05, 1.71~5.43) and SGA (1.90, 1.34~2.69), and had an earlier distribution of gestational weeks at delivery (P = 0.004) and a lower distribution of neonatal birth weights (P = 0.000), but the actual between-group differences were minuscule. The areas under ROC curves were 0.572 (P = 0.001), 0.579 (P = 0.015) and 0.565 (P = 0.000) for preterm birth, preeclampsia and SGA, respectively. Subdivisions for the disorders did not obviously improve the performances of MS-AFP. Conclusions: Elevated first-trimester MS-AFP is associated with increased risk of preterm birth, preeclampsia and SGA. However, the predictive efficiencies were low and it is not a good predictor for these APOs.

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Section: Discussionsupporting

confidence: 90%

First-trimester maternal serum alpha-fetoprotein is not a good predictor for adverse pregnancy outcomes: a retrospective study of 3325 cases

Zhang

et al. 2020

BMC Pregnancy Childbirth

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“…For all these predictors, the performance was better for early than for late PE, and was better when assessed later in pregnancy than at 11–13 weeks, i.e. closer to the development of PE.…”

Section: Combined Screening Strategiesmentioning

confidence: 96%

“…Combined screening has been the subject of approximately 400 PubMed articles up to April 2018. Multiple studies have shown that women who go on to develop PE have, on average, higher mean arterial pressure, higher concentrations of maternal serum soluble fms‐like tyrosine kinase‐1 (sFlt‐1) and alpha‐fetoprotein (AFP), and lower concentrations of pregnancy‐associated plasma protein‐A (PAPP‐A) and PlGF, along with higher resistance in the uterine arteries, compared with women who do not. For all these predictors, the performance was better for early than for late PE, and was better when assessed later in pregnancy than at 11–13 weeks, i.e.…”

Section: Combined Screening Strategiesmentioning

confidence: 99%

ISUOG Practice Guidelines: role of ultrasound in screening for and follow‐up of pre‐eclampsia

Sotiriadis

Hernández‐Andrade

Costa

et al. 2018

Ultrasound in Obstet & Gyne

143

115

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RESUMEN Pautas de práctica de ISUOG: la función del ultrasonido en la detección y seguimiento de la preeclampsia Introducción La hipertensión en el embarazo afecta hasta el 10% de las mujeres embarazadas y la incidencia global combinada de la preeclampsia (PE) es de aproximadamente el 3%. Las diferencias significativas entre los países desarrollados y en desarrollo pueden atribuirse a diferencias reales o a diferencias derivadas de la adquisición de datos. La PE y sus complicaciones contribuyen en gran medida a la morbilidad y mortalidad materna y perinatal en todo el mundo. Dado que la atención oportuna y efectiva puede mejorar los resultados de la PE, el desarrollo de estrategias eficaces de predicción y prevención ha sido uno de los principales objetivos de la atención prenatal y de la investigación. La PE es una enfermedad multisistémica de origen multifactorial: está relacionada con placentación defectuosa, estrés oxidativo, autoinmunidad, activación de plaquetas y trombina, inflamación intravascular, disfunción endotelial, desequilibrio en la angiogénesis y mala adaptación cardíaca materna. La invasión defectuosa de la placenta está fuertemente asociada con la mayoría de los casos de PE temprana y grave. En contraste, la placentación defectuosa parece ser menos importante para el desarrollo de la PE que se manifiesta más tarde en el embarazo, por ejemplo después de las 34 semanas. En comparación con los embarazos afectados por la enfermedad de aparición temprana, en aquellos complicados con PE a término o cerca de este, la frecuencia de anomalías histológicas de las placentas es significativamente menor, y los factores maternos (p. ej. el síndrome metabólico o la hipertensión crónica) tienen una importancia relativamente mayor. También se observan diferencias entre la PE de aparición temprana y la de aparición tardía en los factores de riesgo, la capacidad de respuesta vascular materna, el rendimiento del cribado y la eficacia de la prevención. El conocimiento cada vez mayor sobre la fisiopatología de la PE se refleja en las estrategias de cribado actuales, que se basan en el historial, la demografía, los biomarcadores (como la presión arterial) y el Doppler de la arteria uterina. Actualmente hay más de 10 000 artículos de PubMed relacionados con la detección de la PE, lo que indica el gran interés en este tema. Menos de una quinta parte de estos se refieren a la detección temprana, lo que constituye un avance de la última década. El objetivo de estas Pautas es revisar la evidencia más reciente y, en lo posible, proporcionar recomendaciones basadas en la evidencia con respecto a la función del ultrasonido en el cribado y seguimiento de la PE. Las Pautas se centran en los aspectos técnicos y clínicos del cribado, sin incluir los aspectos económicos y políticos de la salud, como la conveniencia y la rentabilidad del cribado. Además, estas Pautas se elaboraron partiendo del supuesto de que se dispone de los recursos necesarios para la realización del cribado y el seguimiento (equipo, examinadores y conocimient...

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“…Owing to the unknown cause, it is also described as 'unexplained elevated MS-AFP' in the literature. [4][5][6][7][8] However, the mechanism linking elevated MS-AFP and APO is obscure.…”

Section: Introductionmentioning

confidence: 99%

A rat model of placental inflammation explains the unexplained elevated maternal serum alpha‐fetoprotein associated with adverse pregnancy outcomes

Zhang

Chan

et al. 2019

J of Obstet and Gynaecol

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Aim It has been reported in numerous studies that elevated maternal serum alpha‐fetoprotein (MS‐AFP) is associated with adverse pregnancy outcomes (APO), such as pre‐eclampsia, stillbirth, preterm birth and fetal growth restriction. However, the mechanism linking elevated MS‐AFP and APO is obscure. In this study, we tried to explore the mechanism by using pregnant rats. Methods Lipopolysaccharide (LPS) was used to induce placental inflammation in pregnant rats. Maternal serum and placental inflammatory cytokines and placental morphology were used to assess the level of placental inflammation. The incidences of APO and the levels of MS‐AFP were evaluated. The expressions of alpha‐fetoprotein (AFP) in the related organs and fetal serum AFP levels were detected. Results Compared to saline‐treated pregnant rats, LPS led to elevated maternal serum and placental inflammatory cytokines and a higher rate of placental inflammation. Lipopolysaccharide resulted in the features of APO and at the same time elevated MS‐AFP. Maternal serum alpha‐fetoprotein levels were significantly correlated to the evaluation parameters of APO. Lipopolysaccharide did not increase the expressions of AFP in fetal liver, maternal liver and placenta, but reduced the fetal serum AFP levels. Conclusion The phenomenon that elevated MS‐AFP is associated with APO, which has been reported in human pregnancies, is observed in our rat model. Placental inflammation can be the potential cause linking the two manifestations together. Although the source of elevated MS‐AFP is not identified, fetal blood circulation is suspected. Our study may provide an animal model for the future studies on this subject.

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Maternal serum alpha‐fetoprotein at 12, 22 and 32 weeks' gestation in screening for pre‐eclampsia

Abstract: ABSTRACT

Cited by 30 publications

References 19 publications

First-trimester maternal serum alpha-fetoprotein is not a good predictor for adverse pregnancy outcomes: a retrospective study of 3325 cases

First-trimester maternal serum alpha-fetoprotein is not a good predictor for adverse pregnancy outcomes: a retrospective study of 3325 cases

ISUOG Practice Guidelines: role of ultrasound in screening for and follow‐up of pre‐eclampsia

A rat model of placental inflammation explains the unexplained elevated maternal serum alpha‐fetoprotein associated with adverse pregnancy outcomes

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