Outcome of pregnancies associated with raised serum and normal amniotic fluid alpha fetoprotein concentrations.

Evans, Jackie; Stokes, Idris

doi:10.1136/bmj.288.6429.1494

Cited by 21 publications

(4 citation statements)

References 2 publications

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“…There were 86 included studies for SGA [ 7 , 9 , 37 , 39 , 47 , 51 , 53 - 55 , 57 , 59 - 61 , 64 - 67 , 69 , 74 , 76 - 141 ], reporting on 382,005 women (20339 cases of SGA, incidence 5.32%). Among these studies, there were 61 cohort studies and 25 case control studies [ 53 , 55 , 76 , 77 , 82 - 85 , 88 , 89 , 94 , 96 , 97 , 104 , 113 , 116 , 119 , 123 - 125 , 130 , 131 , 133 , 135 , 140 ]. Thirty-one studies were prospective, 17 retrospective and 38 of unclear design.…”

Section: Resultsmentioning

confidence: 99%

Serum screening with Down's syndrome markers to predict pre-eclampsia and small for gestational age: Systematic review and meta-analysis

Morris

Cnossen²,

Langejans³

et al. 2008

BMC Pregnancy Childbirth

108

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BackgroundReliable antenatal identification of pre-eclampsia and small for gestational age is crucial to judicious allocation of monitoring resources and use of preventative treatment with the prospect of improving maternal/perinatal outcome. The purpose of this systematic review was to determine the accuracy of five serum analytes used in Down's serum screening for prediction of pre-eclampsia and/or small for gestational age.MethodsThe data sources included Medline, Embase, Cochrane library, Medion (inception to February 2007), hand searching of relevant journals, reference list checking of included articles, contact with experts. Two reviewers independently selected the articles in which the accuracy of an analyte used in Downs's serum screening before the 25th gestational week was associated with the occurrence of pre-eclampsia and/or small for gestational age without language restrictions. Two authors independently extracted data on study characteristics, quality and results.ResultsFive serum screening markers were evaluated. 44 studies, testing 169,637 pregnant women (4376 pre-eclampsia cases) and 86 studies, testing 382,005 women (20,339 fetal growth restriction cases) met the selection criteria. The results showed low predictive accuracy overall. For pre-eclampsia the best predictor was inhibin A>2.79MoM positive likelihood ratio 19.52 (8.33,45.79) and negative likelihood ratio 0.30 (0.13,0.68) (single study). For small for gestational age it was AFP>2.0MoM to predict birth weight < 10th centile with birth < 37 weeks positive likelihood ratio 27.96 (8.02,97.48) and negative likelihood ratio 0.78 (0.55,1.11) (single study). A potential clinical application using aspirin as a treatment is given as an example.There were methodological and reporting limitations in the included studies thus studies were heterogeneous giving pooled results with wide confidence intervals.ConclusionDown's serum screening analytes have low predictive accuracy for pre-eclampsia and small for gestational age. They may be a useful means of risk assessment or of use in prediction when combined with other tests.

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Section: Resultsmentioning

confidence: 99%

Serum screening with Down's syndrome markers to predict pre-eclampsia and small for gestational age: Systematic review and meta-analysis

Morris

Cnossen²,

Langejans³

et al. 2008

BMC Pregnancy Childbirth

108

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“…We began by examining the relation of PTD to maternal serum alpha‐fetoprotein (MSAFP), the most consistent biomarker of PTD among those measured before the third trimester 21 –34 . Our initial investigations confirmed the strong association between unexplained high MSAFP levels and PTD in both African‐American and white women 35 , 36 .…”

Section: Introductionmentioning

confidence: 89%

“…Chorioamnionitis may permit increased diffusion of AFP across fetal membranes. Alternatively, retroplacental haemorrhage, marked both by early gestational bleeding and by elevated MSAFP 24 , 25 , 33 may serve as a growth‐promoting medium for organisms colonising the decidua. This concept is supported by a study showing the risk of PTD was substantially increased in women with BV and concomitant early gestational bleeding 216 .…”

Section: Biomarkers Of Multiple Ptd Pathwaysmentioning

confidence: 99%

Pregnancy outcomes and community health: the POUCH study of preterm birth

Holzman¹,

Bullen²,

Fisher

et al. 2001

Paediatric Perinatal Epid

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In light of the social/ethnic disparity in preterm delivery (PTD) rates, the Pregnancy Outcomes and Community Health (POUCH) Study takes a broad view of the determinants of PTD by attempting to link underlying biological and psychosocial factors. The relationships between placental pathology, maternal biomarkers, and antecedent psychosocial factors are evaluated in three hypothesised pathways of PTD – one characterised primarily by infection, one by maternal vascular disease, and one by premature elevations in corticotropin releasing hormone in the absence of histological evidence of placental pathology. Within each pathway, an emphasis is placed on understanding the roles of stress and of maternal serum alpha‐fetoprotein, an early biomarker associated with PTD. The POUCH Study enrols pregnant women from five Michigan communities. Information about these women and their environments is gathered through detailed interviews and collection of biological samples including hair, urine, saliva, blood, vaginal fluid, and vaginal smear at 15–26 weeks of gestation. We have chosen to focus on the second trimester – a time when pathological processes may have evolved to a detectable stage, but generally before the onset of biological changes that accompany labour. This focus is consistent with the long‐range goal of early detection/intervention and prevention of PTD.

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“…There is uncertainty as to whether this 'low birthweight' Table 1. Previous studies on maternal AFP levels in relation to low birthweight Author Conclusions Brock et al 1977Wald & Cuckle 1977Gordon et al 1978Keilani et al 1978 Brock et al 1979aBrock et al 19796 Gordon et al 1979 Persson et al 1980Smith 1980Wald et al 1980Purdie et al 1983Corry & Whyler 1984Evans & Stokes 1984Haddow et al 1984Mariona et al 1984 Elevated AFP levels associated with birthweight of <2+5 kg. Elevated AFP levels associated with low birthweight.…”

mentioning

confidence: 94%

Mid‐trimester levels of alphafetoprotein in the screening of low birthweight

Chard

Rice

Kitau

et al. 1986

BJOG

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Elevated maternal levels of alphafetoprotein (AFP) in midtrimester are believed by some to be a useful screening test for premature labour, low birthweight and low birthweight for gestation. In a prospective study on 887 randomly selected pregnant women we found that although there was an association between low birthweight and elevated AFP, the test would miss five out of every six cases of low birthweight and there would be nine false-positives for every case correctly identified. The test is not therefore sufficiently predictive of low birthweight to be of value as a screening test for this condition.

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Outcome of pregnancies associated with raised serum and normal amniotic fluid alpha fetoprotein concentrations.

Cited by 21 publications

References 2 publications

Serum screening with Down's syndrome markers to predict pre-eclampsia and small for gestational age: Systematic review and meta-analysis

Serum screening with Down's syndrome markers to predict pre-eclampsia and small for gestational age: Systematic review and meta-analysis

Pregnancy outcomes and community health: the POUCH study of preterm birth

Mid‐trimester levels of alphafetoprotein in the screening of low birthweight

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