Second-trimester maternal serum alpha-fetoprotein and risk of adverse pregnancy outcome

Krause, Tyra Grove; Christens, Peter; Wohlfahrt, Jan; Lei, Ulrikke; Westergaard, Tine; Nørgaard‐Pedersen, Bent; Melbye, Mads

doi:10.1016/s0029-7844(00)01109-1

Cited by 44 publications

(17 citation statements)

References 29 publications

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“…They should also have a followup ultrasound in the third trimester (e.g. 30-32 weeks) to assess fetal growth, as MSAFP elevations have been associated in numerous reports with fetal growth restriction (Wald et al, 1977;Krause et al, 2001). But, similar to the case with elevations of the MSAFP due to bleeding during the pregnancy, the counseling of the pregnant smoker with an elevated MSAFP should take into consideration the fact that maternal smoking itself is associated with a positive MSAFP screen for open neural tube defects.…”

Section: Discussionmentioning

confidence: 99%

Maternal smoking during pregnancy and false positive maternal serum alpha‐fetoprotein (MSAFP) screening for open neural tube defects

et al. 2008

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Section: Discussionmentioning

confidence: 99%

Maternal smoking during pregnancy and false positive maternal serum alpha‐fetoprotein (MSAFP) screening for open neural tube defects

et al. 2008

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“…In the absence of fetal chromosomal or structural anomalies, mid-trimester ms-AFP levels >2.5 MoM are thought to reflect a defect in placentation [placental abruption, placenta previa, abnormal placental adherence (placenta accreta, increta and percreta)] (3, 36, 37). They also associated with an increased risk for pregnancy complications including: late fetal loss [OR 10.1 (95% CI: 7.5-13.5)], gestational hypertension [OR 1.6 (95% CI: 1.3-2.1)], preeclampsia [OR 0.83 (95% CI: 0.44–1.56)], IUGR [OR 2.3 (95% CI: 1.8-2.9)], preterm delivery [OR 1.8 (95% CI: 1.5-2.3)] and IUFD [OR 5.3 (95% CI: 3.8-7.3)] (3, 4, 17, 23-25, 38, 39). Mechanisms for elevated mid-trimester ms-AFP levels with a structurally normal fetus include: disruption of the fetal-maternal placental barrier, placental vascular damage from early abruption, fetal-maternal bleeding and fetal-placental ischemia (3, 36, 40-42).…”

Section: Evidence Acquisitionmentioning

confidence: 99%

“…It is unknown whether elevated ms-AFP levels, are the cause or the result of these lesions. Probably the factor that leads to adverse pregnancy outcome also increases ms-AFP (3, 38). …”

Section: Evidence Acquisitionmentioning

confidence: 99%

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Mid-Trimester Maternal Serum hCG and AFP Levels: Clinical Significance and Prediction of Adverse Pregnancy Outcome

Georgios

Panagiotis

Decavalas

2013

Int J Endocrinol Metab

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ContextMaternal serum human Chorionic Gonadotropin (hCG) and Alpha Fetal Protein (AFP) were originally introduced to detect trisomy 21 and neural tube defects. However, in the absence of aneuploidy or neural tube defects, mid-trimester maternal serum hCG and/or maternal serum AFP associated with adverse pregnancy outcomes. Pregnancies with unexplained mid-trimester elevation in maternal serum hCG and/or maternal serum AFP, are at increased risk for pregnancy complications resulting from placental insufficiency.Evidence AcquisitionMid-trimester maternal serum hCG>2.5 MoM associated with an increased risk for pregnancy complications including: late fetal loss, gestational hypertension, preeclampsia, intrauterine growth restriction (IUGR), preterm delivery and intrauterine fetal death(IUFD). Mid-trimester maternal serum AFP levels >2.5 MoM are thought to reflect a defect in placentation and associated with an increased risk for pregnancy complications including: late fetal loss, gestational hypertension, preeclampsia, IUGR, preterm delivery and IUFD.ResultsCombined mid-trimester elevation in maternal serum hCG and AFP levels suggest a more complex type of placental pathology. They have stronger association with pregnancy complications including: late fetal loss, gestational hypertension, preeclampsia, IUGR, preterm delivery and IUFD.ConclusionsMid-trimester maternal serum hCG or AFP levels alone cannot detect all pregnant women with increased risk to develop pregnancy complications. Multiparameter testing of placental function in mid-trimester (maternal serum hCG and AFP screening, uterine artery Doppler and placental morphology) may allow us to identify women with increased risk to develop severe placental insufficiency and pregnancy complications. However, future prospective studies are needed to confirm the prognostic significance of multiparameter testing of placental function in mid-trimester.

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“…Very low MSAFP of <0.25 MoM is associated with miscarriage (OR 15.1) and stillbirth (OR 4.0) (Krause et al 2001).…”

Section: Low Msafpmentioning

confidence: 99%

Extreme Values of Maternal Serum Analytes in Second Trimester Screening: Looking Beyond Trisomy and NTD's

McPherson¹,

Thomas²,

Manlick

et al. 2011

Journal of Genetic Counseling

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Second trimester maternal serum screening can identify high risk pregnancies and fetuses at risk for birth defects (in addition to those in the standard interpretation). The purpose of this study was to quantify such risks to improve counseling. We compared outcomes of 692 pregnancies that had abnormal levels of at least one analyte with a cohort of 713 pregnancies with normal analytes. Increased risks include: demise with high AFP and low uE3; intrauterine growth restriction with high AFP, high and low hCG, and low uE3; placental abnormalities with high AFP; fetal stress with high AFP and high hCG. Birth defects are increased with high AFP, high hCG, and low hCG. When two or more analytes are abnormal, 46% have a poor outcome. Abnormal levels of maternal serum analytes provide information in addition to the risks for neural tube defects, Down syndrome, and trisomy 18. This information is important for counseling and pregnancy management.

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Second-trimester maternal serum alpha-fetoprotein and risk of adverse pregnancy outcome

Abstract: Pregnant women with extreme MSAFP values in the second trimester have an increased risk of fetal and infant deaths. Obstet Gynecol 2001;97:277-82.

Cited by 44 publications

References 29 publications

Maternal smoking during pregnancy and false positive maternal serum alpha‐fetoprotein (MSAFP) screening for open neural tube defects

Maternal smoking during pregnancy and false positive maternal serum alpha‐fetoprotein (MSAFP) screening for open neural tube defects

Mid-Trimester Maternal Serum hCG and AFP Levels: Clinical Significance and Prediction of Adverse Pregnancy Outcome

Extreme Values of Maternal Serum Analytes in Second Trimester Screening: Looking Beyond Trisomy and NTD's

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