Fetal and Placental Causes of Elevated Serum Alpha-Fetoprotein Levels in Pregnant Women

Abstract

The most common association related to alpha-fetoprotein (AFP) is fetal neural tube defect (NTD), and indeed, this is where the international career of this protein began. In times when ultrasonography was not yet technically advanced, the detection of high levels of AFP in maternal serum (MS-AFP) and amniotic fluid was the basis for suspecting neural tube defects. In cases where there was no confirmation of NTD, other causes were sought. It has been established that high titers of MS-AFP could originate in other defects or diseases, such as (1) increased proteinuria in severe fetal kidney diseases; (2) pathological overproduction in liver diseases; (3) penetration through the membranes of gastrointestinal organs exposed to amniotic fluid; (4) passage through the walls of skin vessels; and as a side effect of (5) hepatic hematopoiesis and increased transfer through the edematous placenta in fetal anemia. This article provides a review of the current literature on congenital defects and genetic diseases in the fetus where an elevated level of MS-AFP may serve as the initial diagnostic clue for their detection.

Diagnosis, Prevention, and Management of Fetal Growth Restriction (FGR)

“…One source of oxidative stress is placental ischemia from underdeveloped spiral arterioles. The production of free oxygen radicals (FORT) during oxidative stress is associated with tissue damage in many diseases [41], and trophoblast damage is caused more by hypoxia/reoxygenation than by hypoxia alone [42,43]. Placentas in FGR pregnancies show clear signs of oxidative stress, with decreased protein expression and a particular decrease in key proteins, including those in the AKT and mTOR signaling pathways [44].…”