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

Abstract

Purpose: To investigate the predictive values of first-trimester maternal serum alpha-fetoprotein (MS-AFP) to preterm birth, stillbirth, preeclampsia and small for gestational age (SGA). 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 adverse pregnancy outcomes (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), while the risk of stillbirth was not significantly increased (1.33, 0.40~4.41). The areas under ROC curves were 0.572 (P = 0.001), 0.597 (P = 0.060), 0.579 (P = 0.015) and 0.565 (P = 0.000) for preterm birth, stillbirth, preeclampsia and SGA, respectively. Women with MS-AFP ≥ 2.5MoM had an earlier distribution of gestational weeks at delivery (P = 0.004) and a lower distribution of neonatal birth weights (P = 0.000) compared to those with MS-AFP < 2.5MoM, but the actual between-group differences were minuscule. Conclusion: 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.

Second trimester maternal serum biomarkers and the risk of cerebral palsy

“…Given the heterogeneous and complex etiology of CP, it is unlikely that one test could predict all cases of CP. Although the literature documents associations between AFP, hCG, uE3, and inhibin and adverse pregnancy outcomes, these markers have shown inconclusive prognostic ability and utility as diagnostic tests for these outcomes 20–22 . This was consistent with our findings that although elevated levels of AFP and inhibin showed an association with the subsequent occurrence of CP, all biomarkers showed poor predictive ability for CP on ROC curve analysis.…”

Preterm Delivery: Predictive Value of Salivary Estriol, and Alpha Feto Protien

“…(14) Green N et al, recommended that this relation may be restricted to preterm babies with preterm rupture of membranes. (15) Yuan W et al in their study were strongly agreed with current study (Maternal AFP strongly agreed related preterm labor), but only in the situation of the presence of abnormality in other pregnancy markers. (16)…”

A comparison of the maternal levels of serum proprotein convertase subtilisin/kexin type 9 in pregnant women with the complication of fetal open neural tube defects

“…7,13 It is not recommended for use in first trimester serum screening due to its low sensitivity. 27,28 In cases with unclear USG findings and high MSAFP, amniotic fluid AFP (AFAFP) and amniotic fluid AChE can be used as primary biochemical tests for NTD detection. 29,30 Folic acid supplementation should start in the preconceptional period and continue throughout the first trimester of the pregnancy.…”