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

Chard, Tim; Rice, A.; Kitau, M. J.; Hird, V.; Grudzinskas, J. G.; Nysenbaum, A. M.

doi:10.1111/j.1471-0528.1986.tb07810.x

Cited by 22 publications

(11 citation statements)

References 16 publications

(11 reference statements)

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“…In the interpretation of MAFP levels, maternal weight had been regarded as an influential factor (9). These mentioned studies on MAFP were done in the first or second trimesters (4)(5)(6)(7)15). Here we report the levels at late pregnancies without medical of obstetrical complication.…”

Section: Discussionmentioning

confidence: 83%

“…At pregnancy, interpretation of MAFP levels is useful in screening certain obstetrical or abnormal fetal conditions. High maternal alpha-fetoprotein (MAFP) levels have association with later premature labor, fetal open neural tube defect or twin pregnancies (4)(5)(6)(7). High MAFP levels are also associated with low birth weight (6-9), although not sufficiently predictive (6).…”

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confidence: 99%

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Fetal sex and maternal alpha‐fetoprotein concentration at late normal singleton pregnancies

Chen

And

Huang

1994

Acta Obstet Gynecol Scand

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The aim of this study is to investigate maternal and fetal clinical parameters on maternal serum alpha-fetoprotein (MAFP) levels at late pregnancies. The studied subjects were 36 to 40 weeks pregnant. The pregnancies were singletons without any medical or gynecologic disease. Delivery followed within three days after blood sampling. A total of 192 subjects were included. The MAFP levels were measured by radioimmunoassay. The results showed the average MAFP was 108.2 ng/ml (SE 4.8 ng/ml). Male-fetus-bearers had higher MAFP (mean 121.4, SE 8.2 ng/ml, n = 84) than female-fetus-bearers (mean 97.9, SE 5.43 ng/ml, n = 108) (p = 0.014). MAFP did not have significant correlation with fetal weight (p > 0.05) regardless of whether the fetus was a male (p > 0.05) or female (p > 0.05). By stepwise multiple regression, fetal sex was revealed to be the only factor that can affect MAFP (p = 0.0071). MAFP did not correlate with maternal age, gravidity, parity, maternal weight, total weight gain during pregnancy, gestational weeks, or fetal weight (all p > 0.05). Since fetal sex is the only factor that influences MAFP levels at uncomplicated late pregnancies, MAFP values should be interpreted with caution.

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Section: Discussionmentioning

confidence: 83%

mentioning

confidence: 99%

Fetal sex and maternal alpha‐fetoprotein concentration at late normal singleton pregnancies

Chen

And

Huang

1994

Acta Obstet Gynecol Scand

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“…Although various authors have found an association between abnormal concentrations of MSAFP and an adverse perinatal outcome, this marker has a minimal clinical impact in selecting women at increased risk of adverse perinatal outcome (Chard et al, 1986;Maher et al, 1994) because most of the women who deliver a compromised infant would have had a normal MSAFP level in the second trimester. Therefore, we would miss the vast majority of cases, i.e., the detection rate (=sensitivity) is low.…”

Section: Discussionmentioning

confidence: 99%

Abnormal levels of maternal serum human chorionic gonadotropin and alpha‐fetoprotein in the second trimester: Relation to fetal weight and preterm delivery

Morssink¹,

Kornman²,

Beekhuis³

et al. 1995

Prenatal Diagnosis

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The aim of this prospective descriptive cross-sectional study was to examine the clinical significance of abnormal maternal serum human chorionic gonadotropin (MShCG) and alpha-fetoprotein (MSAFP) in the second trimester of pregnancy. The study group comprised 8892 women with a singleton pregnancy, who were screened for a neural tube defect and Down's syndrome. Exclusion criteria were unknown pregnancy outcome, a congenital anomaly, delivery before 25 weeks of amenorrhoea, or known insulin-dependent diabetes. MSAFP and MShCG were determined between 15 and 20 weeks' amenorrhoea. An abnormal result was defined as (a) MSAFP or MShCG > or = 2.5 MOM, (b) MSAFP or MShCG < or = 0.5 MOM, and (c) MSAFP and MShCG > or = 2.5 MOM. Birth weight percentiles and the duration of amenorrhoea at the time of delivery were employed as outcome parameters. Of the women with an abnormally elevated MSAFP, 9.4 per cent had an extremely small-for-gestational age (SGA) infant (< 2.3rd percentile; P < 0.01, relative risk 4.5), 27.1 per cent had an SGA infant (< tenth percentile; P < 0.01, relative risk 2.7), and 14.3 per cent had an appropriate-for-gestational age (AGA) infant that was delivered preterm (< 259 days; P < 0.01, relative risk 2.4). In the cases where the MShCG level was elevated, 4.4 per cent had an extremely SGA infant (P < 0.01, relative risk 2.1) and 15.5 per cent had an SGA infant (P < 0.01, relative risk 1.5). No significant association was found between an elevated MShCG level and preterm delivery. Low MShCG was significantly associated with SGA infants (P < 0.01, relative risk 1.2) but not with extremely SGA or preterm deliveries. In the group whose MSAFP and MShCG levels were both elevated, 23.8 per cent delivered an extremely SGA infant (P < 0.01, relative risk 10.9), 38.1 per cent an SGA infant (P < 0.01, relative risk 3.7) and 47.6 per cent had a preterm delivery or an SGA infant (P < 0.01, relative risk 3.0). Isolated or combined elevation of the MSAFP and MShCG levels in the second trimester of pregnancy is an indication for extra vigilance during further prenatal care. This applies to a lesser extent to a low MShCG level.

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“…In the course of multiple‐marker screening for fetal Down's syndrome, 4% of the women with an euploid fetus were found to have maternal serum human chorionic gonadotrophin (MShCG) levels higher than 2.5 MOM 2 . Follow up studies have shown that pregnant women with such an un‐explained elevation of MSAFP or MShCG are at increased risk of an adverse pregnancy outcome, such as fetal death, pregnancy induced hypertension, preterm delivery or the delivery of a small for gestational age (SGA) infant 3–7 . The cause of the unexplained abnormal analyte levels remains unclear, although it has been suggested that the concentrations of MSAFP and MShCG are a reflection of placental histology and placental function 8–10 .…”

Section: Introductionmentioning

confidence: 99%

The relation between serum markers in the second trimester and placental pathology. A study on extremely small for gestational age fetuses

Kingdom

1996

BJOG

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Objective To examine whether in women who are delivered of an extremely small for gestational age infant, raised levels of second trimester maternal serum alpha‐fetoprotein (MSAFP) or human chorionic gonadotrophin (MShCG) levels are related to the presence of placental pathology detected at birth. Design Retrospective cross‐sectional study. Setting Department of Obstetrics and Gynaecology, Antenatal Diagnosis Unit, Groningen University Hospital, The Netherlands. Participants Eighty‐four women who were delivered of an extremely SGA infant (< 2.3rd centile) in whom the MSAFP and the MShCG levels were known and placental pathology reports were available (study group), and 8692 women in whom the MSAFP and MShCG levels were known and the pregnancy outcome was normal (control group). Pregnancies with congenital anomalies were excluded. Analyte levels were expressed in multiples of the median (MOM) for gestational age. Statistical analysis between groups was performed by ANOVA, after logarithmic transformation of the MOMS, to normalise their distribution. Main outcome measures 1. The means of the MSAFP and MShCG concentrations in the study group with and without placental lesions were compared with those in the control population. 2. The means of the MSAFP and MShCG levels in the study group with placental lesions were compared with those in the study group without placental lesions. Results 1. Comparison of study groups with controls: in the study group without placental lesions, the mean log MSAFP MOM (0.062), as well as the mean log MShCG MOM (–0.033), was not significantly different (P= 0.11 and P= 0.68, respectively) from the mean analyte levels in the control population (0.002 and 0.006, respectively). The mean logs of these analytes in the study group with placental lesions (0.162 and 0.129, respectively) were significantly higher compared with the MSAFP and MShCG levels in the control population (P < 0.001 for both analytes). 2. Comparison of study groups with each other: the mean log of the MSAFP level of 0.162 in the group with placental lesions was significantly different from the mean of 0.062 of the study group without placental lesions (P < 0.025). The higher mean log MShCG MOM of 0.129 in the group with placental lesions was significantly different from the mean log MShCG MOM of −0.033 in the study group without placental lesions (P < 0.025). Conclusions Raised levels of second trimester MSAFP and MShCG in women who are subsequently delivered of an extremely small for gestational age infant are related to the presence of pathological changes in the placenta, detectable at birth. It is speculated that these placental pathological changes, which frequently accompany small for gestational age pregnancies, have their origin in the second trimester, when the normal physiological changes of the placenta occur.

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

Cited by 22 publications

References 16 publications

Fetal sex and maternal alpha‐fetoprotein concentration at late normal singleton pregnancies

Fetal sex and maternal alpha‐fetoprotein concentration at late normal singleton pregnancies

Abnormal levels of maternal serum human chorionic gonadotropin and alpha‐fetoprotein in the second trimester: Relation to fetal weight and preterm delivery

The relation between serum markers in the second trimester and placental pathology. A study on extremely small for gestational age fetuses

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