The relationship between second trimester alpha fetoprotein levels and adverse pregnancy outcome

Abstract

Design: Retrospective analysis. Setting: East London Hospital. Subjects: 724 women who had maternal serum alphafetoprotein levels measured between 15 to 19 weeks gestation. Main outcome measure: The main outcome measures were defined as any case of preeclampsia, small-for-gestational age (SGA) birth- weight < 5th centile, placental abruption, stillbirth or early neonatal death. Methods: Women with MSAFP > 2.0 Multiples of Median (MoM) were classified as screen positive. Results: 41 (5.7%) women developed preeclampsia. Women with MSAFP > 2.0 Multiples of the Median (MoM) were significantly more likely to develop preeclampsia (p < 0.00001), deliver a SGA < 5th centile (p < 0.00001), or have a stillbirth/early neonatal death (p < 0.001) compared to women with MSAFP < 2.0 MoM. The odds ratio (OR) for developing preeclampsia was 5.2 (95% confidence interval [CI] 2.4 - 11.3), and 8.2 (CI 2.9 - 23.3) for preeclampsia requiring delivery before 37 weeks gestation. Conclusion: Unexplained elevated MSAFP in the second trimester was strongly associated with a subsequent risk of preeclampsia especially those requiring preterm delivery, as well as other complications related to uteroplacental insufficiency.

Share and Cite:

Allen, R. , Marleen, S. , Velauthar, L. , Harrington, K. and Aquilina, J. (2013) The relationship between second trimester alpha fetoprotein levels and adverse pregnancy outcome. Open Journal of Obstetrics and Gynecology, 3, 262-266. doi: 10.4236/ojog.2013.32049.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Beta, J.B.F., Rodriguez, J., Akolekar, R. and Nicolaides, K. (2011) Maternal serum alphafetoprotein at 11 13 weeks’ gestation in spontaneous early preterm delivery. Fetal Diagnosis and Therapy, 30, 88-93. doi:10.1159/000324352
[2] Dugoff, L.H.J., Nalone, F., Vidaver, J., Sullivan, L. and Canick, J. (2005) Quad screen as a predictor of adverse pregnancy outcome. Obstetrics and Gynecology, 106, 260-267. doi:10.1097/01.AOG.0000172419.37410.eb
[3] Dehghani-Firouzabadi, R.T.N., Ghasemi, N. and Tahmasbi, Z. (2010) The association between second-trimester maternal serum alpha-fetoprotein in 14-22 weeks and adverse pregnancy outcome. Acta Medica Iranica, 48, 234-238
[4] Smith, G., Shah, I., Crossley, J., Aitken, D., Pell, J., Nelson, S. et al. (2006) Pregnancy associated plasma protein A and Aplpha-fetoprotein and prediction of adverse perinatal outcome. Obstetrics and Gynecology, 107, 161-166. doi:10.1097/01.AOG.0000191302.79560.d8
[5] Waller, K.L.L., Cunningham, G., Feuchtbaum, L. and Hook, E. (1996) The association between maternal serum alpha-fetoprotein and preterm birth, small for gestational age infants, preeclampsia and placental complications. Obstetrics and Gynecology, 88, 816-822.
[6] Wald, N.J., Cuckle, H. and Brock, J.H.L. (1977) Maternal serum-alpha-fetoprotein measurement and low birth weight. Lancet, 1, 1323-1332.
[7] Brock, D.J., Barron, L. and Watt, M. (1979) The relation between maternal plasma alpha-fetoprotein and birth weight in twins. British Journal of Obstetrics and Gynaecology, 86, 710-712. doi:10.1111/j.1471-0528.1979.tb11271.x
[8] Burton, B.K. (1988) Outcome of pregnancy in patients with unexplained elevated or low levels of. Obstetrics & Gynecology, 72, 709-713
[9] Morssink, L. P., de Wolf, B.T., Kornman, L.H., Beekhuis, J.R., van der Hall, T.P.J. and Mantingh, A. (1996) The relation between serum markers in the second trimester and placental pathology. A study on extremely small for gestational age fetuses. British Journal of Obstetrics and Gynaecology, 103, 779-783.
[10] Krause, T., Christens, P., Wohlfahrt, J., Lei, U., Westergaard, T., Norgaard-Pedersen, B., et al. (2001) Second trimester maternal serum alpha-fetoprotein and risk of adverse pregnancy outcome. Obstetrics and Gynecology, 97, 277-282.
[11] Audibert, F.B.Y., Benhatter, C., Champagne, C. and Frydman, R. (2005) Prediction of preeclampsia or intrauterine growth restriction by second trimester serum screening and uterine doppler velocimetry. Fetal Diagnosis and Therapy, 20, 48-53.
[12] Mc Pherson, E., Thomas, G., Manlick, C., Zaleski, C., Reynolds, K., Rasmussen, K. et al. (2011) Extreme values of maternal serum analytes in second trimester screening. Looking beyond trisomy and NTD’s. Journal of Genetic Counselling, 20, 396-403.
[13] Robinson, L., Grau, P. and Crandall, B.F. (1989) Pregnancy outcomes after increasing maternal serum alphafetoprotein levels. Obstetrics & Gynecology, 74, 17-20.
[14] Walters, B.N., Lao, T., Smith, V., et al. (1985) Alphafetoprotein elevation and proteinuric pre-eclampsia. British Journal of Obstetrics and Gynaecology, 92, 341-344.
[15] Kang, J., Farina, A., Park, J., Kim, S., Kim, J., Rizzo, N. et al. (2008) Down Syndrome biochemical markers and screening for preeclampsia at first and second trimester: Correlation with the week of onset and severity. Prenatal Diagnosis, 28, 704-709.
[16] Wald, N. and Morris, J. (2001) Multiple marker second trimester serum screening for pre eclampsia. Journal of Medical Screening, 8, 65-68.
[17] Davidson, E., Riley, S., Roberts, S., Shearing, C., Groome, N. and Martin, C. (2003) Maternal serum activin, inhibin, human chorionic gonadotrophin and alpha-fetopprotein as second trimester predictors of preeclampsia. British Journal of Obstetrics and Gynaecology, 110, 543-552.
[18] Boyd, P. and Keeling, J. (1986) Raised maternal serum alphafetoprotein in the absence of fetal abnormality-placental findings. A quantitative morphometric study. Prenatal Diagnosis, 6, 369-373.
[19] Brazerol, W.F., Grover, S. and Donnenfield, A.E. (1994) Unexplained elevated maternal serum alpha-fetoprotein levels and perinatal outcome in an urban clinic population. American Journal of Obstetrics and Gynecology, 171, 1030-1035. doi:10.1016/S0029-7844(00)01109-1

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.