The Association between Second-Trimester Maternal Serum Alpha-Fetoprotein in 14-22 Weeks and Adverse Pregnancy Outcome

  • Razieh Dehghani–Firouzabadi Department of Obstetrics & Gynecology, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
  • Naeimeh Tayebi Genetic Counselor General Practitioner, Genetic Research Center, Welfare Organization, Yazd, Iran.
  • Nasrin Ghasemi Mail Department of Medical Genetics, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
  • Zahra Tahmasbi Department of Obstetrics & Gynecology, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Keywords:
Alpha- fetoproteins, pregnancy outcomes, mothers

Abstract

Aim of this study is to determine the risk of adverse pregnancy outcome by maternal serum alphafetoprotein (MSAFP) level. We followed 295 pregnant women from MSAFP screening in the 14th to 22th week of gestation until the end of pregnancy and information on pregnancy outcome have been recorded in questionnaires. Of 295 pregnant women, 270 had term labor and 25 had preterm labor. The frequencies of pregnancy outcomes were as following: 3 (1.01%) stillbirths, 25(8.47%) preterm labor, and 10 (3.4%) preterm rupture of membranous (PROM), 15 (5.1%) pre-eclampsia, 23 (7.8%) oligohydramnious, and 1 (0.33%) miscarriage. The mean of preterm labor was significantly associated with the higher level of MSAFP (P =0.021). The mean was 55.1 ng/cc in preterm labor and 41.1 ng/cc in term labor. Also, second trimester MSAFP levels were higher in women with pre-eclampsia (P <0.001). The significant association was found between higher level of MSAFP with oligohydramnious (P <0.001) and low birth weight (P <0.001). Pregnancies with an elevated MSAFP level are associated with adverse obstetric outcomes and need more prenatal care.

References

Seppala M, Ruoslahti E. Alpha fetoprotein in maternal serum: A new marker for detection of fetal distress and intrauterine death. Am J Obstet Gynecol 1973;115(1):48-52.

Wald N, Cuckle H, Stirrat GM, Bennett MJ, Turnbull AC. Maternal serum-alpha-fetoprotein and low birth-weight. Lancet 1977;2(8032):268-70.

Burton BK. Outcome of pregnancy in patients with unexplained elevated or low levels of maternal serum alpha-fetoprotein. Obstet Gynecol 1988;72(5):709-13.

Robinson L, Grau P, Crandall BF. Pregnancy outcomes after increasing maternal serum alpha-fetoprotein levels. Obstet Gynecol 1989;74(1):17-20.

Waller DK, Lustig LS, Smith AH, Hook EB. Alphafetoprotein: a biomarker for pregnancy outcome. Epidemiology 1993;4(5):471-6.

Walsh S, Mortimer G. Unexplained stillbirths and sudden infant death syndrome. Med Hypotheses 1995;45(1):73-5.

Fifer WP, Myers MM. Sudden fetal and infant deaths: shared characteristics and distinctive features. Semin Perinatol 2002;26(1):89-96.

Brock DJ, Barron L, Raab GM. The potential of midtrimester maternal plasma alpha-fetoprotein measurement in predicting infants of low birth weight. Br J Obstet Gynaecol 1980;87(7):582-5.

Redman CW. Current topic: pre-eclampsia and the placenta. Placenta 1991;12(4):301-8.

Moore MP, Redman CWG. Case-control study of severe pre-eclampsia of early onset. Br Med J 1983;287(6392):580-3.

Walters BN, Lao T, Smith V, De Swiet M. alpha- Fetoprotein elevation and proteinuric pre-eclampsia. Br J Obstet Gynaecol 1985;92(4):341-4.

Milunsky A, Jick SS, Bruell CL, MacLaughlin DS, Tsung YK, Jick H, et al. Predictive values, relative risks, and overall benefits of high and low maternal serum alphafetoprotein screening in singleton pregnancies: new epidemiologic data. Am J Obstet Gynecol 1989;161(2):291-7.

Williams MA, Hickok DE, Zingheim RW, Luthy DA,,Kimelman J, Nyberg DA, et al. Elevated maternal serum alpha-fetoprotein levels and midtrimester placental abnormalities in relation to subsequent adverse pregnancy outcomes. Am J Obstet Gynecol 1992;167(4 Pt 1):1032-7.

Brock DJ, Sutcliffe RG. Alpha-fetoprotein in the antenatal diagnosis of anencephaly and spina bifida. Lancet 1972;300(7770):197-9.

Cuckle HS, Wald NJ, Lindenbaum RH. Maternal serum alpha-fetoprotein measurement: A screening test for Down syndrome. Lancet 1984;1(8383):926-9.

Merkatz IR, Nitowsky HM, Macri JN, Johnson WE. An association between low maternal serum alpha-fetoprotein and fetal chromosomal abnormalities. Am J Obstet Gynecol 1984;148(7):886-94.

Bennett MJ, Solymar M, Turnbull AC, Cuckle HS, Wald NJ. Pregnancies associated with low maternal serum alphafetoprotein= concentrations. Am J Obstet Gynecol 1979;135(4):545-6.

Haddow JE, Hill LE, Palomaki GE, Knight GJ. Very low versus undetectable maternal serum alphafetoprotein values and fetal death. Prenat Diagn 1987;7(6):401-6.

Simpson JL, Baum LD, Depp R, Elias S, Somes G, Marder R. Low maternal serum alpha-fetoprotein and perinatal outcome. Am J Obstet Gynecol 1987;156(4):852-62.

Firoozabadi RD, Ghasemi N, Firoozabadi MD. Sonographic fetal weight estimation using femoral length: Honarvar equation. Ann Saudi Med 2007; 27(3):179-82.

Mizejewski GJ. Biological roles of alpha-fetoprotein during pregnancy and perinatal development. Exp Biol Med (Maywood) 2004;229(6):439-63.

Bernstein IM, Barth RA, Miller R, Capeless EL. Elevated maternal serum alpha-fetoprotein: association with placental sonolucencies, fetomaternal hemorrhage, vaginal bleeding, and pregnancy outcome in the absence of fetal anomalies. Obstet Gynecol 1992;79(1):71-4.

Neggers YH, Goldenberg RL, DuBard MB, Cliver SP. Increased risk of preterm delivery with elevated maternal alpha-fetoprotein and plasma zinc levels in African- American women. Acta Obstet Gynecol Scand 2000;79(3):160-4.

Kuo PL, Lin CC, Lin YH, Guo HR. Placental sonolucency and pregnancy outcome in women with elevated second trimester serum alpha-fetoprotein levels. J Formos Med Assoc 2003;102(5):319-25.

Huerta-Enochian G, Katz V, Erfurth S. The association of abnormal alpha-fetoprotein and adverse pregnancy outcome: does increased fetal surveillance affect pregnancy outcome? Am J Obstet Gynecol 2001;184(7):1549-53; discussion 1553-5.

Tikkanen M, Hämäläinen E, Nuutila M, Paavonen J, Ylikorkala O, Hiilesmaa V. Elevated maternal second-trimester serum alpha-fetoprotein as a risk= factor for placental abruption. Prenat Diagn 2007; 27(3):240-3.

Waller DK, Lustig LS, Cunningham GC, Feuchtbaum LB, Hook EB. The association between maternal serum alphafetoprotein and preterm birth, small for gestational age infants, preeclampsia, and placental complications. Obstet Gynecol 1996;88(5):816-22.

Khoo SK, Chang A, Mackay EV. A comparison of maternal serum levels of alpha-fetoprotein in normal and pre-eclamptic pregnancies. Br J Obstet Gynaecol 1978;85(12):914-20.

Wald NJ, Morris JK, Ibison J, Wu T, George LM. Screening in early pregnancy for pre-eclampsia using Down syndrome quadruple test markers. Prenat Diagn 2006;26(6):559-64.

Kiran TSU, Bethel J, Bhal PS. Correlation of abnormal second trimester maternal serum alpha-fetoprotein (MSAFP) levels and adverse pregnancy outcome. J Obstet Gynaecol 2005;25(3):253-6.

Brock DJ, Barron L, Watt M, Scrimgeour JB, Keay AJ. Maternal plasma alpha-fetoprotein and low birthweight: a prospective study throughout pregnancy. Br J Obstet Gynaecol 1982;89(5):348-51.

Haddow JE, Palomaki GE, Knight GJ. Can low birth weight after elevated maternal serum alpha-fetoprotein be explained by maternal weight? Obstet Gynecol 1987;70(1):26-8.

Mariona FG, Hassan MM, Syner FN, Chik LC, Sokol RJ. Maternal serum alpha-fetoprotein (MSAFP) and fetal growth. J Perinat Med 1984;12(4):179-83.

Morssink LP, Kornman LH, Beekhuis JR, De Wolf BT, Mantingh A. Prenat Diagn 1997;15(11):1041-6.

Cusick W, Rodis JF, Vintzileos AM, Albini SM, McMahon M, Campbell WA. Predicting pregnancy outcome from the degree of maternal serum alphafetoprotein elevation. J Reprod Med 1996;41(5):327-32.

Baschat AA, Harman CR, Farid G, Chodirker BN, Evans JA. Very low second-trimester maternal serum alphafetoprotein: Association with high birth weight. Obstet Gynecol 2002;99(4):531-6.

Simpson JL, Elias S, Morgan CD, Andersen RN, Shulman LP, Sibai BM, et al. Does unexplained second-trimester (15 to 20 weeks' gestation) maternal serum alphafetoprotein elevation presage adverse perinatal outcome? Pitfalls and preliminary studies with late second- and third-trimester maternal serum alphafetoprotein. Am J Obstet Gynecol 1991;164(3):829-36.

How to Cite
1.
Dehghani–Firouzabadi R, Tayebi N, Ghasemi N, Tahmasbi Z. The Association between Second-Trimester Maternal Serum Alpha-Fetoprotein in 14-22 Weeks and Adverse Pregnancy Outcome. Acta Med Iran. 48(4):234-238.
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