Does the Predictive Value of Maternal Serum Alpha-Fetoprotein on Adverse Pregnancy Outcomes Vary by Race/Ethnicity?

Background: Alpha-fetoprotein (AFP) is the major serum protein in the embryonic stage and in the early fetal stage. The aim of this study was to measure maternal serum AFP levels in second trimester between 15-20 weeks of gestation and to determine whether unexplained elevated MSAFP levels is an effective predictor of adverse pregnancy outcome among Indian population.Methods: This study was a prospective observational study, carried out on 400 pregnant women. Maternal serum alpha-fetoprotein (MSAFP) was measured between 15 and 20 weeks of gestation after excluding congenital malformation or birth defects. MSAFP level was determined by using a radio-immunoassay technique. Women with MSAFP level >2.0 MoM was considered as abnormal while MSAFP level≤ 2.0 MoM was considered as normal. All women were followed up till delivery and pregnancy outcomes were noted and compared between two groups.Results: Women with elevated MSAFP had significantly higher adverse pregnancy outcomes (75.4%) compared to women with MSAFP ≤2.0 MoM (26.1%) (p<0.0001 with relative risk of 2.89, 95% confidence interval 2.276 -3.667).Conclusions: Unexplained elevated MSAFP has high sensitivity, specificity, positive predictive value and negative predictive value in predicting adverse pregnancy outcomes. It would, therefore be worthwhile screening pregnant women in second trimester for maternal serum alpha-fetoprotein levels as it would help to identify high risk pregnancies and allow close antenatal survillence for better pregnancy outcome.

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

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-2789-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jilin Hu ◽

Jinman Zhang ◽

Guilin He ◽

Shu Zhu ◽

Xinhua Tang ◽

...

Keyword(s):

Retrospective Study ◽

Pregnancy Outcomes ◽

Good Predictor ◽

First Trimester ◽

Maternal Serum ◽

Adverse Pregnancy Outcomes ◽

Alpha Fetoprotein ◽

Serum Alpha Fetoprotein ◽

Adverse Pregnancy

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A rat model of placental inflammation explains the unexplained elevated maternal serum alpha‐fetoprotein associated with adverse pregnancy outcomes

Journal of Obstetrics and Gynaecology Research ◽

10.1111/jog.14085 ◽

2019 ◽

Vol 45 (10) ◽

pp. 1980-1988 ◽

Cited By ~ 5

Author(s):

Jilin Hu ◽

Jinman Zhang ◽

Ying Chan ◽

Baosheng Zhu

Keyword(s):

Rat Model ◽

Pregnancy Outcomes ◽

Maternal Serum ◽

Adverse Pregnancy Outcomes ◽

Alpha Fetoprotein ◽

Serum Alpha Fetoprotein ◽

Placental Inflammation ◽

Adverse Pregnancy

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

10.21203/rs.2.14706/v2 ◽

2020 ◽

Author(s):

Jilin Hu ◽

Jinman Zhang ◽

Guilin He ◽

Shu Zhu ◽

Xinhua Tang ◽

...

Keyword(s):

Preterm Birth ◽

Pregnancy Outcomes ◽

Good Predictor ◽

Roc Curves ◽

First Trimester ◽

Maternal Serum ◽

Adverse Pregnancy Outcomes ◽

Alpha Fetoprotein ◽

Serum Alpha Fetoprotein ◽

Adverse Pregnancy

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), and had an earlier distribution of gestational weeks at delivery (P = 0.004) and a lower distribution of neonatal birth weights (P = 0.000), but the actual between-group differences were minuscule. The areas under ROC curves were 0.572 (P = 0.001), 0.579 (P = 0.015) and 0.565 (P = 0.000) for preterm birth, preeclampsia and SGA, respectively. Subdivisions for the disorders did not obviously improve the performances of MS-AFP. 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.

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Is First Trimester Maternal Serum Alpha Fetoprotein Predictive of Adverse Pregnancy Outcomes? [30L]

Obstetrics and Gynecology ◽

10.1097/01.aog/01.aog.0000559264.32642.aa ◽

2019 ◽

Vol 133 (1) ◽

pp. 136S-137S

Author(s):

Cheryl Dinglas ◽

Nur Afsar ◽

Jay Davis ◽

Sara Kim ◽

Kimberly Herrera ◽

...

Keyword(s):

Pregnancy Outcomes ◽

First Trimester ◽

Maternal Serum ◽

Adverse Pregnancy Outcomes ◽

Alpha Fetoprotein ◽

Serum Alpha Fetoprotein ◽

Adverse Pregnancy

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

10.21203/rs.2.14706/v1 ◽

2019 ◽

Author(s):

Jilin Hu ◽

Jinman Zhang ◽

Guilin He ◽

Shu Zhu ◽

Xinhua Tang ◽

...

Keyword(s):

Preterm Birth ◽

Pregnancy Outcomes ◽

Good Predictor ◽

Roc Curves ◽

First Trimester ◽

Maternal Serum ◽

Adverse Pregnancy Outcomes ◽

Alpha Fetoprotein ◽

Serum Alpha Fetoprotein ◽

Adverse Pregnancy

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.

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

10.21203/rs.2.14706/v3 ◽

2020 ◽

Author(s):

Jilin Hu ◽

Jinman Zhang ◽

Guilin He ◽

Shu Zhu ◽

Xinhua Tang ◽

...

Keyword(s):

Preterm Birth ◽

Pregnancy Outcomes ◽

Good Predictor ◽

Roc Curves ◽

First Trimester ◽

Maternal Serum ◽

Adverse Pregnancy Outcomes ◽

Alpha Fetoprotein ◽

Serum Alpha Fetoprotein ◽

Adverse Pregnancy

Abstract Background: It is well known that second-trimester maternal serum alpha-fetoprotein (MS-AFP) is a predictor for adverse pregnancy outcomes (APOs), such as preterm birth, stillbirth, preeclampsia and small for gestational age (SGA). However, it is unknown whether first-trimester MS-AFP is also predictive of APOs. 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 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), and had an earlier distribution of gestational weeks at delivery (P = 0.004) and a lower distribution of neonatal birth weights (P = 0.000), but the actual between-group differences were minuscule. The areas under ROC curves were 0.572 (P = 0.001), 0.579 (P = 0.015) and 0.565 (P = 0.000) for preterm birth, preeclampsia and SGA, respectively. Subdivisions for the disorders did not obviously improve the performances of MS-AFP. Conclusions: 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.

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