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.
Cite this paper
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.
 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.
 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
 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
 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.
 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.
 Wald, N.J., Cuckle, H. and Brock, J.H.L. (1977) Maternal serum-alpha-fetoprotein measurement and low birth weight. Lancet, 1, 1323-1332.
 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.
 Burton, B.K. (1988) Outcome of pregnancy in patients with unexplained elevated or low levels of. Obstetrics & Gynecology, 72, 709-713
 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.
 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.
 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.
 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.
 Robinson, L., Grau, P. and Crandall, B.F. (1989) Pregnancy outcomes after increasing maternal serum alphafetoprotein levels. Obstetrics & Gynecology, 74, 17-20.
 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.
 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.
 Wald, N. and Morris, J. (2001) Multiple marker second trimester serum screening for pre eclampsia. Journal of Medical Screening, 8, 65-68.
 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.
 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.
 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