Results and benefits of a maternal serum alpha-fetoprotein screening program.

Maternal serum alpha-fetoprotein (MSAFP) screening was offered in a private suburban practice to 21,000 nondiabetic and 442 diabetic women with apparently normal pregnancies. Using 2.5 or greater multiples of the median as the normal upper limit, 249 (1.2%) had a raised MSAFP level. There were 25 neural tube defects (NTDs) (1.2/1,000 births); 18 were detected by screening and two by ultrasound scanning. Three had closed spina bifida lesions. Two had anencephaly with normal MSAFP levels, but were studied at more than 24 weeks' gestation. An additional 13 with raised MSAFP levels had other congenital defects. One in 400 women screened had a recommended amniocentesis; 26.4% of them had a fetus with an NTD or major malformation. Our detection efficiency before 24 weeks' gestation for anencephaly was 85.7% (12/14), 62.5% (5/8) for open and closed spina bifida, and 1/1 for encephalocele. A raised MSAFP level occurred in ten (2.3%) of the 442 diabetic women, four (0.9%) of whom had a fetus with an open NTS. A screening program should be established only where there is linked excellent interdisciplinary support among obstetrician, laboratory, clinical geneticist, ultrasonographer, and an identified program coordinator.

[1]  A. Milunsky.  Prenatal diagnosis of neural tube defects. , 1977, JAMA.

[2]  J. Kitzmiller,et al.  Prenatal diagnosis of neural tube defects. VIII. The importance of serum alpha-fetoprotein screening in diabetic pregnant women. , 1982, American journal of obstetrics and gynecology.

[3]  N. Wald,et al.  SMALL BIPARIETAL DIAMETER OF FETUSES WITH SPINA BIFIDA: IMPLICATIONS FOR ANTENATAL SCREENING , 1980, British journal of obstetrics and gynaecology.

[4]  N. Wald,et al.  THE EFFECT OF MATERNAL WEIGHT ON MATERNAL SERUM ALPHA‐FETOPROTEIN LEVELS , 1981, British journal of obstetrics and gynaecology.

[5]  A. Milunsky,et al.  Antenatal Diagnosis, Alpha Fetoprotein and the FDA , 1976 .

[6]  M. Ferguson-Smith,et al.  AVOIDANCE OF ANENCEPHALIC AND SPINA BIFIDA BIRTHS BY MATERNAL SERUM-ALPHAFETOPROTEIN SCREENING , 1978, The Lancet.

[7]  B. Crandall,et al.  Maternal serum alpha-fetoprotein screening for the detection of neural tube defects. , 1983, The Western journal of medicine.

[8]  J. Haddow,et al.  Screening for neural tube defects in the United States. A summary of the Scarborough Conference. , 1979, American journal of obstetrics and gynecology.

[9]  J. Hobbins,et al.  Stage II ultrasound examination for the diagnosis of fetal abnormalities with an elevated amniotic fluid alpha-fetoprotein concentration. , 1982, American journal of obstetrics and gynecology.

[10]  A. Milunsky.  Prenatal detection of neural tube defects. VI. Experience with 20,000 pregnancies. , 1980, JAMA.

[11]  R. Neff,et al.  Prenatal Diagnosis of Neural Tube Defects: IV. MATERNAL SERUM ALPHA-FETOPROTEIN SCREENING , 1980, Obstetrics and gynecology.

[12]  V. Sapirstein,et al.  Prenatal Diagnosis of Open Neural Tube Defects Using the Amniotic Fluid Acetylcholinesterase Assay , 1982, Obstetrics and gynecology.

[13]  Macri Jn,et al.  Prenatal serum alpha-fetoprotein screening for neural tube defects. , 1982 .

[14]  D. Brock,et al.  Prenatal diagnosis of anencephaly through maternal serum-alphafetoprotein measurement. , 1973, Lancet.

[15]  Brock Dj.  The use of maternal serum AFP in screening for neural tube defects. , 1978 .

[16]  M. Sherman,et al.  Alpha‐Fetoprotein (AFP) Levels in Matermal Serum in Relation to Pregnancy Outcome in 7 158 Pregnant Women Prospectively Investigated During their 14th‐20th Week Post Last Menstrual Period , 1977, Acta obstetricia et gynecologica Scandinavica. Supplement.

[17]  A. Loucopoulos,et al.  Management of multifetal pregnancies: sixteen years' experience at the Sloan Hospital for Women. , 1982, American journal of obstetrics and gynecology.

[18]  A. Milunsky,et al.  Maternal serum AFP secreening. , 1978, The New England journal of medicine.