Management strategy in pregnancies with elevated second-trimester maternal serum alpha-fetoprotein based on a second assay.

Emmanuel Spaggiari, Marie Ruas, Sophie Dreux, Anne-Sylvie Valat, Isabelle Czerkiewicz, Fabien Guimiot, Thomas Schmitz, Anne-Lise Delezoide, Françoise Muller

Department of Developmental Biology, AP-HP, Robert Debré Hospital, University Paris Diderot and Paris Sorbonne-Cité, Paris, France.

American journal of obstetrics and gynecology 2013 Apr

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To assess maternal-fetal outcomes in pregnancies associated with persistently elevated second-trimester maternal serum alpha-fetoprotein. A retrospective cohort study in 658 patients with maternal serum alpha-fetoprotein ≥2.5 multiple of median, performed at routine Down syndrome screening. Maternal serum alpha-fetoprotein was assayed a second time in 341 of them. Outcomes were recorded in all cases. The group with unexplained maternal serum alpha-fetoprotein persistently ≥2.5 multiple of median was associated with more pregnancy complications 37 of 92 (40.2%) as fetal death, preeclampsia, intrauterine growth restriction, and congenital nephrotic syndrome, compared with the group with maternal serum alpha-fetoprotein that returned to a normal level 37 of 226 (16.4%) (P < .001). When maternal serum alpha-fetoprotein returns to a normal level on a second assay, the risk of adverse outcome significantly decreases, but these pregnancies are still at risk of complications and therefore need close surveillance. Repeat maternal serum alpha-fetoprotein assay allows identification of patients who should be offered amniocentesis to evaluate the risk of nephrotic syndrome and epidermolysis bullosa. Alpha-fetoprotein should be monitored in pregnancies associated with unexplained high maternal serum alpha-fetoprotein. A management strategy based on ultrasound examination, second maternal serum alpha-fetoprotein assay and amniocentesis is proposed to improve prenatal counseling and management of such pregnancies. However, a prospective study remains necessary to evaluate it. Copyright © 2013 Mosby, Inc. All rights reserved.

Citation

Emmanuel Spaggiari, Marie Ruas, Sophie Dreux, Anne-Sylvie Valat, Isabelle Czerkiewicz, Fabien Guimiot, Thomas Schmitz, Anne-Lise Delezoide, Françoise Muller. Management strategy in pregnancies with elevated second-trimester maternal serum alpha-fetoprotein based on a second assay. American journal of obstetrics and gynecology. 2013 Apr;208(4):303.e1-7