DATA FROM AN ALPHA-FETOPROTEIN PILOT SCREENING-PROGRAM IN MAINE

Abstract

In Maine [USA], maternal serum .alpha.-fetoprotein (AFP) values equaled 2 or more multiples of the median in 4.8% of screened women. Between 2.0 and 2.9 multiples of the median repeat maternal serum AFP testing and sonography were comparable as the next diagnostic step; at 3 multiples of the median or higher, sonography was superior. Sonography moved dates back in only 10 singleton viable pregnancies with maternal serum AFP elevations; 3 of these had open fetal defects. Among singletons, all 5 anencephaly cases, 1 of 2 open spina bifida lesions, and all 3 open ventral wall defects were identified. Three closed singleton neural tube defects and 2 open spina bifida defects in twins were not detected. Of 36 multiple gestations, 19 had maternal serum AFP 2 or higher multiples of the median. In singletons maternal serum AFP of 3 or higher multiples of the median indicated a 30-fold increased risk for fetal death and a 7-fold increased risk for birth weight under 2500 g.