title: Management strategy in pregnancies with elevated second-trimester maternal serum alpha-fetoprotein based on a second assay.
abstract: OBJECTIVE
  To assess maternal-fetal outcomes in pregnancies associated with persistently elevated second-trimester maternal serum alpha-fetoprotein.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors: Department of Developmental Biology, AP-HP, Robert Debré Hospital, University Paris Diderot and Paris Sorbonne-Cité, Paris, France.
authors: Emmanuel
authors: E
authors: Spaggiari
authors: Marie
authors: M
authors: Ruas
authors: Sophie
authors: S
authors: Dreux
authors: Anne-Sylvie
authors: AS
authors: Valat
authors: Isabelle
authors: I
authors: Czerkiewicz
authors: Fabien
authors: F
authors: Guimiot
authors: Thomas
authors: T
authors: Schmitz
authors: Anne-Lise
authors: AL
authors: Delezoide
authors: Françoise
authors: F
authors: Muller
mesh_terms: D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood*; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second / Q000097:blood*; D018566:Pregnancy, High-Risk / Q000097:blood; D012189:Retrospective Studies; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D000509:alpha-Fetoproteins