title: Associations between pregnancy outcomes and unexplained high and low maternal serum alpha-fetoprotein levels.
abstract: OBJECTIVE
  To determine the relationship between adverse pregnancy outcomes and maternal serum alpha-fetoprotein (MSAFP) levels.
  
  
  METHODS
  A retrospective cohort study was conducted on consecutive singleton pregnancies, screened for fetal Down syndrome, in the northern part of Thailand. The prospective database of our fetal Down screening program was assessed to recruit all consecutive records. Pregnancies with medical complication and fetal abnormality were excluded. The recruited women were categorized into three groups: normal (≥0.76 to ≤2.0 MoM), low (<0.76 MoM) and high (>2.0 MoM) MSAFP levels.
  
  
  RESULTS
  Of 7,110 screened women, 5,486 met inclusion criteria, including 240; 5,016 and 230 in the group of high, normal and low MSAFP levels, respectively. The rates of preterm birth, pregnancy-induced hypertension (PIH), fetal growth restriction (FGR), fetal death, low birth weight (LBW) and low APGAR scores were significantly higher in women with high MSAFP levels (11.7 vs. 6.6 %, 7.5 vs. 3.3 %, 7.5 vs. 3.3 %, 2.1 vs. 0.3 %, 15.8 vs. 6.7 %, and 2.9 vs. 0.5 % respectively), with relative risk of 1.76, 2.28, 2.27, 7.46, 2.35 and 6.09, respectively. The rates of preterm birth, FGR and LBW were significantly lower in low MSAFP levels with relative risk of 0.39, 0.26 and 0.26, respectively, whereas the rates of PIH and fetal death and low Apgar scores were not significantly different.
  
  
  CONCLUSIONS
  Pregnant women with high MSAFP levels had an increased risk of poor pregnancy outcomes, while those with low MSAFP levels had a significantly lower risk of such outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
authors.forename: Pongsun
authors.initials: P
authors.lastname: Puntachai
authors.forename: Chanane
authors.initials: C
authors.lastname: Wanapirak
authors.forename: Supatra
authors.initials: S
authors.lastname: Sirichotiyakul
authors.forename: Fuanglada
authors.initials: F
authors.lastname: Tongprasert
authors.forename: Kasemsri
authors.initials: K
authors.lastname: Srisupundit
authors.forename: Suchaya
authors.initials: S
authors.lastname: Luewan
authors.forename: Kuntharee
authors.initials: K
authors.lastname: Traisrisilp
authors.forename: Theera
authors.initials: T
authors.lastname: Tongsong
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005313:Fetal Death; D005317:Fetal Growth Retardation / Q000453:epidemiology; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012306:Risk; D013785:Thailand; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D000509:alpha-Fetoproteins