Pregnancy Outcomes Regarding Maternal Serum AFP Value in Second Trimester Screening

Aim: The aim of this study was to evaluate the predictive value of alpha-fetoprotein in maternal serum (MS-AFP) as a marker for diverse pregnancy outcomes. Methods: The study was based on pregnancy and delivery data from 5520 women between 1999 and 2014 at University Hospital of Zurich (UHZ). Inclusion criteria: both MS-AFP and pregnancy outcome were known for the same pregnancy. Pregnancy outcomes and characteristics such as fetal malformation, intrauterine fetal death (IUFD) and intrauterine growth retardation as well as maternal age, weight before pregnancy, gestational age (GA) at delivery, newborn weight, length and head circumference were analyzed with respect to the MS-AFP value. MS-AFP value was categorized into three groups: elevated MS-AFP > 2.5 multiples of the median (MoM), normal 0.5-2.49 MoM and decreased < 0.5 MoM. Results: Newborn weight (g) and length (cm) were significantly lower in the elevated MS-AFP (P < 0.001) group, and infants had 1 week lower GA at delivery (P < 0.05). In the group of elevated MS-AFP (n = 46), 26.1% of pregnancies were significantly related to adverse pregnancy outcomes, such as fetal malformations, fetuses small for gestational age (SGA) and IUFD. Adverse pregnancy outcomes of 5.6% were registered in the group of normal MS-AFP and 7.3% in the group of low MS-AFP (P < 0.05). Conclusion: MS-AFP level in the second trimester is still an important indicator of fetal surface malformations; however, ultrasound still outweighs as a screening method. Nevertheless, pregnant women with elevated MS-AFP values and with no sonographically detected fetal malformations should additionally receive the third trimester ultrasound examination to exclude other possible complications of pregnancy.