High first-trimester msAFP: increased risk for ischaemic placental disease

  • Am J Obstet Gynecol

  • International Clinical Digest
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Takeaway

  • Screening maternal serum alpha-fetoprotein (msAFP) abnormalities may predict risk for poor neonatal outcomes, including ischemic placental disease, fetal growth restriction (FGR), and preterm birth.

Why this matters

  • msAFP is a fetal glycoprotein synthesized in early pregnancy that diffuses across the placental membrane into the maternal circulation. 
  • Disruption of this interface leads to altered diffusion and abnormal maternal serum levels.
  • msAFP may be used to screen for perinatal risk factors and allow for the initiation of preventive measures.

Key results

  • Elevated first-trimester msAFP is associated (ORs, 95% CIs) with:
    • Ischemic placental disease: 2.26 (1.33-3.87);
    • FGR; 3.40 (1.56-7.42); and
    • Spontaneous preterm birth: 2.69 (1.26-5.74).
  • No association between elevated msAFP and preeclampsia was found.

Study design 

  • Multisite retrospective cohort study.
  • Participants with first-trimester msAFP and complete records between 2015 and 2017 were identified (n=1280).
  • Elevated msAFP was defined as >2.0 MoM.
  • Primary aim was to investigate an association between elevated msAFP at 11-14 weeks of gestation and ischemic placental disease (preeclampsia, FGR, and/or placental abruption).
  • Funding: None disclosed.

Limitations

  • Findings did not show an association between preeclampsia and elevated msAFP.
  • Incomplete delivery records resulted in smaller study numbers.