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. 2015 Jul-Dec;9(3-4):18-23.
doi: 10.11138/jpm/2015.9.3.018.

Alpha-fetoprotein and its value for predicting pregnancy outcomes - a re-evaluation

Ayham Alhaj Darouich  1 , Thomas Liehr  1 , Anja Weise  1 , Dietmar Schlembach  2 , Ekkehart Schleußner  2 , Michael Kiehntopf  3 , Isolde Schreyer  4
Affiliations

Alpha-fetoprotein and its value for predicting pregnancy outcomes - a re-evaluation

Ayham Alhaj Darouich et al. J Prenat Med. 2015 Jul-Dec.

Abstract

Introduction: Alpha-fetoprotein (AFP) concentrations can be determined framing others from invasively acquired amnion fluid (AF-AFP). While the biological role of AFP remains unclear it is well known that AFP-levels can be altered in connection with specific clinical and/or genetic alterations of the fetus.

Materials and method: here a retrospective study based on 3,119 singleton and 56 twin pregnancies is presented. The standard levels of amnion fluid derived alpha-fetoprotein level (AF-AFP) between 12th and 36th weeks of gestation were determined. Additionally, acetylcholinesterase (AChE) test results for 63 cases, ultrasonography results for 32 cases and abnormal karyotypic findings for 100 cases were available for selected cases.

Results and discussion: according to the present data the AF-AFP test is reliable and provides expected test results in terms of population studies. However, individual AF-AFP test results can be subject to high individual variations. In this study AF-AFP multiple of medians (MoM) over 1.7 were indicative for neuronal tube defects and/or omphalocele in only 6.3% of the cases, while such AF-AFP values were hints on severe sonographic signs in 62% of the cases. Also, altered AF-AFP concentrations were present in 82% of cytogenetically abnormal cases. Overall, even though predicative value of the AF-AFP-test is matter of discussion it continues to be widely applied in invasive prenatal diagnostics. This study indicates that it only can be applied reliably in combination with other tests like banding cytogenetics, ultrasonography and all embedded in well-established genetic counseling.

Keywords: acetylcholinesterase (AChE); amnion fluid derived alpha-fetoprotein level (AF-AFP); chromosomal aberrations; ultrasonography.

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Figures

Figure 1
Figure 1
Distribution of AF-AFP-MoM values in 56 twin pregnancies. The higher value was assigned to one twin, the lower to the other twin. They were denominated as 1st and 2nd twin for this chart and not as they were assigned due to sonographic data.
Figure 2
Figure 2
Pie chart of 32 cases with AF-AFP-MoM >1.7 and the results of ultrasonography.
Figure 3
Figure 3
Distribution of AF-AFP-MoM values in 100 cases with cytogenetic aberrations. The 100 cases are subdivided in 9 groups and depicted as 9 different symbols as indicated in the legend. For cases with MoM >1.4 the values are written beside the symbols.
See this image and copyright information in PMC

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