Williams M A, Hickok D E, Zingheim R W, Luthy D A, Kimelman J, Nyberg D A, Mahony B S
Center for Perinatal Studies, University of Washington School of Public Health, Seattle.
Am J Obstet Gynecol. 1992 Oct;167(4 Pt 1):1032-7. doi: 10.1016/s0002-9378(12)80033-0.
Unexplained elevations of maternal serum alpha-fetoprotein levels in the second trimester of pregnancy are associated with adverse pregnancy outcomes, including intrauterine growth retardation, preterm delivery, preeclampsia, and abruptio placentae. In addition, elevations of maternal serum alpha-fetoprotein have been associated with placental lesions detected during second-trimester ultrasonographic evaluations. We examined the relationship between adverse pregnancy outcomes and unexplained elevations of maternal serum alpha-fetoprotein and placental abnormalities in the second trimester of pregnancy.
During the period from January 1989 to March 1991 we conducted a cohort study of 201 women with an elevated maternal serum alpha-fetoprotein (> or = 2.0 multiples of the median) and a second-trimester ultrasonographic evaluation at Swedish Hospital Medical Center and 211 women with normal maternal serum alpha-fetoprotein levels who had also undergone ultrasonographic evaluation at the same institution. All women in this investigation had singleton pregnancies without fetal anomalies.
Elevated maternal serum alpha-fetoprotein was associated with the following adverse pregnancy outcomes: low birth weight (adjusted risk ratio 3.7), preterm delivery (adjusted risk ratio 3.6), intrauterine growth retardation (adjusted risk ratio 4.0), preeclampsia (adjusted risk ratio 3.8) and abruptio placentae (adjusted risk ratio 4.8). Placental abnormalities detected during second-trimester ultrasonographic evaluations were also associated with adverse pregnancy outcomes: low birth weight (adjusted risk ratio 2.0), preterm delivery (adjusted risk ratio 2.3), intrauterine growth retardation (adjusted risk ratio 1.4), and abruptio placentae (adjusted risk ratio 9.0). A joint positive history of second-trimester elevations of maternal serum alpha-fetoprotein and placental abnormalities was more strongly associated with the following adverse infant outcomes: low birth weight (adjusted risk ratio 6.9), preterm delivery (adjusted risk ratio 5.6), and intrauterine growth retardation (adjusted risk ratio 5.3).
Unexplained elevated levels of maternal serum alpha-fetoprotein and placental abnormalities detected in the second trimester of pregnancy are associated with particularly poor pregnancy outcome. Careful examination for placental abnormalities should be part of the evaluation of elevated maternal serum alpha-fetoprotein.
孕中期孕妇血清甲胎蛋白水平不明原因升高与不良妊娠结局相关，包括胎儿宫内生长受限、早产、先兆子痫和胎盘早剥。此外，孕妇血清甲胎蛋白升高与孕中期超声检查发现的胎盘病变有关。我们研究了不良妊娠结局与孕中期孕妇血清甲胎蛋白不明原因升高及胎盘异常之间的关系。
1989年1月至1991年3月期间，我们在瑞典医院医疗中心对201名孕妇血清甲胎蛋白水平升高（≥中位数的2.0倍）且在孕中期进行了超声检查的妇女，以及211名孕妇血清甲胎蛋白水平正常且在同一机构也接受了超声检查的妇女进行了队列研究。本研究中的所有妇女均为单胎妊娠且无胎儿畸形。
孕妇血清甲胎蛋白升高与以下不良妊娠结局相关：低出生体重（校正风险比3.7）、早产（校正风险比3.6）、胎儿宫内生长受限（校正风险比4.0）、先兆子痫（校正风险比3.8）和胎盘早剥（校正风险比4.8）。孕中期超声检查发现的胎盘异常也与不良妊娠结局相关：低出生体重（校正风险比2.0）、早产（校正风险比2.3）、胎儿宫内生长受限（校正风险比1.4）和胎盘早剥（校正风险比9.0）。孕中期孕妇血清甲胎蛋白升高和胎盘异常的联合阳性病史与以下不良婴儿结局的关联更强：低出生体重（校正风险比6.9）、早产（校正风险比5.6）和胎儿宫内生长受限（校正风险比5.3）。
孕中期孕妇血清甲胎蛋白水平不明原因升高及胎盘异常与特别差的妊娠结局相关。对胎盘异常进行仔细检查应作为孕妇血清甲胎蛋白升高评估的一部分。
