Waller D K, Lustig L S, Cunningham G C, Golbus M S, Hook E B
School of Public Health, University of California, Berkeley 94720.
N Engl J Med. 1991 Jul 4;325(1):6-10. doi: 10.1056/NEJM199107043250102.
The finding of an elevated level of maternal serum alpha-fetoprotein during the second trimester of pregnancy may indicate that the fetus has died or is about to die. It is uncertain, however, whether the finding is associated with an increased risk of fetal death later in gestation independent of known causes of elevation, such as the presence of neural-tube defects or multiple gestation.
To address this question, we performed a case-control study of 612 women whose pregnancies ended in fetal death and 2501 women who gave birth to live infants, using reports from California vital statistics for 1987. All the women had signleton pregnancies and alpha-fetoprotein screening in the second trimester.
Women with elevated levels of serum alpha-fetoprotein in the second trimester of pregnancy had an increased risk of fetal death, and the risk was increased until term. Women with the highest levels of serum alpha-fetoprotein--greater than or equal to 3.0 times the median value--had a very high risk of fetal death (odds ratio, 10.4; 95 percent confidence interval, 4.9 to 22.0) as compared with women who had normal levels of alpha-fetoprotein. Maternal serum alpha-fetoprotein levels that were 2.0 to 2.9 times the median were also associated with an elevated risk of fetal death (odds ratio, 2.4; 95 percent confidence interval, 1.7 to 3.4). Elevated levels of alpha-fetoprotein were especially likely to be associated with fetal death in cases in which maternal hypertension or placental infarction was also present. CONCLUSIONs. An unexplained elevated level of maternal serum alpha-fetoprotein in the second trimester of pregnancy is associated with an increased risk of subsequent fetal death, up to four to five months after alpha-fetoprotein screening.
孕期中期母体血清甲胎蛋白水平升高可能表明胎儿已经死亡或即将死亡。然而，尚不确定这一发现是否与妊娠后期胎儿死亡风险增加相关，而与已知的升高原因无关，如神经管缺陷或多胎妊娠的存在。
为解决这一问题，我们利用1987年加利福尼亚生命统计报告，对612名妊娠结局为胎儿死亡的妇女和2501名分娩活婴的妇女进行了病例对照研究。所有妇女均为单胎妊娠，并在孕期中期进行了甲胎蛋白筛查。
孕期中期血清甲胎蛋白水平升高的妇女胎儿死亡风险增加，且该风险一直增加至足月。血清甲胎蛋白水平最高的妇女——大于或等于中位数的3.0倍——与甲胎蛋白水平正常的妇女相比，胎儿死亡风险非常高（比值比，10.4；95%置信区间，4.9至22.0）。甲胎蛋白水平为中位数的2.0至2.9倍也与胎儿死亡风险升高相关（比值比，2.4；95%置信区间，1.7至3.4）。在同时存在母体高血压或胎盘梗死的情况下，甲胎蛋白水平升高尤其可能与胎儿死亡相关。结论：孕期中期母体血清甲胎蛋白水平不明原因升高与随后胎儿死亡风险增加相关，在甲胎蛋白筛查后四至五个月内均如此。
