Department of Developmental Biology, AP-HP, Robert Debré Hospital, University Paris Diderot and Paris Sorbonne-Cité, Paris, France.
Am J Obstet Gynecol. 2013 Apr;208(4):303.e1-7. doi: 10.1016/j.ajog.2013.01.010. Epub 2013 Jan 10.
To assess maternal-fetal outcomes in pregnancies associated with persistently elevated second-trimester maternal serum alpha-fetoprotein.
A retrospective cohort study in 658 patients with maternal serum alpha-fetoprotein ≥2.5 multiple of median, performed at routine Down syndrome screening. Maternal serum alpha-fetoprotein was assayed a second time in 341 of them. Outcomes were recorded in all cases.
The group with unexplained maternal serum alpha-fetoprotein persistently ≥2.5 multiple of median was associated with more pregnancy complications 37 of 92 (40.2%) as fetal death, preeclampsia, intrauterine growth restriction, and congenital nephrotic syndrome, compared with the group with maternal serum alpha-fetoprotein that returned to a normal level 37 of 226 (16.4%) (P < .001).
When maternal serum alpha-fetoprotein returns to a normal level on a second assay, the risk of adverse outcome significantly decreases, but these pregnancies are still at risk of complications and therefore need close surveillance. Repeat maternal serum alpha-fetoprotein assay allows identification of patients who should be offered amniocentesis to evaluate the risk of nephrotic syndrome and epidermolysis bullosa. Alpha-fetoprotein should be monitored in pregnancies associated with unexplained high maternal serum alpha-fetoprotein. A management strategy based on ultrasound examination, second maternal serum alpha-fetoprotein assay and amniocentesis is proposed to improve prenatal counseling and management of such pregnancies. However, a prospective study remains necessary to evaluate it.
评估与妊娠中期母体血清甲胎蛋白持续升高相关的母婴结局。
在 658 例母体血清甲胎蛋白≥2.5 中位数倍数的患者中进行回顾性队列研究，这些患者均在常规唐氏综合征筛查中进行。对其中 341 例患者进行了第二次母体血清甲胎蛋白检测。所有病例均记录了结局。
与母体血清甲胎蛋白恢复正常水平的 226 例患者（16.4%）相比，母体血清甲胎蛋白持续≥2.5 中位数倍数的不明原因组更易发生妊娠并发症（37/92，40.2%），如胎儿死亡、子痫前期、宫内生长受限和先天性肾病综合征（P<.001）。
当第二次检测母体血清甲胎蛋白恢复正常水平时，不良结局的风险显著降低，但这些妊娠仍存在并发症风险，因此需要密切监测。重复母体血清甲胎蛋白检测可识别出应进行羊膜穿刺术以评估肾病综合征和大疱性表皮松解症风险的患者。应监测与不明原因母体血清甲胎蛋白升高相关的妊娠。提出了一种基于超声检查、第二次母体血清甲胎蛋白检测和羊膜穿刺术的管理策略，以改善此类妊娠的产前咨询和管理。然而，仍需要前瞻性研究来评估该策略。
