Hu Ji-Lin, Zhang Yang-Jia, Zhang Jin-Man, Zhu Shu, Li Dong-Mei, Yin Yi-Fei, Su Jie, Chan Ying, He Jing, Cao Yong-Jiu, Zhu Bao-Sheng
Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming 650500, Yunnan, PR China; Medical School, Kunming University of Science and Technology, Kunming 650500, Yunnan, PR China.
National Health Commission's Key Laboratory for Healthy Births in Western China, Department of Obstetrics and Gynecology, First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, PR China.
Taiwan J Obstet Gynecol. 2020 Jan;59(1):73-78. doi: 10.1016/j.tjog.2019.11.011.
The aim of this study was to investigate the overall distribution of pregnancy outcomes in women with elevated second-trimester maternal serum alpha-fetoprotein (MS-AFP), and to determine the risk of adverse pregnancy outcomes (APOs) by MS-AFP level.
We retrospectively analyzed the clinical data of 429 women with elevated MS-AFP (≥2.5 multiple of the median (MOM)) and 1555 women with normal MS-AFP (0.5-2.49MOM) from a total of 46,741 prenatally screened singleton pregnant women. The overall distribution of APOs of the two groups, the risk of APOs by MS-AFP level, and the predictive value of elevated MS-AFP to APOs were analyzed.
The incidence rate of APOs in elevated MS-AFP group was significantly higher than that in normal MS-AFP group (42.89 vs. 8.23%). In elevated MS-AFP group, the top three APOs, in term of incidence rate, were structural fetal abnormalities (7.93%), spontaneous abortion (7.46%) and preterm birth (7.23%); regarding to the risk, the top three APOs were stillbirth, spontaneous abortion and early-onset preeclampsia (odds ratio 35.98, 20.81 and 8.58 respectively). For structural fetal abnormalities, MS-AFP had predictive values for fetal open neural tube defects (ONTDs), gastroschisis and multiple malformations.
Elevated MS-AFP is associated with increased risks of APOs. ONTDs complicate merely a small proportion of pregnancies with elevated MS-AFP, and the rest of them have high risks of obstetric complications. MS-AFP can help to identify these women at high risk of APOs in earlier second-trimester.
本研究旨在调查孕中期母体血清甲胎蛋白（MS-AFP）升高的孕妇妊娠结局的总体分布情况，并根据MS-AFP水平确定不良妊娠结局（APO）的风险。
我们回顾性分析了46741例接受产前筛查的单胎孕妇中，429例MS-AFP升高（≥2.5倍中位数（MOM））和1555例MS-AFP正常（0.5-2.49MOM）孕妇的临床资料。分析了两组APO的总体分布、MS-AFP水平导致APO的风险以及MS-AFP升高对APO的预测价值。
MS-AFP升高组的APO发生率显著高于MS-AFP正常组（42.89%对8.23%）。在MS-AFP升高组中，按发生率排列，前三位的APO是胎儿结构异常（7.93%）、自然流产（7.46%）和早产（7.23%）；按风险排列，前三位的APO是死产、自然流产和早发型子痫前期（比值比分别为35.98、20.81和8.58）。对于胎儿结构异常，MS-AFP对胎儿开放性神经管缺陷（ONTD）、腹裂和多发畸形有预测价值。
MS-AFP升高与APO风险增加相关。ONTD仅使一小部分MS-AFP升高的妊娠复杂化，其余妊娠有较高的产科并发症风险。MS-AFP有助于在孕中期早期识别这些有APO高风险的女性。
