Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington.
Obstet Gynecol. 2023 Mar 1;141(3):438-444. doi: 10.1097/AOG.0000000000005045. Epub 2023 Feb 2.
Black racial designation is the only race for which adjustment is recommended for maternal prenatal serum alpha-fetoprotein (AFP) screening. The objective of this study is to reevaluate the relationship between maternal race and maternal serum AFP values in prenatal analyte screening.
This was a single-center retrospective analysis of patients who underwent prenatal analyte screening between January 2007 and December 2020. Nomograms for raw maternal serum AFP values by gestational age were created and compared between patients identified as "Black" and "non-Black" on the laboratory requisition. Multivariable linear regression models were created to evaluate the relationship among gestational age, maternal weight, and maternal race on maternal serum AFP levels. The new models were compared with the laboratory-derived calculations, which used historically determined race adjustments.
A total of 43,997 patients underwent analyte screening, and 27,710 patients had complete data for analysis. Of these, 6% were identified as Black. Black patients had laboratory blood draws at a mean gestational age of 123 days, compared with 120 days in non-Black patients ( P <.001), and had higher maternal weight (mean 170 vs 161 lbs, P <.001). Nomograms for raw maternal serum AFP values did not differ between Black and non-Black patients ( P =.065). When adjusted for gestational age and maternal weight, no difference in maternal serum AFP values was identified between Black and non-Black individuals ( P =.81).
No difference in maternal serum AFP values was identified between Black and non-Black pregnant individuals when adjusted by maternal weight and gestational age at blood draw. These findings suggest that routine race-based adjustment of maternal serum AFP screening should be discontinued.
黑色人种是唯一被建议进行母体产前血清甲胎蛋白（AFP）筛查调整的种族。本研究的目的是重新评估母体种族与产前分析物筛查中母体血清 AFP 值之间的关系。
这是一项对 2007 年 1 月至 2020 年 12 月期间进行产前分析物筛查的患者进行的单中心回顾性分析。根据实验室申请中确定的“黑人”和“非黑人”患者，创建了按孕周划分的原始母体血清 AFP 值的列线图，并进行了比较。建立了多变量线性回归模型，以评估孕周、产妇体重和产妇种族对母体血清 AFP 水平的关系。新模型与实验室衍生的计算方法进行了比较，该方法使用了历史上确定的种族调整。
共有 43997 名患者接受了分析物筛查，其中 27710 名患者有完整的数据进行分析。其中，6%被认定为黑人。黑人患者的实验室采血平均孕周为 123 天，而非黑人患者为 120 天（P<0.001），且体重较重（平均 170 磅对 161 磅，P<0.001）。黑人患者和非黑人患者的原始母体血清 AFP 值列线图无差异（P=0.065）。在校正孕周和产妇体重后，黑人患者和非黑人患者的母体血清 AFP 值无差异（P=0.81）。
在调整采血时的母体体重和孕周后，黑人孕妇和非黑人孕妇的母体血清 AFP 值没有差异。这些发现表明，应停止常规基于种族的母体血清 AFP 筛查调整。
