Dai Xiaoqing, Zhang Huimin, Wu Bin, Ning Wenwen, Chen Yijie, Chen Yiming
School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China.
Department of the Fourth School of Clinical Medical, Zhejiang Chinese Medical University, Hangzhou, China.
Clin Exp Hypertens. 2023 Dec 31;45(1):2175848. doi: 10.1080/10641963.2023.2175848.
To evaluate the correlation between elevated maternal serum alpha-fetoprotein (AFP) in the second trimester and ischemic placental disease (IPD).
A retrospective cohort study was conducted to analyze the data of 22,574 pregnant women who delivered in the Department of Obstetrics at Hangzhou Women's Hospital from 2018 to 2020, and were screened for maternal serum AFP and free beta-human chorionic gonadotropin (free β-hCG) in the second trimester. The pregnant women were divided into two groups: elevated maternal serum AFP group (n = 334, 1.48%); and normal group (n = 22,240, 98.52%). Mann-Whitney U-test or Chi-square test was used for continuous or categorical data. Modified Poisson regression analysis was used to calculate the relative risk (RR) and 95% confidence interval (CI) of the two groups.
The AFP MoM and free β-hCG MoM in the elevated maternal serum AFP group were higher than the normal group (2.25 vs. 0.98, 1.38 vs. 1.04) and the differences were all statistically significant (all < .001). Placenta previa, hepatitis B virus carrying status of pregnant women, premature rupture of membranes (PROM), advanced maternal age (≥35 years), increased free β-hCG MoM, female infants, and low birth weight (RR: 2.722, 2.247, 1.769, 1.766, 1.272, 0.624, 2.554 respectively) were the risk factors for adverse maternal pregnancy outcomes in the elevated maternal serum AFP group.
Maternal serum AFP levels during the second trimester can monitor IPD, such as IUGR, PROM, and placenta previa. Maternal women with high serum AFP levels are more likely to deliver male fetuses and low birth weight infants. Finally, the maternal age (≥35 years) and hepatitis B carriers also increased maternal serum AFP significantly.
评估孕中期母体血清甲胎蛋白（AFP）升高与胎盘缺血性疾病（IPD）之间的相关性。
进行一项回顾性队列研究，分析2018年至2020年在杭州市妇产科医院产科分娩的22574名孕妇的数据，这些孕妇在孕中期接受了母体血清AFP和游离β-人绒毛膜促性腺激素（游离β-hCG）筛查。孕妇分为两组：母体血清AFP升高组（n = 334，1.48%）；正常组（n = 22240，98.52%）。连续或分类数据分别采用曼-惠特尼U检验或卡方检验。采用修正泊松回归分析计算两组的相对风险（RR）和95%置信区间（CI）。
母体血清AFP升高组的AFP中位数倍数（MoM）和游离β-hCG MoM高于正常组（2.25对0.98，1.38对1.04），差异均有统计学意义（均P <.001）。前置胎盘、孕妇乙肝病毒携带状态、胎膜早破（PROM）、高龄产妇（≥35岁）、游离β-hCG MoM升高、女婴和低出生体重（RR分别为：2.722、2.247、1.769、1.766、1.272、0.624、2.554）是母体血清AFP升高组不良妊娠结局的危险因素。
孕中期母体血清AFP水平可监测IPD，如胎儿生长受限、胎膜早破和前置胎盘。血清AFP水平高的孕妇更有可能分娩男胎和低出生体重儿。最后，高龄产妇（≥35岁）和乙肝携带者也会使母体血清AFP显著升高。
