Hong S, Berkowitz G, Wang W, Stone J, Ainbender E
Mount Sinai School of Medicine, New York, New York, USA.
Obstet Gynecol. 1996 Sep;88(3):337-42. doi: 10.1016/0029-7844(96)00202-5.
To evaluate whether elevated maternal serum alpha-fetoprotein (MSAFP) levels in uncomplicated twin gestations are associated with an increased risk for pregnancy complications and adverse outcomes.
A retrospective data-base analysis was conducted of 267 women with twin pregnancies delivered between January 1988 and October 1994, of whom 42 had elevated MSAFP levels and 225 had normal levels. We evaluated rates of preterm delivery (defined as gestational age less than 34 weeks at delivery), birth weight less than 1500 g, twin-to-twin birth weight discordance, small for gestational age (SGA) infants (defined as birth weight below the tenth percentile for gestational age), and fetal malformations. Also assessed were potentially confounding variables such as obstetric and medical histories as well as sociodemographic factors.
Among nulliparous women, an unexplained elevation in MSAFP levels was associated with a statistically significant increased risk for preterm delivery. Among multiparous women, this association is suggested by the data, but not significantly so. An unexplained elevation in MSAFP level was also associated with a significantly increased risk for birth weight less than 1500 g, but this was related to the increased rate of preterm births. No appreciably increased risk was apparent for SGA infants, fetal malformations (other than neural tube defects and abdominal wall defects), or twin-to-twin birth weight discordance.
In twin pregnancies, an unexplained elevation in MSAFP level may increase the risk for preterm delivery but not other adverse pregnancy outcomes.
评估单胎妊娠中孕妇血清甲胎蛋白（MSAFP）水平升高是否与妊娠并发症及不良结局风险增加相关。
对1988年1月至1994年10月间分娩的267例双胎妊娠妇女进行回顾性数据库分析，其中42例MSAFP水平升高，225例水平正常。我们评估了早产率（定义为分娩时孕周小于34周）、出生体重小于1500 g、双胎出生体重差异、小于胎龄儿（SGA，定义为出生体重低于孕周第十百分位数）及胎儿畸形情况。还评估了潜在的混杂变量，如产科和病史以及社会人口学因素。
在未生育妇女中，MSAFP水平不明原因升高与早产风险在统计学上显著增加相关。在经产妇中，数据提示存在这种关联，但未达显著水平。MSAFP水平不明原因升高还与出生体重小于1500 g的风险显著增加相关，但这与早产率增加有关。对于小于胎龄儿、胎儿畸形（神经管缺陷和腹壁缺陷除外）或双胎出生体重差异，未发现明显增加的风险。
在双胎妊娠中，MSAFP水平不明原因升高可能增加早产风险，但不会增加其他不良妊娠结局的风险。
