Establishment of a collaborative university-commercial maternal serum α-fetoprotein screening program: A model for tertiary center outreach

Abstract

Expansion of the availability of tertiary level services beyond major medical centers has proved to be a major problem in health care delivery. Routine maternal serum α-fetoprotein screening for neural tube defects, and now also for aneuploidy, is a classic example in which there has been a schism between the clinical expertise to manage such a program within a tertiary level reproductive genetics center and the ability to reach patients in regions that are not routinely accessible to the tertiary center. To address this problem we have established a collaborative university-commercial laboratory statewide maternal serum α-fetoprotein program that we believe can serve as a model for others. In the first 4 months since its implementation, the program volume has increased tenfold. The detection frequency of neural tube defects has been consistent with that of other programs (11690). Three aneuploid karyotypes were found in amniotic fluid of 118 women <30 years old who underwent genetic amniocentesis because of a low maternal serum α-fetoprotein value. Thus we conclude that: (1) the establishment of a joint university-commercial maternal serum α-fetoprotein program may provide a successful model for efficient tertiary center outreach, (2) assessment of our data suggests that a population at high risk for abnormal fetuses can be identified among patients not generally considered at high risk, (3) low maternal serum α-fetoprotein values may likely be a more important public health measure than high ones.