The Outcome of a Uniform Program for Alpha‐Fetoprotein Screening in Early Pregnancy in Seven Regions in Sweden

Abstract

Abstract. In 1979—1980 a multicenter study on serum alpha‐fetoprotein (S‐AFP) screening for detection of fetal neural‐tube and abdominal wall defects (NTD/AWD) was carried out in seven different regions in Sweden. A total of 22991 pregnant women, attending 84 public antenatal clinics, were offered an AFP test between their 15th and 18th completed gestational weeks. The average participation rate was 80.8%. The AFP assays were performed by five hospital laboratories, using the same commercially available assay method. In 19704 women screened, all with known pregnancy outcome, 17/22 fetuses affected by open NTD and 6/8 fetuses having AWD, gave S‐AFP levels exceeding 2 MOM. One placental haemangioma was recognized. Controlsampling was undertaken in 10.5% of the women. Amniocentesis was performed in 1.1% of all women screened with no false negative test results. However, three apparently normal fetuses were aborted at the parents request due to AFP levels in amniotic fluid exceeding 3 MoM.Thus, AFP screening in women at low risk enables detection of 3/4 of fetuses affected by NTD/AWD. A program with higher efficiency would be obtained by more accurate gestational dating by ultrasonography, by complementary diagnostic methods such as neurospecific acetylcholinesterase in amniotic fluid, by a reduction of the work‐load by shifting the action limit to 3 MOM and by continous appropriate training of the medical staff.