Maternal Serum Alpha-fetoprotein Levels Research Articles

Use of Maternal Race and Weight Provides Equitable Performance in Serum Screening for Open Neural Tube Defects.

Maternal serum alpha-fetoprotein (AFP) levels are used in screening for open neural tube defects (ONTD). Historical reports show that AFP levels and maternal weights are higher in self-reported Black than White individuals, but recent reports question the need to account for these variables in screening. Our study compares screening performance with and without accounting for race. Retrospective analysis was performed on deidentified prenatal screening records including maternal weight and self-reported race of White or Black. Gestational age-specific medians and weight-adjusted multiples of the median levels were calculated separately for each group and using a race-agnostic analysis. Outcome measures included the proportion of screen-positive results. Records for analysis (n = 13 316) had an ultrasound confirmed gestational age between 15 and 21 completed weeks, singleton pregnancy, and self-reported race. Race was Black for 26.3%. AFP levels for pregnancies in Black individuals were higher than in White individuals: 6% to 11% depending on gestational age. Race-specific gestational age and maternal weight analyses resulted in similar screen-positive rates for self-reported White and Black individuals at 0.74% vs 1.00%, respectively (P = 0.14). However, use of race-agnostic analyses resulted in a screen-positive rate that was 2.4 times higher in Black than White individuals (P < 0.001). These data show that the historical method of accounting for maternal race and weight in prenatal screening for ONTD provides equitable performance. Using a race-agnostic methodology results in an increased screen-positive rate and a disproportionate rate of required follow-up care for individuals who self-identify as Black.

The Effect of In-vitro Fertilization Procedures on Alpha-fetoprotein Levels in Second Trimester Screening for Fetal Defects

Objective Prenatal screening for developmental and chromosomal fetal defects during both the first and second trimesters of pregnancy is considered standard practice. In the second trimester, screening for spinal cord malformations, such as spina bifida and anencephaly (a type of neural tube defect), involves measuring alpha-fetoprotein levels in maternal blood. The cutoffs used to identify increased risks for neural tube defects are typically tailored for factors like race, multiple fetuses, reported smoking, and the presence of maternal insulin-dependent diabetes. What remains unclear is the impact of assisted reproductive technology, commonly known as in vitro fertilization procedures, on alpha-fetoprotein levels and other measured analytes. Method This report presents a retrospective study that examines the impact of reported in vitro fertilization procedures on second-trimester levels of alpha-fetoprotein. The study utilizes consecutive data from March 20, 2019, through March 29, 2023, sourced from laboratory records. Result We illustrate elevated levels of maternal serum alpha-fetoprotein across all racial subgroups undergoing in vitro fertilization procedures. Additionally, we demonstrate that maternal serum alpha-fetoprotein levels rise with maternal age. Conclusion This study underscores the significance of our findings in evaluating the risk of neural tube defects, such as spina bifida, Down syndrome, and other genetic anomalies. It holds considerable value in guiding clinical practices. Furthermore, it highlights the need for further investigation to evaluate how our findings impact the assessment of fetal well-being.

Impact of subchorionic hematoma on maternal serum alpha-fetoprotein levels and second trimester screening outcomes in threatened abortion cases

Impact of subchorionic hematoma on maternal serum alpha-fetoprotein levels and second trimester screening outcomes in threatened abortion cases

Prenatal Diagnosis and Outcomes of Cervical Meningocele and Myelomeningocele.

Prenatal diagnosis of myelomeningocele remains challenging for obstetricians, ultrasonographers, and radiologists, although the increased maternal serum alpha-fetoprotein level aids in the confirmative diagnosis. Fetal cervical myelomeningocele and meningocele are very rare and unique types of myelomeningocele. Prenatal diagnosis of cervical myelomeningocele and meningocele should include the differential diagnosis and association of many intracranial and spino-skeletal pathogenetic variants and genetic diseases, including subependymal nodular heterotopia and Klippel-Feil syndrome. In this report, a comprehensive review of fetal cervical myelomeningocele with its prenatal diagnosis and long-term outcomes is presented.

Correlation between elevated maternal serum alpha-fetoprotein and ischemic placental disease: a retrospective cohort study

ABSTRACT Background To evaluate the correlation between elevated maternal serum alpha-fetoprotein (AFP) in the second trimester and ischemic placental disease (IPD). Methods 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. Results 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 P < .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. Conclusions 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.

Reconsidering Race Adjustment in Prenatal Alpha-Fetoprotein Screening.

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.

Prenatal screening for neural tube defects: from maternal serum alpha-fetoprotein to ultrasonography.

The two main screening tests during pregnancy are those for chromosomal abnormalities and neural tube defects (NTDs). In particular, for NTDs, measurement of maternal serum alpha-fetoprotein (MSAFP) levels early in the second trimester (15-18 weeks of gestation) has been considered the gold standard screening test for the past 4 decades. However, with remarkable technological advancements and the widespread use of ultrasound during those periods, mid-trimester ultrasonography has gradually replaced the role of measuring MSAFP levels as a screening method for NTDs. This change was initiated more about 10 years ago in some countries, which have issued national guidelines to use mid-trimester ultrasonography instead of measuring MSAFP levels as a prenatal screening method for NTDs. However, no significant changes have occurred in Korea, where second-trimester ultrasonography is routinely performed with high-quality equipment. We aimed to provide information regarding the importance of changing the screening method for NTDs from MSAFP measurement to ultrasonography, and to detail methods of implementing mid-trimester ultrasonography for screening purposes. We also share our experience of operating a prenatal diagnostic program for NTDs without using MSAFP for more than 15 years.

Ultrasound findings in prenatal diagnosis of trisomy 18 associated with elevated levels of maternal serum alpha-fetoprotein

Rationale: Trisomy 18, also referred to as Edwards syndrome, is the second most common autosomal trisomy syndrome. Trisomy 18 can be identified during prenatal screening by the detection of abnormal maternal serum results and one or more structural abnormalities on ultrasound. Previous studies confirmed that levels of pregnancy-related plasma protein A, alpha-fetoprotein, and free β-subunit of human chorionic gonadotropin in the serum of pregnant women carrying fetuses with trisomy 18 were lower than those in women with normal pregnancies. Patient concerns: A 29-year-old pregnant woman with a high risk of trisomy 18 underwent maternal serum screening at 16 weeks of gestation. The patient exhibited an elevated level of maternal serum alpha-fetoprotein (125 U/mL; 3.5225-fold higher than the multiple of the median). Ultrasonography revealed multiple abnormalities. Diagnoses: Culture of amniotic fluid cells revealed a karyotype of 47, XY, +18. Interventions and outcomes: The pregnancy was terminated. Lessons: Trisomy 18 can be identified prenatally by detection of abnormal levels of key proteins in the maternal serum, and detection of one or more structural abnormalities by ultrasound screening. Prenatal serological screening combined with ultrasound can effectively diagnose fetuses with trisomy 18 in the second trimester.

Recurrence Rate for Isolated Elevated Maternal Serum Alpha-Fetoprotein Levels and Pregnancy Outcomes.

Objective: To examine the rate of recurrence for elevated isolated maternal serum alpha-fetoprotein (MSAFP) and its associated adverse outcomes during a subsequent pregnancy. Materials and Methods: A retrospective cohort study of pregnant multiparous women who had elevated MSAFP levels during an initial and a subsequent pregnancy between 1994 and 2020. Results: Twenty-seven out of 344 (7.8%) women with elevated MSAFP had recurrent elevated MSAFP in a subsequent pregnancy. Four women were excluded due to missing data. Of the 23 women included, 5 (22%) had fetal growth restriction (FGR), 2 (9%) had pre-eclampsia, 9 (35%) had preterm births, and 2 (9%) had fetal death/miscarriage in their subsequent pregnancy. Looking at individual outcomes, 60% of women had recurrence of preterm labor, 33% had recurrence of fetal death, and 25% had recurrence of FGR. Conclusion: Women with elevated MSAFP levels during an initial pregnancy should be informed during preconception counseling about their risk of recurring elevated MSAFP and its associated adverse outcomes risks.

External Quality Assessment of Maternal Serum Levels of Alpha-Fetoprotein, Free Beta-Human Chorionic Gonadotropin, and Unconjugated Estriol in Detecting Down Syndrome and Neural Tube Defects in the Second Trimester of 87 Maternal Serum Samples, Based on 105-139 Days.

BackgroundWe aimed to insure the accuracy and reproducibility of alpha-fetoprotein (AFP), free beta-human chorionic gonadotropin (free β-hCG), and unconjugated estriol (uE3) concentrations for the screening for trisomy 21 (T21) and neural tube defects (NTD) in the second trimester. We conducted an external quality assessment of 6 laboratories, using maternal serum specimens.Material/MethodsSerum specimens collected from 87 women of singleton pregnancies (4 with T21, 5 with NTD, and 78 with normal fetuses) were divided into 6 equivalent-volume fractions and transported to 6 laboratories (A, B, C, D, E, and F). All laboratories used the time-resolved fluorescence analyzer and supporting reagents to measure concentrations of AFP, free β-hCG, and uE3. The screening efficacies of T21 and NTD were compared with the certified or accredited status of the participants’ quality systems.ResultsConcentrations of AFP measured by laboratory F were low compared with those determined by the other 5 laboratories, and the differences were significant (P<0.01). There was no statistically significant difference in the free β-hCG and uE3 concentrations measured by the 6 laboratories (P>0.05). The correlation coefficients for the 3 multiples of the median values were all >0.900. The McNemar paired chi-squared test showed the differences in the positivity and detection rates were not statistically significant (P=1.000).ConclusionsAFP, freeβ-hCG, and uE3 values measured by the other 5 laboratories were comparable with those of laboratory A, with good linear correlation. When used in the maternal prenatal screening of T21 and NTD, the test results met the clinical requirements.

Hemodynamical parameters in functional system "motherplacenta-fetus" in women had higher levels of alpha-fetoprotein (AFP) and horionic gonadotropin (HG) in 11 trimester of pregnancy

Haemodinamic parameters in the functional system mother-placenta-fetus in 49 women with elevated mildtrimester maternal serum AFP (2MoM) and in 38 women with elevated maternal serum hCG (2MoM) were studed. The control group included 32 women with normal mildtnmester serum AFP and hCG. Indexes of impedance to flow in the uterine arteries were significantly higher in patients with elevated MSAFP or MShCG comparing with women of the control group, beginning from 28 weeks of pregnancy. There was a significant association between the maternal serum AFP levels and indexes of impedance to flow in the uterine artery, umbilical artery and fetal aorta during pregnancy. In patients with abnormal (more then 95th centile) uterine arteries Resistance Index at 2024 weeks, abnormal dynamic of MSAFP and MShCC levels from 16 until 24 weeks was observed. We suppose that unexplained elevated mildtri mester maternal serum AFP and hCC сaп be associated with disturbed utero-placental circulation.

Re-Evaluating Race Adjustment in Prenatal AFP Screening

The association of maternal serum alpha fetoprotein (AFP) levels and neural tube defects (NTD) was reported over 50 years ago. Risk adjustment for race is commonly used in interpreting AFP. Modern appraisal of race as a social construct necessitates re-evaluation of these 1980s race adjustments. We evaluated the relationship between AFP and race in a general population genetic screening cohort.

Second trimester maternal serum D-dimer combined with alpha-fetoprotein and free \u03b2-subunit of human chorionic gonadotropin predict hypertensive disorders of pregnancy: a systematic review and retrospective case\u2013control study

BackgroundThis study investigated whether maternal serum D-dimer (DD) alone or DD combined with alpha-fetoprotein (AFP) and free β-subunit of human chorionic gonadotropin (free β-hCG) in the second trimester could be used to predict hypertensive disorders of pregnancy (HDP).Materials and methodsIn this retrospective case–control study, the data of gravidas patients who delivered at hospital were divided into the following groups: control (n = 136), gestational hypertension (GH, n = 126), preeclampsia (PE, n = 53), and severe preeclampsia (SPE, n = 41). Receiver operator characteristic (ROC) curves were used to evaluate the diagnostic value of maternal serum DD, AFP, and free β-hCG levels for HDP.ResultsDD levels of the GH, PE, and SPE groups were significantly higher than that of the control group (P < 0.001). The order of effectiveness for models predicting HDP was as follows: DD + AFP + free β-hCG > DD > DD + AFP > DD + free β-hCG > AFP + free β-hCG > AFP > free β-hCG. For predicting different types of HDP, DD alone had the best diagnostic value for SPE, followed by PE and GH. DD alone had a sensitivity of 100% with a 0% false negative rate and had the highest positive likelihood ratio (+ LR) for SPE. DD alone in combination with AFP alone, free β-hCG alone and AFP + free β-hCG could reduce false positive rate and improve + LR.ConclusionDD is possible the best individual predictive marker for predicting HDP. Levels of DD alone in the second trimester were positively correlated with the progression of elevated blood pressure in the third trimester, demonstrating the predicting the occurrence of HDP. The risk calculation model constructed with DD + free β-hCG + AFP had the greatest diagnostic value for SPE.

Maternal serum alpha-fetoprotein level and the relationship to ventriculomegaly in fetal neural tube defect: A retrospective cohort study

ObjectiveTo estimate the significance of the association between mid-trimester maternal serum alpha-fetoprotein (MSAFP) level and fetal neuroanatomic findings in cases of open neural tube defect (ONTD). MethodsRetrospective study of patients referred for prenatal ONTD repair between 2012 and 2018. Cases were classified into three groups based on their MSAFP level: 1)High MSAFP (>3.8MoM – n = 22), 2)Moderately high MSAFP (≤3.8 and ≥2.5MoM – n = 28), 3)Normal MSAFP (<2.5MoM – n = 18). MRI scans at the time of referral were used to assess the relationship between MSAFP and: A)Type of ONTD; B) Ventriculomegaly; C) Size of the myeloschisis lesion; D) Volume of myelomeningocele; E) Anatomical level of the lesion (LL). ResultsHaving a high MSAFP level was more likely to be associated ventriculomegaly at mid-gestation than a moderately high or normal MSAFP level (OR = 8.4;CI95[0.9–73.4];p = 0.05 and OR = 2.8;CI95[0.9–8.8];p = 0.07). There were no differences between the three groups regarding type of lesion, size of the myeloschisis lesion, anatomic LL, or volume of the myelomeningocele sac. Myeloschisis cases with normal MSAFP had a larger surface area when compared to myeloschisis cases with moderately high MSAFP (219.8[104.4−551] vs 155.4[38.5−502.4] mm², p = 0.04). ConclusionA 2nd trimester MSAFP level >3.8MoM in a fetus with ONTD is associated with mid-gestation ventriculomegaly.

Evaluation of Actual Maternal Serum Alpha-Fetoprotein (MSAFP) Levels in Placental Abruption and Associations with Adverse Outcomes

To evaluate the relationship between the actual maternal serum alpha-fetoprotein (MSAFP) levels and maternal, fetal, and neonatal outcomes in patients diagnosed with placental abruption. This prospective case-control study included 40 patients who presented at the Perinatology Department between December 15, 2018, and September 01, 2019, were diagnosed with placental abruption and underwent cesarean section delivery at ≥ 34 weeks, and 41 healthy individuals without any additional systemic pathologies, who had a cesarean section under elective conditions. The patient demographic data, MSAFP levels, and maternal, fetal, and neonatal results were compared. Correlation analyses were applied between the MSAFP levels and demographic characteristics, birthweight, Apgar scores, and transfusion requirement in the group with placental abruption. MSAFP levels (ng/ml) were significantly higher in the group with placental abruption than in the healthy control group (299.1 ± 214 and 156.2 ± 52.3, p = 0.012). In the neonatal results, birthweight and 1st and 5th minutes Apgar scores were lower in the group with placental abruption than in the control group (p = 0.025 and p < 0.001). The neonatal intensive care unit admission rate was higher in the group with placental abruption than in the healthy control group (p = 0.017 and p = 0.002). A statistically significant, negative correlation was found between MSAFP and 1st and 5th minutes Apgar scores (r = − 0.526, r = − 0.522 and p < 0.001, p = 0.001, respectively). The data obtained in this study suggest that MSAFP, which is a simple test, can be used in the clinical management of suspicious placental abruption or antepartum hemorrhage of unknown origin and the prediction of neonatal prognosis.

472 G6PD deficiency is associated with decreased maternal serum Alpha-fetoprotein levels

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an inherited X-linked recessive disorder, being the most common enzymatic defect of erythrocytes in humans. Since G6PD deficiency has been associated with metabolic comorbidities and placental dysfunction, we aimed to examine whether this disorder can affect the levels of maternal serum biochemical screening markers. For this retrospective study, we collected data of all pregnant women delivering in our medical center between January 2015 to December 2019. The inclusion criteria were any documentation of maternal serum biochemical screening markers: free beta-human chorionic gonadotropin (HCG), pregnancy-associated plasma protein A (PAPP-A), maternal serum alpha-fetoprotein (AFP), HCG and unconjugated estriol. Overall, 6,186 women with documented maternal serum biochemical screening markers were detected, 63 of these (1.0%) with G6PD deficiency. No difference in demographic or obstetrical characteristics was noted between G6PD-deficient women to the remaining cohort (including maternal age, body mass index, gestational age and birth weight). In G6PD-deficient women, significantly lower levels of maternal AFP were found compared to the remaining cohort (0.87±0.28 vs. 1.05±0.28 multiples of median, respectively, p<0.001, Table 1). In addition, marginally lower second trimester HCG levels were found in G6PD deficiency (1.0±0.58 vs. 1.15±0.69 multiples of median in the remaining cohort, p=0.07). Since the placenta plays a major role in HCG synthesis, as well as in transferring the fetal AFP to maternal circulation, the placental effects of G6PD deficiency may explain lower levels of these markers. As maternal serum AFP measurement serves as a screening tool for neural tube defects, as well as a component of biochemical screening for Down syndrome, G6PD status may affect the screening results. Thus, the findings of our study may be of great importance in prenatal surveillance, and should be further explored.

Clinical manifestations of placental mesenchymal dysplasia in Japan: A multicenter case series.

This study aimed to evaluate the clinical features and pregnancy outcomes of placental mesenchymal dysplasia (PMD) in Japan. We requested detailed clinical information and placental tissue of PMD cases in 2000-2018 from Japanese facilities with departments of obstetrics and gynecology and analyzed the pregnancy course and neonatal outcomes. We collected 49 cases of PMD. Of 18 patients with measured maternal serum alpha-fetoprotein (MSAFP) levels, 15 (83.3%) had elevated levels. Maternal serum human chorionic gonadotropin (MShCG) levels were transiently elevated in five (17.8%) of 28 patients. Forty-seven patients continued their pregnancies. All pregnancies were singleton and 40 (85.1%) were associated with adverse events including fetal growth restriction (FGR), threatened premature delivery, fetal demise, and hypertensive disorder of pregnancy in 34 (72.3%), 14 (29.8%), eight (17.0%), and six (12.8%) patients, respectively. Of 47 infants, there were eight stillbirths. There were 40 (85.1%) female infants, and eight (17.0%) had Beckwith-Wiedemann syndrome. Of 39 live births, 23 (59.0%) were associated with premature induction of labor or cesarean section for obstetric indications related to FGR. Eighteen (46.2%) neonates had complications. PMD-affected placentas were pathologically heterogeneous in both grossly PMD-affected and non-affected areas. Our study included the largest number of PMD cases with detailed clinical information. PMD is a high-risk condition for both the mother and the child. Elevated MSAFP levels with normal MShCG levels indicate PMD. Conventional perinatal management of FGR in Japan might be effective in reducing the fetal mortality rate.

Point-of-Care Quantification of Serum Alpha-Fetoprotein for Screening Birth Defects in Resource-Limited Settings: Proof-of-Concept Study.

Background:Maternal serum alpha-fetoprotein (MSAFP) concentration typically increases during pregnancy and is routinely measured during the second trimester as a part of screening for fetal neural tube defects and Down syndrome. However, most pregnancy screening tests are not available in the settings they are needed the most. A mobile device–enabled technology based on MSAFP for screening birth defects could enable the rapid screening and triage of high-risk pregnancies, especially where maternal serum screening and fetal ultrasound scan facilities are not easily accessible. Shifting the approach from clinic- and laboratory-dependent care to a mobile platform based on our point-of-care approach will enable translation to resource-limited settings and the global health care market.Objective:The objective of this study is to develop and perform proof-of-concept testing of a lateral flow immunoassay on a mobile platform for rapid, point-of-care quantification of serum alpha-fetoprotein (AFP) levels, from a drop of human serum, within a few minutes.Methods:The development of the immunoassay involved the selection of commercially available antibodies and optimization of their concentrations by an iterative method to achieve the required detection limits. We compared the performance of our method with that of commercially obtained human serum samples, with known AFP concentrations quantified by the Abbott ARCHITECT chemiluminescent magnetic microparticle immunoassay (CMIA).Results:We tested commercially obtained serum samples (N=20) with concentrations ranging from 2.2 to 446 ng/mL to compare the results of our point-of-care assay with results from the Abbott ARCHITECT CMIA. A correlation of 0.98 (P<.001) was observed on preliminary testing and comparison with the CMIA. The detection range of our point-of-care assay covers the range of maternal serum AFP levels observed during pregnancy.Conclusions:The preliminary test results from the AFP test on the mobile platform performed in this study represent a proof of concept that will pave the way for our future work focused on developing a mobile device–enabled quad-screen point-of-care testing with the potential to enable the screening of high-risk pregnancies in various settings. The AFP test on the mobile platform can be applied to enable screening for high-risk pregnancies, within a few minutes, at the point of care even in remote areas where maternal serum tests and fetal ultrasound scans are not easily accessible; assessment of whether clinical follow-up and diagnostic testing may be needed after a positive initial screening evaluation; and development of surveillance tools for birth defects.

A challenging case of alpha-fetoprotein-result discrepancies in a patient with chronic hepatitis B.

Alpha-fetoprotein (AFP) is the most abundant serum protein found in the human fetus, produced by the yolk sac and the liver [1]. The levels of maternal serum AFP reach a peak value at ∼28–32 weeks of gestation and decrease rapidly after birth and usually drop to the normal at 8–12 months of age. The normal serum AFP level for an adult is <20 ng/mL [2]. In contrast, liver-tumor cells usually synthesize and secrete an increased level of AFP. Abdominal ultrasound and AFP are generally recommended as the screening modality for HCC for patients at risk for development of hepatocellular carcinoma (HCC) [1]. AFP-L3, an isoform of AFP that binds Lens culinaris agglutinin, can be particularly useful in the early identification of aggressive HCC [2]. These assays, however, can generate false-positive and false-negative AFP values. Of patients with advanced HCC, ∼20% had normal AFP levels, whereas some patients with liver diseases had significant AFP elevation without liver cancer in long-term surveillance [3]. Elevated AFP levels could be associated with active liver diseases with hepatocyte regeneration [4, 5]. In that setting, the AFP level will decline with improvement of the underlying liver condition. Our case illustrated the dilemma and uncertainties as a result of persistent abnormal AFP values after extensive clinical investigations.

Correlation and diagnostic value of maternal serum alpha-fetoprotein level, predelivery age and body mass with gestational diabetes mellitus

To investigate the correlation and diagnostic value of maternal serum alpha-fetoprotein (MSAFP) level, predelivery age and body mass with gestational diabetes mellitus (GDM) at 9 ∼ 13 + 6 weeks (early pregnancy) and 15 ∼ 20 + 6 weeks (middle pregnancy). 486 normal and 1290 GDM women were examined for serum pregnancy-associated plasma protein A (PAPP-A), MSAFP, free β-subunit of human chorionic gonadotropin (free β-hCG) and nuchal transparency (NT) levels. Binary logistic regression analysis was used to analyze the risk factors and calculate the Odds ratio (OR) of each relevant variable. In GDM group, the predelivery age, body mass in early pregnancy and middle pregnancy were statistically higher than that in control group. The level of MSAFP in GDM group was 0.97(0.54–1.86) MOM, higher than that in control group 0.92 (0.51–1.78), (z = 3.159, p = .002). Area under curve (AUC) of MSAFP, age and body mass to GDM was 0.549, 0.645 and 0.625, respectively. The level of MSAFP, predelivery age and body mass are associated with GDM, which may be helpful for the prediction of GDM in late pregnant women. However, PAPP-A, NT and free β-hCG during pregnancy have no predicting value for GDM.