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  Vol. 252 No. 11, September 21, 1984 TABLE OF CONTENTS
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Results and Benefits of a Maternal Serum {alpha}-Fetoprotein Screening Program

Aubrey Milunsky, MBBCh, DSc, FRCP, DCH; Elliot Alpert, MD

JAMA. 1984;252(11):1438-1442.


Abstract

Maternal serum {alpha}-fetoprotein (MSAFP) screening was offered in a private suburban practice to 21,000 nondiabetic and 442 diabetic women with apparently normal pregnancies. Using 2.5 or greater multiples of the median as the normal upper limit, 249 (1.2%) had a raised MSAFP level. There were 25 neural tube defects (NTDs) (1.2/1,000 births); 18 were detected by screening and two by ultrasound scanning. Three had closed spina bifida lesions. Two had anencephaly with normal MSAFP levels, but were studied at more than 24 weeks' gestation. An additional 13 with raised MSAFP levels had other congenital defects. One in 400 women screened had a recommended amniocentesis; 26.4% of them had a fetus with an NTD or major malformation. Our detection efficiency before 24 weeks' gestation for anencephaly was 85.7% (12/14), 62.5% (5/8) for open and closed spina bifida, and 1/1 for encephalocele. A raised MSAFP level occurred in ten (2.3%) of the 442 diabetic women, four (0.9%) of whom had a fetus with an open NTS. A screening program should be established only where there is linked excellent interdisciplinary support among obstetrician, laboratory, clinical geneticist, ultrasonographer, and an identified program coordinator.

(JAMA 1984;252:1438-1442)



Author Affiliations

From the Center for Human Genetics, Departments of Pediatrics and Obstetrics and Gynecology, Boston University School of Medicine, Boston City and University Hospitals (Dr Milunsky); and the Division of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston (Dr Alpert).


Footnotes

Reprint requests to Center for Human Genetics, Boston University School of Medicine, 80 E Concord St, Boston, MA 02118 (Dr Milunsky).



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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Prenatal Ultrasonographic Findings After One Test Showing Elevated Maternal Serum Alpha-Fetoprotein Levels
Persutte et al.
Journal of Diagnostic Medical Sonography 1992;8:122-126.
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{alpha}-Fetoprotein Screening and the Standard of Care
Weiss
JAMA 1987;257:188-188.
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Results and Benefits of a Maternal Serum {alpha}-Fetoprotein Screening Program
Macri
JAMA 1985;253:2364-2365.
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