Correlation Between Amniotic Fluid Alpha-Fetoprotein and Adverse Pregnancy Outcomes

Milani, Forozan; Sharami, Seyedeh Hajar; Gholamalipour, Negar; Kazemnezhad Leyli, Ehsan; Dalil Heirati, Seyedeh Fatemeh; Donyaei-Mobarrez, Yalda

doi:10.30699/jogcr.9.1.53

Document Type : Original Research Article

Authors

¹ Department of Obstetrics and Gynecology, Reproductive Health Research Center, Al-zahra Hospital, Guilan University of Medical Sciences, Rasht, Iran

² Department of Biostatistics, School of Health, Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran

³ Department of Midwifery, Reproductive Health Research Center, Al-zahra Hospital, Guilan University of Medical Sciences, Rasht, Iran

https://doi.org/10.30699/jogcr.9.1.53

Abstract

Background & Objective: Evaluation of the alpha-fetoprotein is one of the screening tests during pregnancy. The purpose of this study was to determine the relationship between the level of alpha-fetoprotein in amniotic fluid (AF-AFP) and adverse pregnancy outcomes.
Materials & Methods: This comparative analytical study was performed on 244 pregnant women who referred to a private prenatal clinic in Rasht (Iran). Amniocentesis was performed on pregnant women with maternal serum alpha-fetoprotein (MS-AFP) was higher than 2.5MoM in the second trimester and based on this finding, participants were divided into four groups of 61 patients. The first group (control group) included pregnant women with normal MS-AFP, the second group included pregnant women with high MS-AFP and normal AF-AFP, the third group included pregnant women with high MS-AFP and low AF-AFP and the fourth group included pregnant women with high MS-AFP and high AF-AFP.
Results: Adverse outcomes include abortion (6.6%), stillbirth (6.6%), IUGR (18%), LBW (29.5%), PTL (21.3%), fetal abnormalities (4.9%), preeclampsia (14.8%), gestational diabetes (8.2%), in the fourth group (high AF-AFP) was higher than other groups. The incidence of adverse pregnancy outcomes in the fourth group was 1.2 times higher than the control group, and this relationship was borderline statistically significant (P=0.056).
Conclusion: Considering that adverse pregnancy outcomes are important causes of mortality and morbidity, early diagnosis of high-risk pregnancies and efforts for preventive interventions can be associated with reducing mortality and morbidity. Therefore, evaluation of the level AF-AFP can be helpful in determining adverse pregnancy outcomes.

Highlights

✅ Considering that adverse pregnancy outcomes are important causes of mortality and morbidity, early diagnosis of high-risk pregnancies and efforts for preventive interventions can be associated with reducing mortality and morbidity. Therefore, evaluation of the level AF-AFP can be helpful in determining adverse pregnancy outcomes.

Keywords

Main Subjects

Gynecology Oncology

References

1. Glowska-Ciemny J, Pankiewicz J, Malewski Z, Von Kaisenberg C, Kocylowski R. Alpha-fetoprotein (AFP) - new aspects of a well-known marker in perinatology. Ginekol Pol. 2022;93(1):70-5. [DOI:10.5603/GP.a2021.0226] [PMID]

2. Masihi S, Ebrahimi-Lagha M, Barati M, Saadati N, Farhadi E. Evaluation of the Role of Maternal Serum Alpha-Phytoprotein (Ms-Afpi In The Management of Perinatal Care. Eur Chem Bull. 2023;12(4):11948-56.

3. Ling Y, Yu Y-H, Jin S, Hu C-X, Peng W, Zhang H-Y, et al. Study of concentration of amniotic fluid alpha-fetal protein in thalassemia fetus. Asian Pac J Trop Med. 2017;10(2):201-3. [DOI:10.1016/j.apjtm.2017.01.001] [PMID]

4. Ahmed AM, Israa'H AA. Maternal serum Alpha-fetoprotein Level at 12, 22 and 32weeks' gestation in screening for pre-eclampsia. Tikrit j Pure Sci. 2018;23(8):1-9. [DOI:10.25130/tjps.v23i8.535] [DOI:10.25130/tjes.25.2.01]

5. Naeem DSM, Al-Nakkash DUMAJ. The association of Maternal Alpha fetoprotien and BHCG with umbilical artery pattern in mid trimester. Int j Clin Obstet Gynaecol. 2021;5(3):80-4. [DOI:10.33545/gynae.2021.v5.i3b.906]

6. Gurashi RA, Fadl-Elmula I. Maternal Serum Triple Screening Test and Pregnancy Outcome in Elderly Sudanese Pregnant Ladies in Khartoum State-Sudan. Am J Lab Med. 2017;2(6):172-8. [DOI:10.11648/j.ajlm.20170206.19]

7. Kim GJ, Seong JS, Oh JA. Prenatal screening for neural tube defects: from maternal serum alpha-fetoprotein to ultrasonography. Obstet Gynecol Sci. 2023;66(1):1-10. [DOI:10.5468/ogs.22263] [DOI:10.5468/ogs.2017.60.1.1] [PMCID]

8. Abd Elraheim MM, Abd Elraheim IM, Mohamed MA, Mohamed AH. Alpha feto protein in obstetrics. Sohag Med J. 2020;24(2):187-91. [DOI:10.21608/smj.2020.24854.1109]

9. Bartkute K, Balsyte D, Wisser J, Kurmanavicius J. Pregnancy outcomes regarding maternal serum AFP value in second trimester screening. J Perinat Med. 2017;45(7):817-20. [DOI:10.1515/jpm-2016-0101] [PMID]

10. Mir H, Sadiq S, Musharaf S. Maternal serum alpha-feto-protein as a predictor of the pregnancy outcome. Eur J Mol Clin Med. 2021;8(04):2021.

11. Başbuğ D, Başbuğ A, Gülerman C. Is unexplained elevated maternal serum alpha-fetoprotein still important predictor for adverse pregnancy outcome? Ginekol Pol. 2017;88(6):325-30. [DOI:10.5603/GP.a2017.0061] [PMID]

12. Dong N, Gu H, Liu D, Wei X, Ma W, Ma L, et al. Complement factors and alpha‐fetoprotein as biomarkers for noninvasive prenatal diagnosis of neural tube defects. Ann N Y Acad Sci. 2020;1478(1):75-91. [DOI:10.1111/nyas.14443] [PMID]

13. Corroenne R, Zhu K, Orman G, Huisman TAGM, Mehollin-Ray AR, Johnson E, et al. Maternal serum alpha-fetoprotein level and the relationship to ventriculomegaly in fetal neural tube defect: A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol. 2021;259:185-90. [DOI:10.1016/j.ejogrb.2021.02.010] [PMID]

14. Pradhan A, Mishra P, Tiwari S, Choure K, Gupta A. Prediction of Low Birth Weight by Quadruple Parameters in High-Risk Pregnancies. Int j Appl Basic Med Res. 2022;12(4):277-83. [DOI:10.4103/ijabmr.ijabmr_155_22] [PMID] [PMCID]

15. Hu J-L, Zhang Y-J, Zhang J-M, Zhu S, Li D-M, Yin Y-F, et al. Pregnancy outcomes of women with elevated second-trimester maternal serum alpha-fetoprotein. Taiwan J Obstet Gynecol. 2020;59(1):73-8. [DOI:10.1016/j.tjog.2019.11.011] [PMID]

16. Alizadeh-Dibazari Z, Alizadeh-Ghodsi Z, Fathnezhad-Kazemi A. Association Between Serum Markers Used in the Routine Prenatal Screening with Pregnancy Outcomes: A Cohort Study. J Obstet Gynaecol India. 2022;72(Suppl 1):6-18. [DOI:10.1007/s13224-021-01508-8] [PMID] [PMCID]

17. Alvarez-Nava F, Soto M, Lanes R, Pons H, Morales-Machin A, Bracho A. Elevated second-trimester maternal serum β-human chorionic gonadotropin and amniotic fluid alpha-fetoprotein as indicators of adverse obstetric outcomes in fetal Turner syndrome. J Obstet Gynaecol Res. 2015;41(12):1891-8. [DOI:10.1111/jog.12813] [PMID]

18. Goto E. Association of high maternal blood alpha-fetoprotein level with risk of delivering small for gestational age: a meta-analysis. Pediatr Res. 2020;89(7):1742-50. [DOI:10.1038/s41390-020-01124-8] [PMID]

19. Taghavipour M, Galini-Moghaddam T, Mousavi SJ. First and Second-Trimester Maternal Serum Analytes for the Prediction of Adverse Pregnancy Outcomes. J Obstet Gynecol Cancer Res. 2021;6(1):22-8. [DOI:10.30699/jogcr.6.1.22]

20. Turkgeldi LS, Turkgeldi E, Kiyak H, YÜCel N. Abnormal First And Second Trimester Matenal Seum Marker Levels For Aneuploidy Screening And Adverse Pregnancy Outcomes. East J Med. 2021;26(3):418-25. [DOI:10.5505/ejm.2021.77775]

21. Singh SS, Vini Gupta A. Association between second trimester maternal serum alpha fetoprotein in 14-22 weeks and adverse pregnancy outcome. Eur J Mol Clin Med. 2022;9(1):1035-9.

22. Karya U, Kumari S, Rani A, Singh S. Clinical significance of unexplained elevated maternal serum alpha feto-protein in second trimester of pregnancy. Int j Reprod Contracept Obstet Gynecol. 2018;7(6):2245. [DOI:10.18203/2320-1770.ijrcog20182329]

23. Mir H, Sadiq S, Malik S. Association between second trimester maternal serum alphafetoprotein in 14-22 weeks and adverse pregnancy outcome. Eur J Mol Clin Med. 2022;9(1):225-31.

24. Yassaee F, Shekarriz-Foumani R, Sadeghi S. Amniocentesis following positive first trimester combined screening: A comparative study. Acta Med Iran. 2019;57(6). [DOI:10.18502/acta.v57i6.1879]

25. Ciortea R, Malutan AM, Bucuri CE, Berceanu C, Rada MP, Ormindean CM, Mihu D. Amniocentesis-When It Is Clear That It Is Not Clear. J Clin Med. 2023;12(2):454. [DOI:10.3390/jcm12020454] [PMID] [PMCID]

26. Sharony R, Dayan D, Kidron D, Manor M, Berkovitz A, Biron-Shental T, Maymon R. Is the ratio of maternal serum to amniotic fluid AFP superior to serum levels as a predictor of pregnancy complications? Arch Gynecol Obstet. 2016;293:767-70. [DOI:10.1007/s00404-015-3905-9] [PMID]

27. Yue C-Y, Zhang C-Y, Ying C-M. Serum markers in quadruple screening associated with adverse pregnancy outcomes: A case-control study in China. Clin Chim Acta. 2020;511:278-81. [DOI:10.1016/j.cca.2020.10.029] [PMID]

28. Celik OY, Obut M, Keles A, Calık MG, Dagdeviren G, Yucel A, Sahin D. Outcomes of pregnancies diagnosed with circumvallate placenta, and use of uterine artery pulsatility index and maternal serum alpha-fetoprotein for prediction of adverse outcomes. Eur J Obstet Gynecol Reprod Biol. 2021;262:57-61. [DOI:10.1016/j.ejogrb.2021.05.008] [PMID]

29. Dabiri Oskoei A, Jamshidasl M, Faghihzadeh S, Esmaeilzadeh A, F B. The relationship between amniotic fluid alpha-fetoprotein, alkaline phosphatase and ferritin in the second trimester of pregnancy and preterm birth. Iran J Obstet Gynecol Infertil. 2019;22(2):9-16.

30. Mahmooda E, Helaly L, Yousif T. Studying of some proteins levels and enzymes activities in the amniotic fluid for pregnant associated with premature birth. Libyan j Sci Technol. 2021;16(2):116-20. [DOI:10.37376/ljst.v13i2.2319]

31. Yazdani S, Rouholahnejad R, Asnafi N, Sharbatdaran M, Zakershob M, Bouzari Z. Correlation of pregnancy outcome with quadruple screening test at second trimester. Med J Islam Repub Iran. 2015;29:281.

32. Izairi P, Velickova N. Association of adverse pregnancy outcome with the values of serum biomarkers of Quadruple test. Alban J Med Health Sci. 2021;57:1-12.

33. Erol SA, Altinboga O, Yakistiran B, Halici Ozturk F, Baser E, Caglar AT. Evaluation of Actual Maternal Serum Alpha-Fetoprotein (MSAFP) Levels in Placental Abruption and Associations with Adverse Outcomes. SN Compr Clin Med. 2021;3(2):611-7. [DOI:10.1007/s42399-021-00794-7]

34. Dai X, Zhang H, Wu B, Ning W, Chen Y, Chen Y. Correlation between elevated maternal serum alpha-fetoprotein and ischemic placental disease: a retrospective cohort study. Clin Exp Hypertens. 2023;45(1):2175848. [DOI:10.1080/10641963.2023.2175848] [PMID]

35. Ozgen G, Adanas Aydin G. The predictive value of maternal serum screening tests for adverse pregnancy outcomes. Ann Med Res. 2021;27(4):1268-74. [DOI:10.5455/annalsmedres.2020.01.032]

Journal of Obstetrics, Gynecology and Cancer Research

Correlation Between Amniotic Fluid Alpha-Fetoprotein and Adverse Pregnancy Outcomes

References

References

Volume 9, Issue 1 - Serial Number 36
January and February 2024
Pages 53-62

Correlation Between Amniotic Fluid Alpha-Fetoprotein and Adverse Pregnancy Outcomes

References

References

Volume 9, Issue 1 - Serial Number 36January and February 2024Pages 53-62

Volume 9, Issue 1 - Serial Number 36
January and February 2024
Pages 53-62