Maternal serum alpha-fetoprotein (MSAFP) and fetal growth

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Abstract
Early mid-trimester screening of maternal serum .alpha.-fetoprotein (MSAFP) for the detection of neural tube defects is becoming a routine part of obstetrical care. In singleton pregnancies in the absence of fetal chromosomal abnormalities and anatomical anomalies high levels of AFP [alpha fetoprotein] have been variablty been variably related to increased risk for low birthweight infant outcome. The overall relationship, if any, of maternal serum AFP to infant birthweight has, however, not been previously characterized. Between 15 and 20 wk gestation, MSAFP values were determined for 110 women carrying single, anatomically and karyotypically normal fetuses. Statistical analysis utilizing polynomial and multilinear regression was used to determine the relationship of early mid-trimester MSAFP 1st to neonatal birthweiht and then to gestational age and birthweight adjusted for gestational age. For every increase of 1 multiple of the median in MSAFP, neonatal birthweight fell 322 g. This was accounted for almost entirely by decreased fetal growth; early midtrimester MSAFP was linearly related to birthweight adjusted for gestational age 10 times more strongly than to gestational age alone. The explanation for this relationship remains speculative, but the utility of routine AFP screening for the antenatal detection of intrauterine growth retardation certainly deserves further study.