Maternal Serum Alpha-Fetoprotein (MSAFP) Testing:

 

  • About 12 of every 10,000 Oklahoma babies are born with the disorders collectively known as neural tube defects (NTDs).

  • NTDs result from failure of the neural tube to close in early embryogenesis.

  • NTDs are associated with a high rate of perinatal mortality, morbidity, and long-term physical and developmental disability.

  • NTDs include the fatal condition anencephaly, various forms of spina bifida such as the severely debilitating condition lumbar meningomyelocele, and potentially surgically correctable lesions such an encephalocele.

  • A family history of NTD in either parent or in one or more siblings results in an increased risk of an NTD in an infant.

  • However, 90 to 95 % of all NTDs occur in families without a family history.

  • Only about 30% of pregnant women receive the recommended daily amount of folic acid known to significantly reduce NTDs.

  • Maternal serum alpha-fetoprotein (MSAFP) testing represents the most significant advance in the early detection of NTDs and other serious fetal malformations.

  • MSAFP levels are elevated in the presence of an open NTD 980 to 90% of all cases).

  • Elevated MSAFP levels also occur with omphalocele, gastroschisis, congenital nephrosis, Turner syndrome with cystic hygroma, fetal bowel obstruction, and teratoma.

  • Fetal growth retardation, fetal death, and other adverse outcomes are also associated with abnormally high levels of MSAFP.

  • MSAFP testing for all pregnancies became an expected standard of care in the United States in the mid-1980’s.

  • The American College of Obstetricians and Gynecologists issued a Professional Liability Alert to all obstetricians regarding the duty to advise every prenatal patient of the availability of this test.

  • Statements recommending MSAFP testing for all pregnancies have also been issued by the American Academy of Pediatrics and the American Society of Human Genetics.

  • MSAFP screening has been shown to be cost-beneficial in terms of early recognition of NTDs and other adverse pregnancy outcomes.

  • In pregnancies with NTDs, delivery by cesarean section before the onset of labor results in better motor function than vaginal delivery or delivery by cesarean section after a period of labor.