Unexplained elevation in maternal serum XXXX and subsequent fetal loss.

@entity1 @entity154 @entity6677 @entity160 @entity5617 @entity2241
OBJECTIVE: To examine the frequency and timing of @entity5617 and its association with maternal serum @entity160 (MSAFP) levels. METHODS: Pregnancy outcomes were evaluated in 6927 predominantly middle-class @entity1 (83% white, 17% black) who had second-trimester MSAFP determinations performed in our laboratory. All cases of @entity6677 , preexisting @entity5617 , and @entity2241 were excluded. RESULTS: The overall @entity5617 rate was 13 per 1000 (n = 90). Black @entity1 had a higher @entity5617 rate than white @entity1 (35.6 per 1000 versus 8.4 per 1000; P < .001). One hundred forty-eight @entity1 (2.1%) had an adjusted MSAFP multiples of the median (MoM) value of at least 2.5, which was not explained by @entity6677 , @entity154 , or preexisting @entity5617 . As the MSAFP increased, the @entity5617 rate increased (MoM less than 2.0, 11 per 1000; MoM 2-2.49, 29 per 1000; MoM 2.5 or greater, 95 per 1000; P < .001). Despite the increased risk of @entity5617 in the elevated MSAFP group, most @entity5617 (84%) occurred in @entity1 with levels below 2.5 MoM. Furthermore, the timing of fetal loss was significantly different between the group less than 2.5 MoM and the group at or above 2.5 MoM. @entity5617 occurred at or after 26 weeks in 45% of the @entity1 with normal MSAFP, compared with only 14% of @entity1 with high MSAFP (at least 2.5 MoM) (P = .023). CONCLUSIONS: @entity1 with unexplained elevations in MSAFP are at increased risk for fetal loss, with most of the losses occurring in the second trimester. Because many of these @entity5617 occur at gestational ages when the neonatal survival is very low, it is unlikely that antepartum fetal surveillance aimed at early delivery would substantially increase fetal salvage.
