UNEXPLAINED ELEVATED MATERNAL SERUM ALPHA-FETOPROTEIN LEVELS AND PREGNANCY OUTCOME IN TWINS

Objective: To evaluate whether elevated maternal serum alpha-fetoprote in (MSAFP) levels in uncomplicated twin gestations are associated with an increased risk for pregnancy complications and adverse outcomes. M ethods: A retrospective data-base analysis was conducted of 267 women with twin pregnancies delivered between January 1988 and October 1994, of whom 42 had elevated MSAFP levels and 225 had normal levels. We ev aluated rates of preterm delivery (defined as gestational age less tha n 34 weeks at delivery), birth weight less than 1500 g, twin-to-twin b irth weight discordance, small for gestational age (SGA) infants (defi ned as birth weight below the tenth percentile for gestational age), a nd fetal malformations. Also assessed were potentially confounding var iables such as obstetric and medical histories as well as sociodemogra phic factors. Results: Among nulliparous women, an unexplained elevati on in MSAFP levels was associated with a statistically significant inc reased risk for preterm delivery. Among multiparous women, this associ ation is suggested by the data, but not significantly so. An unexplain ed elevation in MSAFP level was also associated with a significantly i ncreased risk for birth weight less than 1500 g, but this was related to the increased rate of preterm births. No appreciably increased risk was apparent for SGA infants, fetal malformations (other than neural tube defects and abdominal wall defects), or twin-to-twin birth weight discordance. Conclusion: In twin pregnancies, an unexplained elevatio n in MSAFP level may increase the risk for preterm delivery but not ot her adverse pregnancy outcomes.