MATERNAL SERUM TESTING FOR ALPHA-FETOPROTEIN AND HUMAN CHORIONIC-GONADOTROPIN IN HIGH-RISK PREGNANCIES

To evaluate the variations and potential clinical use of serial matern al alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) in p regnancies at risk of pregnancy-induced hypertension (PIH) and/or intr auterine growth retardation (IUGR), we investigated the relationship b etween placental sonographic findings, uterine artery Doppler measurem ents, and maternal serum AFP, hCG, and uric acid levels between 20 and 34 weeks of pregnancy. Maternal serum samples were collected from 41 singleton pregnancies with bilateral uterine notches and/or an increas ed uterine artery pulsatility index at 20-24 weeks. Maternal serum AFP , intact hCG and free alpha and beta subunits, and uric acid circulati ng levels were measured in all cases at 20-24 weeks and 25-28 weeks. P lacental sonographic investigations comprised measurements of thicknes s and morphology. Twenty pregnancies had a normal outcome and 21 had a n adverse outcome, including eight complicated by severe PIH with feta l IUGR, eight by isolated IUGR, three by mild PIH with normal fetal gr owth, and two by placental abruption. At the time of the first scan, t he placental thickness and maternal serum levels of AFP, hCG, and uric acid were significantly increased in pregnancies with adverse outcome s, compared with those with a normal outcome. In subsequent maternal s erum examinations, the incidence of elevated hormonal levels fell for AFP, intact hCG, and beta-hCG, whereas it increased for the uric acid level. No difference was found at any stage for the alpha-hCG level. S even out of 11 pregnancies complicated by PIH presented with elevated MSAFP and MShCG and a large heterogeneous placenta at the first visit, whereas no pregnancy with a normal outcome presented with similar fea tures. This study has shown a significant association between abnormal development of the utero-placental circulation, elevated MSAFP and MS hCG at mid-gestation, and subsequent adverse pregnancy outcome. Serial measurements of MSAFP and MShCG do not provide extra information for the follow-up of these pregnancies.