ELEVATION OF MATERNAL ALPHA-FETOPROTEIN IN SYSTEMIC LUPUS-ERYTHEMATOSUS - A CONTROLLED-STUDY

Objective. To determine if maternal alpha fetoprotein (AFP) is elevate d in lupus pregnancy and, if so, whether it is associated with treatme nt or outcome. Methods. Maternal serum AFP values were obtained once d uring Weeks 16.3 to 31.7 in 54 pregnancies followed prospectively. AFP was measured by the Maryland State Health Department, who reported th e AFP level and a corrected value, multiple of the median (AFP MOM), a djusted for weight, gestational age, and insulin dependent diabetes. C ontrols were 1001 consecutive samples measured by the same laboratory. Results. AFP MOM was higher in lupus pregnancies (1.425 +/- 0.73 vs 1 .169 +/- 0.50, p = 0.001), as were the unadjusted AFP levels (lupus 68 .26 +/- 42.2, control 52.49 +/- 27.25, p = 0.001). Of lupus pregnancie s 7.4 vs 2.6% of control pregnancies had an abnormal AFP MOM (p = 0.06 ). The 4 patients with abnormal AFP-MOM, using the 2.3 cutoff, were ta king more prednisone (27.25 +/- 18.54 mg vs 10.85 +/- 12.29 mg, p = 0. 02), were more likely to have delivered preterm (31.50 vs 36.31 weeks, p = 0.02), and were more likely to have a high anticardiolipin (aCL) antibody during the pregnancy (p = 0.03). Conclusion. AFP is higher in lupus than in control pregnancies, without any increase in neural tub e or other birth defects. An abnormal maternal serum AFP level is asso ciated with higher prednisone dose, preterm delivery and aCL. Patients and obstetricians need to be aware that an elevated maternal AFP in l upus pregnancy is not necessarily due to a birth defect, and may be pr edictive of preterm delivery.