UNEXPLAINED ELEVATED MATERNAL SERUM ALPHA-FETOPROTEIN LEVELS AND PERINATAL OUTCOME IN AN URBAN CLINIC POPULATION

OBJECTIVE: Our purpose was to determine whether obstetric patients wit h unexplained elevated maternal serum alpha-fetoprotein levels from an indigent clinic population are at increased risk for adverse perinata l outcome compared with similar patients with normal values. STUDY DES IGN: Perinatal outcomes from inner-city obstetric patients with unexpl ained elevated maternal serum alpha-fetoprotein levels (>2.0 multiples of the median) were compared with patients from the same clinic with normal values. The frequency of adverse outcomes in the two groups was subjected to chi(2) analysis. RESULTS: Adverse perinatal outcomes occ urred in 33 of 57 (58%) of the subjects with unexplained elevated mate rnal serum alpha-fetoprotein levels compared with 163 of 719 (23%) pat ients with normal values (p < 0.001). Statistically significant differ ences were observed for abruptio placentae (p < 0.025), intrauterine g rowth retardation (p < 0.025), stillbirth at >20 weeks (p < 0.001), an d pregnancy-induced hypertension (p < 0.01). Differences in the freque ncies of preterm premature rupture of membranes, preterm delivery, pre gnancy loss <20 weeks, and congenital malformations were not statistic ally significant. CONCLUSION: In contrast to a previous report, we fou nd that unexplained elevated maternal serum alpha-fetoprotein levels c onfer an increased risk of adverse perinatal outcome in an urban clini c population over and above the already increased risk related to soci oeconomic status.