EFFECT OF ADJUSTMENT OF MATERNAL SERUM ALPHA-FETOPROTEIN LEVELS IN INSULIN-DEPENDENT DIABETES-MELLITUS

Our objective was to determine the effect of the 20% upward adjustment of maternal serum alphafetoprotein (MSAFP) in patients with insulin-d ependent diabetes mellitus (IDDM) on the number of patients that would be classified at increased risk for pregnancy complicated by either D own syndrome (DS) or neural tube defect (NTD), We retrospectively eval uated a database containing 63,110 patients who underwent multiple ser um marker screening between 14 and 22 weeks gestation; 620 patients wi th IDDM had measurements of MSAFP of which 479 also had measurements o f beta-HCG, allowing calculation of DS risk, Increased NTD risk was de fined as MSAFP >2.5 MOM while increased DS risk was defined as a calcu lated risk greater than or equal to 1/270. One IDDM patient delivered an infant with a NTD; it was not detected on serum screening. No infan ts were born with DS, Of the 620 patients with MSAFP determinations, 9 had values >2.5 MOM before adjustment, After upward adjustment, 7 add itional patients were identified. Sixteen patients were identified at increased risk for DS before and after adjustment, Our data suggest th at the 20% upward adjustment of MSAFP increases by 78%, the number of patients who would require further evaluation for NTD's, Although we w ere able to identify 620 women with IDDM who underwent serum screening for NTD, the low prevalence of NTD's did not allow us to demonstrate an increased detection rate, The effect of upward adjustment of MSAFP on the number of patients categorized at increased DS risk appears to be minimal. (C) 1998 Wiley-Liss, Inc.