Research Article| Volume 155, ISSUE 2, P240-246, August 1986

Critical issues in prenatal maternal serum α-fetoprotein screening for genetic anomalies

      This paper is only available as a PDF. To read, Please Download here.


      Prenatal screening, in this Clinical Opinion article, is defined as a population-based search for subgroups of pregnancy that by virtue of their maternal serum α-fetoprotein levels may be at increased risk for genetic anomalies. The identification of subgroups at risk for (1) neural tube defects, (2) ventral wall defects, and (3) chromosomal trisomies presents clinicians with unprecedented information and issues, including the biomedical basis for prenatal screening, the distinction between screening and diagnosis, and the decision-making function of the patient. The interest and, perhaps, ambivalence of the clinical community to prenatal screening are understandable. Obstetricians ordering prenatal screens are challenged by medical data associated with epidemiology, pathology, and genetics, including: (1) prevalence of disease, (2) interpretive biochemical reporting, and (3) the assessment and communication of patient-specific risks. Obstetricians ordering screens will be called on to provide information generally used by other specialists at other stages of care. What information, how it is biomedically determined, its form for communication to patients, and pitfalls in the process are discussed.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Main DM
        • Mennuti MT
        Neural tube defects: issues in prenatal diagnosis and counselling.
        Obstet Gynecol. 1986; 67: 1
        • Macri JN
        • Weiss RR
        Prenatal serum alpha-fetoprotein screening for neural tube defects.
        Obstet Gynecol. 1982; 59: 633
        • Knight GJ
        • Haddow JE
        • Palomaki G
        An external laboratory quality control program to help ensure reliability for maternal serum alpha-fetoprotein screening.
        Foundation for Blood Research, Scarborough, Maine1985
        • State of New York, Department of Health, Office of Public Health
        • Wadsworth Center for Laboratories and Research
        Oncofetal antigens category. Qualifications for director.
        September, 1984
        • Taylor RN
        • Przybyszewski VA
        • Gray E
        Results of the Centers for Disease Control experimental proficiency testing survey for serum alpha-fetoprotein.
        J Clin Microbiol. 1983; 17: 100
        • Knight GJ
        • Palomaki GE
        • Haddow JE
        Maternal serum alpha-fetoprotein: a problem with a test kit.
        N Engl J Med. 1986; 314: 516
        • Merkatz IR
        • Nitowsky HM
        • Macri JN
        • Johnson WE
        An association between low maternal serum α-fetoprotein and fetal chromosomal abnormalities.
        Am J Obstet Gynecol. 1984; 148: 886
        • Macri JN
        Written comments.
        FDA Public Hearing on Proposed Regulation of AFP Reagents. January 15, 1981;
        • Working Group on Screening for Neural Tube Defects
        Royal College of Physicians, LondonJuly, 1979
        • Adams MJ
        • Windham GC
        • James LM
        • et al.
        Clinical interpretation of maternal serum α-fetoprotein concentrations.
        Am J Obstet Gynecol. 1984; 148: 241
        • Haddow JE
        • Kloza EM
        • Knight GJ
        • Smith DE
        Relation between maternal weight and serum alpha-fetoprotein concentration during the second trimester.
        Clin Chem. 1981; 27: 133
        • Wald N
        • Cuckle H
        • Boreham J
        • et al.
        The effect of maternal weight on maternal serum alpha-fetoprotein levels.
        Br J Obstet Gynaecol. 1981; 88: 1094
        • Johnson AM
        • Langley L
        Correction formula for maternal serum alpha-fetoprotein.
        Lancet. 1984; 1: 812
        • Cuckle HS
        • Wald NJ
        • Lindenbaum RH
        Maternal serum alpha-fetoprotein measurement: a screening test for Down Syndrome.
        Lancet. 1984; 1: 926