Proteins of neural tube defects / 国际儿科学杂志

Neural tube defects(NTD)are a common congenital malformations in humans leading to in-fant mortality or severe disability.The etiology of NTD is complicated,with both environmentaland genetic con-tributions.It has been found that the protein markers associated with NTD are mainly maternal serum alpha feto-protein,amniotic fluid alpha fetoprotein and amniotic fluid glial fibrillary acidic protein.This article reviews the protein biomarks related with NTD.

Clinical Association of Unexplained Elevated Maternal Serum Alpha-Fetoprotein with Adverse Outcomes in Pregnancies Complicated by Placenta Previa / 대한산부인과학회잡지

OBJECTIVE: To determine whether unexplained elevation of maternal serum alpha-fetoprotein(MSAFP) is associated with adverse outcomes in pregnancies complicated by placenta previa. METHODS: One hundred and five pregnant women with placenta previa between January 1995 and March 1999 were included in this study. They underwent the triple test at 14 to 22 gestational weeks. These 105 pregnant women were stratified into two groups by MSAFP at 2.0MOM. The outcomes of pregnancy in high MSAFP(>or=2.0MOM) group were compared with those in normal MSAFP(or=2.0 MOM). Eleven out of 632 pregnant women with high MSAFP were having placenta previa. 3. The incidence of preterm birth was significantly high in high MSAFP group with placenta previa.(p<0.001) 4. Women with unexplained elevated MSAFP and having placenta previa showed the increased risk for preterm delivery (p<0.05), preeclamsa (p<0.001), and bleeding in third trimester (p<0.001), but not placenta accreta, placenta abruption, cesarean hysterctomy and intrauterine fetal death. CONCLUSION: We concluded that unexplained elevated levels of midtrimester MSAFP in complicated placenta previa were associated with the elevated risk of preterm delivery, preeclamsia and bleeding in the early third trimester, but not placenta accreta, placenta abruption, cearean hysterectomy and intrauterine fetal death.

Unexplained Elevated Levels Of Midtrimester Maternal Serum alpha-fetoprotein Are Associated With Spontaneous Preterm Birth / 대한산부인과학회잡지

OBJECTIVES: Our purpose was 1) to determine whether elevated maternal serum alpha- fetoprotein(MSAFP) predict increased risk of spontaneous preterm delivery and indicated preterm delivery; 2) to determine whether elevated maternal serum human chorionic gonadotropin(MSHCG) predict increased risk of preterm delivery. Methods: Between September 1995 and April 1998, 945 of 2105 pregnant women who received midtrimester MSAFP screening were identified and evaluated. 81 women with MSAFP levels of 2.0 MoM or more were included in the study group while 864 women with levels less than 2.0 MoM served as controls. Pregnancy outcome were obtained from hospital records and statistical analysis were performed. RESULTS: Women with elevated MSAFP levels showed an increased risk for preterm delivery(p<0.05), fetal growth restriction(p<0.05) and hypertensive disorders(p<0.05), but not for preterm premature rupture of membrane, fetal death in utero. There was a strong association between unexplained elevated MSAFP levels and spontaneous preterm delivery(p<0.05) but our study does not support an association between unexplained elevated MSAFP levels and indicated preterm delivery. There was no association between elevated MSHCG levels and preterm delivery regardless of MSAFP levels. CONCLUSION: We concluded that unexplained elevated levels of midtrimester MSAFP were associated with an elevated risk of spontaneous preterm delivery but not with a risk of indicated preterm delivery. Elevated MSHCG levels were not associated with a risk of preterm delivery and spontaneous preterm birth.

The Association Between Unexplained Second-Trimester Maternal Serum Alpha-Fetoprotein or Human Chorionic Gonadotropin Elevations and Perinatal Complications / 대한산부인과학회잡지

Our purpose was to study the correlation between elevated maternal serum alpha-fetoprotein(MSAFP) or human chorionic gonadotropin(HCG) levels and pregnancy-induced hypertension (PIH), preeclampsia, preterm delivery. MSAFP and HCG levels were measured in stored second-trimester(14~22 weeks) serum obtained from 510 women. The criteria for patients with unexplained MSAFP elevations were a MSAFP level 2.5 or greater multiples of the median(MoM) and HCG elevations were a HCG level 2.0 or greater multiples of the median(MoM) excluding multiple pregnancy, fetal malformation or death on ultra-sonography and molar pregnancy. In contrast, patients with MSAFP levels 0.5 to < 2.5 MoM, HCG levels < 2.0 MoM were served as controls. Women with elevated HCG levels had more significant association with PIH than control group(22.2 % versus 3.4 % ; p < .005). Elevated MSAFP was significantly associated with preeclampsia(7.7 % versus 1.1 % ; p < .05). But no significant differences were observed in the incidence of preterm delivery. We suggested elevated second-trimester MSAFP or HCG levels appear to be correlated with high risk for PIH and preeclampsia. So, These patients require careful monitoring with adequate obstetric managements.

Unexplained Elevated Maternal Serum Alpha-fetoprotein in Singleton Pregnancies as a Predictor of Fetal Risk / 대한산부인과학회잡지

The aim of the study was to evaluate the significance of unexplained elevated mater- nal serum alpha-fetoprotein in singleton pregnancies as a prediction of fetal risk. The inclusion criteria for patents with unexplained MSAFP elevations were a MSAFP level 2.0 or greater multiples of the median ( MoM ), a single gestation, a confirmed gestatio- nal age and no fetal malformation or death on ultrasonography. In this study, 991 woman who attended the antenatal clinic at Taejeon Eul Ji Hospital from March, 1996 to March, 1997 were reviewed and data from 79 women with elevated maternal serum alpha-fetoprotein levels were analysed. The 67 of 79 patients with elevated maternal serum alpha-fetoprotein levels had on unexplained elevated MSAFP level. 13 women could not follow up. 54 pregnant women with unexplained elevated MSAFP levels were classified as the index group of singleton pregn- ancy and were matched against a control group. 108 patients with MSAFP levels 0.5 to 2.0 MoM served as control group. The incidence of antepartum hemorrhage ( placental previa ), preterm labor, intrauterine growth retardation ( IUGR ), low birth weight and pregnancy induced hypertension ( PIH ) in two groups was analyzed and the results was subjected to Fisher's Exact Test. None of the patients in the index group had chromosomal abnormalites or birth defect. IUGR occurred in 7 ( 12.96% ) of the index group babies but in only 3 ( 2.78% ) in the control group ( p < 0.02 ). preterm labor occurred in 5 ( 9.26% ) in the index group compared with 2 ( 1.85% ) in the control group ( p < 0.05 ). low birth weight occurred in 3 ( 5.5% ) of the index group babies and in 1 ( 0.9% ) in the control group ( p < 0.1 ). This study suggests that patients with unexplained midtrimester elevations of MSAFP are increased risk for IUGR, preterm labor. But no significance differences were observed in the incidence of low birth weight, antepartum hemorrhage ( placental previa ), PIH.

Studies on the prenatal chromosomal analysis and the changes of maternal serum alpha-fetoprotein following chorionic villus sampling

Transcervical chorionic villus sampling (CVS) was performed in 174 patients between 7 & 12 menstrual weeks of pregnancy opting for prenatal diagnosis. Advanced maternal age was the most common indication for CVS (39.7%). The sampling success rate was 95.4% (166/174), representing 88.9% at 7 to 8 weeks, 98.9% at 9 to 10 weeks & 92.7% at 11 to 12 weeks gestation. In 139 of 174 patients (80%), successful sampling was accomplished in one or two catheter passages only. Four spontaneous fetal losses (2.3%) occurred. The cytogenetic analysis routinely used was the direct overnight & long-term culture methods which revealed 4 abnormalities (2.4%). To date, 90 of the women have been delivered & all infants are doing well and the remaining 65 pregnancies are continuing uneventually. Maternal serum alphafetoprotein (MSAFP) concentration was determined in 72 patients immediately before & after CVS. A significant increase of 20% or more, comparable to pre CVS levels, was noted immediately after sampling in 56 of 72 patients (77.8%). The increase in MSAFP concentration correlated with the amount of villi sampled (r = 0.498, p less than 0.001) & with the number of sampling attempts (p less than 0.05). Estimated CVS related fetomaternal hemorrhage (FMH) ranged from 0.005 to 0.1552 ml and in 5 of 72 patients (6.90%) 0.06 ml or more of FMH was noted. Two of the 5 patients had FMH of 0.1 ml or more.