https://orcid.org/0000-0003-1806-3889
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ABSTRACT
Background
To evaluate the correlation between elevated maternal serum alpha-fetoprotein (AFP) in the second trimester and ischemic placental disease (IPD).
Methods
A retrospective cohort study was conducted to analyze the data of 22,574 pregnant women who delivered in the Department of Obstetrics at Hangzhou Women’s Hospital from 2018 to 2020, and were screened for maternal serum AFP and free beta-human chorionic gonadotropin (free β-hCG) in the second trimester. The pregnant women were divided into two groups: elevated maternal serum AFP group (n = 334, 1.48%); and normal group (n = 22,240, 98.52%). Mann-Whitney U-test or Chi-square test was used for continuous or categorical data. Modified Poisson regression analysis was used to calculate the relative risk (RR) and 95% confidence interval (CI) of the two groups.
Results
The AFP MoM and free β-hCG MoM in the elevated maternal serum AFP group were higher than the normal group (2.25 vs. 0.98, 1.38 vs. 1.04) and the differences were all statistically significant (all P < .001). Placenta previa, hepatitis B virus carrying status of pregnant women, premature rupture of membranes (PROM), advanced maternal age (≥35 years), increased free β-hCG MoM, female infants, and low birth weight (RR: 2.722, 2.247, 1.769, 1.766, 1.272, 0.624, 2.554 respectively) were the risk factors for adverse maternal pregnancy outcomes in the elevated maternal serum AFP group.
Conclusions
Maternal serum AFP levels during the second trimester can monitor IPD, such as IUGR, PROM, and placenta previa. Maternal women with high serum AFP levels are more likely to deliver male fetuses and low birth weight infants. Finally, the maternal age (≥35 years) and hepatitis B carriers also increased maternal serum AFP significantly.
Abbreviations
AFP: alpha-fetoprotein; free β-hCG: free beta human chorionic gonadotropin; IPD: ischemic placental disease; IUGR: intrauterine growth restriction; PROM: premature rupture of membranes; HBV: hepatitis B virus; HDP: hypertensive disorders of pregnancy; RR: relative risk; CI: 95% confidence intervals.
Acknowledgments
The authors are grateful to all of the participants and contributors. We would like to thank Songhe Chen from Hangzhou Women’s Hospital for helping to collect the data. We would also like to thank Xiao Lu of the Data Analysis Department, Zhejiang Biosan Biochemical Technologies Co., Ltd., for their contribution to data matching. We thank International Science Editing (http://www.internationalscienceediting.com) for editing this manuscript.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Ethics approval and consent to participate
The study has been conducted under the approval of the Human Research Ethics Committee of the Hangzhou Hospital [2020 Medical Ethics Review A (10)-11], and the procedures have been performed in accordance with the Declaration of Helsinki. Since this study is a retrospective study, the need to obtain informed consent was waived by the Human Research Ethics Committee of the Hangzhou Women’s Hospital.
Author contributions
X.Q. Dai and Y.M. Chen, design, and statistical analysis; Y.J. Chen and W.W. Ning wrote the first draft of the manuscript. H.M. Zang and B. Wu, provision of study material or patients; Y.M. Chen and X.Q. Dai, writing-review & editing. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Data availability statement
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.