The primary purpose of maternal serum α-fetoprotein (MSAFP) screening is to improve the ascertainment of pregnancies with neural tube defects.
The Committee on Genetics of the American Academy of Pediatrics endorses the following guidelines for maternal serum α-fetoprotein screening, based on those developed by the American Society of Human Genetics.1,2
Before maternal serum α-fetoprotein screening is started, the following minimal criteria should be met.
1. Adequate physician/health professional education. The objective of this education is to assure that physicians and other health care professionals understand the nature and range of severity of each of the detectable conditions and anomalies, the objectives of screening and testing, the importance of timing and reporting the low predictive value of test results, and the follow-up procedures and counseling.
2. Access to a qualified MSAFP and amniotic fluid α-fetoprotein laboratory. Criteria for quality control in these laboratories are detailed in the full statement.
3. Adequate facilities and personnel for follow-up of abnormally high or low MSAFP values. Counseling, high-resolution sonography, amniocentesis, and qualitative amniotic fluid acetyicholinesterase assay should be available.
4. Adequate patient education. Information should be provided on the nature of the defects detectable by MSAFP screening, on confirmatory procedures, and on the options available should an abnormal result be confirmed.
The optimal time for MSAFP screening is between 16 and 18 weeks of gestation.
A common MSAFP screening protocol would include: first serum specimen evaluation, second serum specimen evaluation (if indicated), counseling, ultrasonography, and, if further indicated, amniocentesis for measurement of α-fetoprotein and possibly acetylcholinesterase, assessment for fetal blood contamination, and chromosome analysis.
- Copyright © 1991 by the American Academy of Pediatrics