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AFP
Alpha-fetoprotein Screening (AFP)/Enhanced AFP
By Sharon Waldrop
Beginning in the early 1980s, pregnant women were offered Alpha-fetoprotein (AFP) screening to detect neural tube defects such as spina bifida (open spine) as well as Down syndrome. In the late 1980s the test was enhanced to also measure the levels of two pregnancy hormones: estriol and human chorionic gonadotropin (HCG). This new and improved test is commonly known as the Enhanced AFP, AFP3, or a triple screen.
The screening is done 16 to 18 weeks after the last menstrual period. The test is routine and poses no threat to mother or baby. Blood is drawn from the mother's arm and sent to a laboratory for testing. Results are normally available in one week, depending on the laboratory used.
Maternal serum Alpha-fetoprotein (MSAFP) is produced by the liver of the fetus and enters the mother's bloodstream. Elevated levels of MSAFP may mean a neural tube defect or absence of all or part of fetal brain material, otherwise known as anencephaly. Triple screening can diagnose a high percentage of anencephaly and spina bifida cases. A low level of MSAFP could be an indication of Down syndrome; however, an AFP screen is not as accurate as an amniocentesis or chorionic villus sampling (CVS) in detecting Down syndrome, according to R. Harold Holbrook, Jr., M.D. of Stanford University. Only an amniocentesis or CVS screen can definitely diagnose or exclude Down syndrome. An AFP test can show a risk of an abnormality, not a diagnosis.
On a happy note, an elevated MSAFP level could also mean twins have been conceived, according to the Inland Northwest Regional Perinatal Center. A miscalculated due date can cause an elevated level, too.
Additional testing is performed in the event of an abnormal AFP test result and genetic counseling is available for the parents. According to the Cleveland Clinic Health Information Center, for every 1,000 mothers tested, 25 will have an abnormal test result. However, out of those same 25 abnormal results, only one or two will have a confirmed result of an abnormal fetus after further testing is completed. Even with those statistics, an abnormal test result can bring panic and anxiety to an expecting couple.
