Imaging findings in association with altered maternal alpha-fetoprotein levels during pregnancy
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REVIEW
Imaging findings in association with altered maternal alpha‑fetoprotein levels during pregnancy Hassan Aboughalia1 · Sarah Bastawrous1,2 · Margarita V. Revzin3 · Shani S. Delaney4 · Douglas S. Katz5 · Mariam Moshiri1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Maternal serum alpha-fetoprotein is a valuable laboratory test used in pregnant women as an indicator to detect certain clinical abnormalities. These can be grouped into four main categories: fetal factors, pregnancy complications, placental abnormalities, and maternal factors. Imaging is an invaluable tool to investigate the various etiologies leading to altered maternal serum alpha-fetoprotein. By reading this article, the radiologist, sonologist, or other health care practitioner should be able to define the probable pathology leading to the laboratory detected abnormal maternal serum levels, thus helping the clinician to appropriately manage the pregnancy and counsel the patient. Keywords Alpha-fetoprotein · Second trimester screening · High-risk pregnancy · Fetal congenital abnormalities
Introduction
* Mariam Moshiri [email protected] Hassan Aboughalia [email protected] Sarah Bastawrous [email protected] Margarita V. Revzin [email protected] Shani S. Delaney [email protected] Douglas S. Katz [email protected] 1
Alpha-fetoprotein (AFP) is a plasma albuminoid glycoprotein produced by the embryonic yolk sac, fetal liver, and gastrointestinal system during fetal life. Encoded on chromosome 4, AFP is considered the fetal counterpart to adult albumin. Physiological fetal liver AFP synthesis progressively rises until the 20th week of gestation, at which point it plateaus and remains constant until the 32nd week. The fetus excretes AFP via urination into amniotic fluid, where it diffuses across the placenta into the maternal serum. Alpha-fetoprotein can be measured in maternal serum (MSAFP), amniotic fluid, and fetal plasma. The MSAFP concentration is normally much lower than that in amniotic fluid or fetal plasma. When measured in the maternal serum, AFP increases in early pregnancy, peaks between 28 and 32 weeks of gestation, and then drops to lower levels in later pregnancy [1].
Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
2
Department of Radiology, VA Puget Sound Health Care System, Seattle, WA, USA
Clinical utility of AFP measurements
3
Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
4
Division of Maternal‑Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle, WA, USA
5
Department of Radiology, NYU Winthrop Hospital, Mineola, NY, USA
When measured in the maternal serum, alpha-fetoprotein levels offer a non-invasive assessment of fetal growth and development. MSAFP levels are expressed as multiples of the median (MoM), to adjust for the variability of serum levels depending on gestational age, with values ≥ 2.0–2.5 MoM considered abnormal [1].
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