Management of abnormal serum markers in the absence of aneuploidy or neural tube defects

• Published in: The journal of maternal-fetal & neonatal medicine Vol. 25; no. 10; p. 1895
• Main Authors: Schnettler, William T, Hacker, Michele R, Barber, Rachel E, Rana, Sarosh
• Format: Journal Article
• Language: English
• Published: England 01.10.2012
• Subjects: Aneuploidy; Attitude of Health Personnel; Clinical Competence; Cross-Sectional Studies; Directive Counseling; Female; Health Care Surveys; Humans; Maternal Serum Screening Tests; Neural Tube Defects - diagnosis; Perinatology; Physicians; Practice Patterns, Physicians' - statistics & numerical data; Pregnancy; Pregnancy Outcome; Prenatal Care - methods; Prenatal Care - utilization; Surveys and Questionnaires; Ultrasonography, Prenatal - utilization; United States; United States
• ISSN: 1476-4954
• DOI: 10.3109/14767058.2012.668583

Few guidelines address the management of pregnancies complicated by abnormal maternal serum analytes (MSAs) in the absence of aneuploidy or neural tube defects (NTDs). Our objective was to gather preliminary data regarding current opinions and management strategies among perinatologists in the US. This survey of Maternal Fetal Medicine (MFM) physicians and fellows used a secure electronic web-based data capture tool. A total of 545 potential participants were contacted, and 136 (25%) responded. The majority were experienced academic physicians with robust practices. Nearly all (97.7%) respondents reported a belief in an association between abnormal MSAs and adverse pregnancy outcomes other than aneuploidy or NTDs. Plasma protein A (PAPP-A) and α-fetoprotein (AFP) were most often chosen as markers demonstrating a strong association with adverse outcomes. Most (86.9%) respondents acknowledged that abnormal MSAs influenced their counseling approach, and the majority (80.1%) offered additional ultrasound examinations. Nearly half started at 28 weeks and almost one-third at 32 weeks. Respondents acknowledging a relevant protocol in their hospital or practice were more likely to offer additional antenatal testing (p = 0.01). Although most perinatologists were in agreement regarding the association of MSAs with adverse pregnancy outcomes, a lack of consensus exists regarding management strategies.