Alpha Fetoprotein Test?

jgirl123

Hi all,

I had my 15-week appt with my OB today, and they offered me a blood test to screen for neural tube defects called Alpha Fetoprotein? It has to be done between now and 18 weeks, and since my next appt will be when I am almost 20 weeks, I would have to schedule this separately. I asked what can be done/determined from the results on this, and apparently it can detect severe impairments that may result in a termination or it can detect milder problems that may require corrective surgery immediately after delivery or even in utero (but extremely high risk).

I asked the doc if this is a common screening that most women take part in, and he said yes, but I'm not sure if this is a test that is truly necessary? Can anyone shed light on why I should/shouldn't schedule this? Obviously I need to check with my insurance provider for financial reasons, but if that's not a factor then I'd like to know if it's irresponsible to pass on something like this, or if it's of critical importance.

TIA

johnsonia

I'm not sure at all about this test in pregnant women, but my BF is currently being treated for a liver tumor and that was one of the tests. The major issue with him is that that test can sometimes offer false-positives and false-negatives, which is a pretty big deal when you're trying to diagnose cancer. Not sure how similar the test is for us pg women, but I would certainly ask your doc about the false- neg and false-pos results as it relates to you as pregnant and for the NTD. GL

RovinChick

I am opting out of all screening tests, but I know I'm in the minority.  If you get a positive result, it doesn't mean that something is necessarily wrong with your baby.  Likewise, if you get a negative result, it doesn't mean your baby is completely normal.  If it comes up positive, they will encourage you to get an amniocentesis for a more definitive result.  Although the miscarriage rate is low for amino (around 1-2 percent), I still wouldn't want to risk it.  

Here is some info about the test results from the American Pregnancy Association:

There are approximately 25 to 50 abnormal test results for every 1,000 pregnancies tested.  Of these abnormal results, only 1 in 16 to 1 in 33 will actually have a baby that has been affected with a neural tube defect or other condition.  The benefit of screening is that 75% to 90% of babies with neural tube defects are discovered.  

damabo80

It's a blood test. A prick to my arm is worth 10,000 times over knowing if my child is healthy or not.

Assuming it is covered by insurance, why would you even be waffling on this decision?

If you forgo this screening, will you forego all other screening and ultrasounds as well (since those aren't necessary either) and instead just hope the baby comes out healthy?

damabo80

RovinChick:

I am opting out of all screening tests, but I know I'm in the minority.  If you get a positive result, it doesn't mean that something is necessarily wrong with your baby.  Likewise, if you get a negative result, it doesn't mean your baby is completely normal.  If it comes up positive, they will encourage you to get an amniocentesis for a more definitive result.  Although the miscarriage rate is low for amino (around 1-2 percent), I still wouldn't want to risk it.  

Here is some info about the test results from the American Pregnancy Association:

There are approximately 25 to 50 abnormal test results for every 1,000 pregnancies tested.  Of these abnormal results, only 1 in 16 to 1 in 33 will actually have a baby that has been affected with a neural tube defect or other condition.  The benefit of screening is that 75% to 90% of babies with neural tube defects are discovered.  

I could be wrong, but doesn't an amino just test the chromosomes? If so, they won't tell you about a NTD. My son was 100% chromosomaly normal/healthy. The only thing that wasn't normal about him was that he didn't have a skull (open neural tube defect).

BTW: when odds are given, there's no such thing as a "false positive". If you are given 1:3 odds that your child has something...well guess what, that means a 2:3 odds that s/he doesn't. This is not a false positive.

jgirl123

Thanks for the feedback, they've offered me an array of tests and the OB Coordinator I met with during my first appointment told me that some are optional and sometimes overwhelm/stress people out and aren't always necessary if the results wouldn't cause us to change our minds about the pregnancy.

After reading some more about the test and the statistics it seems like this is really something we need to be informed about vs. some of the other tests the coordinator was referring to. I'll be calling my insurance company in the morning to find out about coverage.

 

 

 

johnsonia

damabo80:

RovinChick:

I am opting out of all screening tests, but I know I'm in the minority.  If you get a positive result, it doesn't mean that something is necessarily wrong with your baby.  Likewise, if you get a negative result, it doesn't mean your baby is completely normal.  If it comes up positive, they will encourage you to get an amniocentesis for a more definitive result.  Although the miscarriage rate is low for amino (around 1-2 percent), I still wouldn't want to risk it.  

Here is some info about the test results from the American Pregnancy Association:

There are approximately 25 to 50 abnormal test results for every 1,000 pregnancies tested.  Of these abnormal results, only 1 in 16 to 1 in 33 will actually have a baby that has been affected with a neural tube defect or other condition.  The benefit of screening is that 75% to 90% of babies with neural tube defects are discovered.  

I could be wrong, but doesn't an amino just test the chromosomes? If so, they won't tell you about a NTD. My son was 100% chromosomaly normal/healthy. The only thing that wasn't normal about him was that he didn't have a skull (open neural tube defect).

BTW: when odds are given, there's no such thing as a "false positive". If you are given 1:3 odds that your child has something...well guess what, that means a 2:3 odds that s/he doesn't. This is not a false positive.

 

I understand about odds. I was just refferring to the test that my BF had done which was also the AFP. Serves a slightly different purpose for pregnant women than for patients who potentially have liver cancer. 

 "The sensitivity of AFP for liver cancer is about 60%. In other words, an elevated AFP blood test is seen in about 60% of liver cancer patients. That leaves 40% of patients with liver cancer who have normal AFP levels. Therefore, a normal AFP does not exclude liver cancer. Also, as noted above, an abnormal AFP does not mean that a patient has liver cancer. "

I didnt know the AFP for pregnant women was also a result given by "odds". For my BF it was either positive or negative. 

erincorbridge

 I was offered this same test today at my 15 week appointment.  I too was wondering if I should do it and I'm still talking to my husband about it.  We are leaning towards no.  This is why:  If there is something going on with the baby, we are not going to terminate the pregnancy.  Also,  my doctor told me that most of these things can be detected on a normal ultrasound... Also,  there is only one problem that MAY be fixed by surgery in utero, but it is extremely high risk as you stated.  AND, false positives are very common with this test, which would leave us with something to worry about that isn't even there.  We just don't feel the need to know if our child has any of these issues.  We love our child no matter how it comes out and we will deal with the issues when we need to.  There is not much that can be done for these problems and it would only make us worry more.  I know that some people may think I'm a bad mother, but it's hard to see the point, you know?? It seems like I would just feel helpless if I knew my baby was unhealthy and there was nothing I could do about it... My doctor said that there are a lot of parents like me that are thinking this way.  

x0stephanie

I was offered the maternal serum screening (it tests for a few things, and the proteins are one of them), but I just said no thx.  No one can decide for you.  Its a personal decision.