alpha fetoprotein test - is this a crucial test?

[oregonchick]

My ob casually asked me as I was preparing to leave my last appt if I wanted
to have this test done. I had never heard of it before, and I asked her to
explain. She mentioned it was to find out if the baby was at risk of spinal
cord problems, but didn't really elaborate. She seemed busy and annoyed at
the question. Is this something that everyone has done?

Betsy

[Circe]

"oregonchick" > wrote in message
...
> My ob casually asked me as I was preparing to leave my last appt if I
> wanted to have this test done. I had never heard of it before, and I
> asked her to explain. She mentioned it was to find out if the baby was at
> risk of spinal cord problems, but didn't really elaborate. She seemed busy
> and annoyed at the question. Is this something that everyone has done?
>
In a nutshell, the AFP is a blood test performed on the mother at around
mid-pregnancy. The blood is analyzed and higher/lower concentrations of
certain hormones *can* be indicative that the fetus is at a
higher-than-expected risk of some types of defects, including spina bifida
and trisomy (Down Syndrome, which is T21, being the most common). If the
result of an AFP test is "positive" for any of these conditions, further
testing can be done (amniocentesis in the case of a trisomy, high level
ultrasound in the case of spina bifida) to determine whether or not there is
actually a problem.

It is important to understand that the AFP is only a screening test. A
"positive" result on the test does not mean there is certainly something
wrong, only that the amount of hormone in your blood stream suggests a
higher-than-expected chance that there is something wrong. The AFP is
generally recommended because it is a non-invasive test that poses no risks
to the fetus or the mother, but tends to be fairly accurate in identifying
women for whom further, more invasive testing (read amnio) might be
warranted. That doesn't mean that most women who are referred for further
testing due to AFP results wind up having babies with problems, but rather
that most women who *do* have babies with these sorts of problems are
identified by the AFP.

Before consenting to taking the AFP, you need to decide whether or not you
would consent to further testing if the result is positive. It's also worth
noting that the results are considerably less accurate for women over about
37-38--the tendency is for almost all tests done on women above that age
bracket to come back positive. Also, the usefulness of the AFP as a test for
spina bifida is somewhat overrated, IMO. Unless you would not have a
standard anomaly scan at 20ish weeks of pregnancy, it isn't likely to result
in finding a problem you wouldn't otherwise have discovered. So what the AFP
is *really* doing for you is screening for trisomies.

I am sorry to hear that your practitioner did not explain all of this to you
and that she seemed annoyed by the question. This is not appropriate
behavior on the part of a physician, IMHO. In addition to evaluating whether
or not you want the AFP, I would recommend evaluating whether or not you
wish to continue in the care of a practitioner who does not answer your
questions and treats you rudely. That does not seem like a particularly
positive harbinger for her bedside manner or her ability to get informed
consent before performing other procedures when you are giving birth.
--
Be well, Barbara

[oregonchick]

"Circe" > wrote in message
news:%pkwe.3632$Qo.2525@fed1read01...
> "oregonchick" > wrote in message
> ...
>> My ob casually asked me as I was preparing to leave my last appt if I
>> wanted to have this test done. I had never heard of it before, and I
>> asked her to explain. She mentioned it was to find out if the baby was
>> at risk of spinal cord problems, but didn't really elaborate. She seemed
>> busy and annoyed at the question. Is this something that everyone has
>> done?
>>
> In a nutshell, the AFP is a blood test performed on the mother at around
> mid-pregnancy. The blood is analyzed and higher/lower concentrations of
> certain hormones *can* be indicative that the fetus is at a
> higher-than-expected risk of some types of defects, including spina bifida
> and trisomy (Down Syndrome, which is T21, being the most common). If the
> result of an AFP test is "positive" for any of these conditions, further
> testing can be done (amniocentesis in the case of a trisomy, high level
> ultrasound in the case of spina bifida) to determine whether or not there
> is actually a problem.
>
> It is important to understand that the AFP is only a screening test. A
> "positive" result on the test does not mean there is certainly something
> wrong, only that the amount of hormone in your blood stream suggests a
> higher-than-expected chance that there is something wrong. The AFP is
> generally recommended because it is a non-invasive test that poses no
> risks to the fetus or the mother, but tends to be fairly accurate in
> identifying women for whom further, more invasive testing (read amnio)
> might be warranted. That doesn't mean that most women who are referred for
> further testing due to AFP results wind up having babies with problems,
> but rather that most women who *do* have babies with these sorts of
> problems are identified by the AFP.
>
> Before consenting to taking the AFP, you need to decide whether or not you
> would consent to further testing if the result is positive. It's also
> worth noting that the results are considerably less accurate for women
> over about 37-38--the tendency is for almost all tests done on women above
> that age bracket to come back positive. Also, the usefulness of the AFP as
> a test for spina bifida is somewhat overrated, IMO. Unless you would not
> have a standard anomaly scan at 20ish weeks of pregnancy, it isn't likely
> to result in finding a problem you wouldn't otherwise have discovered. So
> what the AFP is *really* doing for you is screening for trisomies.
>
> I am sorry to hear that your practitioner did not explain all of this to
> you and that she seemed annoyed by the question. This is not appropriate
> behavior on the part of a physician, IMHO. In addition to evaluating
> whether or not you want the AFP, I would recommend evaluating whether or
> not you wish to continue in the care of a practitioner who does not answer
> your questions and treats you rudely. That does not seem like a
> particularly positive harbinger for her bedside manner or her ability to
> get informed consent before performing other procedures when you are
> giving birth.
> --
> Be well, Barbara

Thank you so much for the clear explanation. It sounds like a worthwhile
and noninvasive test, better safe than sorry! As for my practicioner, I
feel a little helpless when it comes to that situation. I have an hmo, and
I've seen a few different OB's through my plan. I'm really not impressed
with any of them. I wish I could find a private birthing center in my
area - I am willing to pay out of pocket. But how does one locate such
services. I'm in Portland, OR, so there should be something like that here.

Betsy

[Amy]

oregonchick wrote:
> I wish I could find a private birthing center in my
> area - I am willing to pay out of pocket. But how does one locate such
> services. I'm in Portland, OR, so there should be something like that here.

Yellow pages.

And when you contact them, ask if there's a discount if you pre-pay.
The local hospital here offered one, and from what I understand, it's
pretty common practice.

Good luck,
Amy

[V.]

"oregonchick" > wrote in message
...
I wish I could find a private birthing center in my
> area - I am willing to pay out of pocket. But how does one locate such
> services. I'm in Portland, OR, so there should be something like that
> here.
>
> Betsy

www.birthcenters.org lists one in Eugene, OR if you were willing to travel.

You can also check for midwives at www.acnm.org

[Cathy Weeks]

oregonchick wrote:
> My ob casually asked me as I was preparing to leave my last appt if I wanted
> to have this test done. I had never heard of it before, and I asked her to
> explain. She mentioned it was to find out if the baby was at risk of spinal
> cord problems, but didn't really elaborate. She seemed busy and annoyed at
> the question. Is this something that everyone has done?

Instead of the AFP, I would consider the Triple Screen (or is it called
the Quadruple Screen now?). It's done the same way - a simple blood
test, and is considered to be more accurate, and I believe that it
includes the AFP as one of the tests. But like Circe said, it's still
just a screening test.

Cathy Weeks

[Circe]

"Cathy Weeks" > wrote in message
oups.com...
> oregonchick wrote:
>> My ob casually asked me as I was preparing to leave my last appt if I
>> wanted
>> to have this test done. I had never heard of it before, and I asked her
>> to
>> explain. She mentioned it was to find out if the baby was at risk of
>> spinal
>> cord problems, but didn't really elaborate. She seemed busy and annoyed
>> at
>> the question. Is this something that everyone has done?
>
> Instead of the AFP, I would consider the Triple Screen (or is it called
> the Quadruple Screen now?). It's done the same way - a simple blood
> test, and is considered to be more accurate, and I believe that it
> includes the AFP as one of the tests. But like Circe said, it's still
> just a screening test.

It seems to me that people use the terms AFP and Triple Screen pretty
interchangeably. I know that when I had what was called the AFP, they also
checked for HCG and estriol, which are the two other hormones tested in the
Triple Screen. The Quad Screen tests for an additional hormone, but I'm not
sure that it's become as common as the Triple Screen.
--
Be well, Barbara

[alath]

Only one point to add to Circe's answer....
Maternal serum screening (with AFP and/or HCG) can also help to
identify moms who are at risk for problems with the placenta, including
preeclampsia and fetal growth restriction. If you do have a risk for
these things, you will need to be monitored more closely in the third
trimester. Early detection of these problems can be life-saving for mom
and/or baby.

[Ilse Witch]

On Tue, 28 Jun 2005 15:29:07 -0700, oregonchick wrote:

> Is this something that everyone has done?

No. IMO there are no crucial tests for a healthy pregnancy. Pregnancy is
not a disease. Doing a lot of prenatal screening always makes me feel that
I am at risk for the most terrible things, which is not true. If you are
healthy and there is no history of perinatal problems in your immediate
family, there is little reason to test, except for the doctors to assure
they won't get sued if something is wrong at birth.

Personally, I find many of the screenings that are offered result in more
stress than necessary. If you decline, you get the feeling you are
withholding your baby the best possible care. If you do get tested, you
have the stress of waiting for the results and then dealing with them.
Usually the results are not even a definite answer, like yes or no,
but a number, e.g. you have a 1 in so many chance to have a baby
with spinal cord defects. Either way, you have worries.

Make sure you know *what* will be tested, and how reliable the results are
before you agree to have testing done. Never get tested just because your
ob/gyn thinks it's a good idea. Also consider what you will do should the
test come back with a bad result. If the answer is nothing, why go through
the ordeal?

--
--I
mommy to DS (July '02)
mommy to four tiny angels (Oct '03 - Oct '04)
guardian of DH (age classified)
expecting twins (boy/girl) in August