MATERNAL SERUM ALPHA-FOETOPROTEIN AS A PREDICTIVE MARKER FOR PRE-ECLAMPSIA AND POOR NEONATAL OUTCOMES IN SOKOTO, NORTHWEST NIGERIA

Abdullahi Abubakar Fakku?, Muhammad Bashir Abdulrahman, Bello Aminu, Kasimu Saidu, Aminu U Abdullahi, Abubakar A Panti, Ibrahim S Aliyu, Abubakar SAkuyam

ABSTRACT

Background: Pre-eclampsia is defined as hypertension that occurs at or after the 20th week of gestation in a previously normotensive woman, accompanied with proteinuria. Pre-eclampsia and neonatal complications associated with it has remained a significant public health threat with global economic concern. The impact of the disease is felt more severely in developing countries, where medical interventions may be ineffective due partly to delay in presentation of cases to the health centre and also due to inadequate health facilities for management of obstetric emergencies. There is, therefore the need for biochemical markers that will predict the development of pre-eclampsia, with a view to applying preventive measures against its development or reduce the severity of the disorder. Alpha foetoprotein is one of such markers that has potential for use in the prediction of pre-eclampsia. Aim: The study aimed to evaluate the role of maternal serum Alpha-Foetoprotein (MSAFP) concentration as a predictive marker for developing pre-eclampsia and its correlation with maternal variables and neonatal outcome. Methods: This was a cross-sectional, case-control study that was carried out on pregnant women who attended antenatal clinic at three selected hospitals in Sokoto metropolis. A total of two hundred subjects (one hundred pre-eclamptic and one hundred apparently healthy singleton pregnant women), matched for gestational age, gravidity, parity and age range were recruited for the study. The pre-eclamptic were further grouped into severe and mild, based on the blood pressure level and urinary protein/ creatinine ratio. Blood pressure was measured and recorded. Maternal blood and urine samples were taken at the time of enrollment and were used to determine the MSAFP levels and urinary protein and creatinine respectively. At delivery, pregnancy outcomes were documented. Results: MSAFP was found to be significantly different (P=0.000) between the three groups (303.10 ± 20.41, 186.80± 10.65 and 88.10± 5.77 for severe pre-eclampsia, mild pre-eclampsia and controls respectively. MSAPF was significantly higher in pre-eclamptic women than controls, and significantly higher (P=0.000) in severe pre-eclampsia than mild pre-eclampsia. Likewise, urinary protein/creatinine ratio was significantly different between the three groups (1.4±0.75, 1.27±0.65 and 0.04±0.24, p= 0.000) for severe pre-eclampsia, mild pre-eclampsia and controls respectively. There was a strong significant positive correlation between the MSAFP and maternal mean arterial blood pressure (r = 0.713, p< 0.000) and with urinary protein/creatinine ratio (r = 0.651, p = 0.000). MAFP excellently predicted pre-eclampsia (Area Under the Curve=0.972, 95%CI is 0.948 to 0.005, p=0.001), at a cut-off point of 114.5ng/ml and above. The birth weight (BW), birth length[1] and Apgar scores (AS) for neonates of pre-eclamptic patients were significantly lower than those of the controls (BW 2.86±0.64kg vs 3.42±0.59kg; BL 48.80±2.64cm vs 49.96±1.97cm; AS 5.85±2.63 vs 7.65±0.98, p < 0.05). There was a negative correlation between MSAFP and birth BW (r 0.399, 0.000) and also with AS (r 0.399, 0.000). Conclusion: Elevated MSAFP at 20 weeks an above is associated with the risk of pre-eclampsia and poor neonatal outcomes.

Keywords: Pre-eclampsia; Neonatal outcomes; Alpha-Foetoprotein; Sokoto.