WOMENS-HEALTH Messages for March, 1998: Re: 1st baby Premature

Re: 1st baby Premature

From: Tracy (anonymous@obgyn.net)
Wed, 18 Mar 1998 06:29:46 -0600 (CST)

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At Tue, 17 Mar 1998, Sherrie wrote: >
>How often is the second child premature?
>And how often is it likely for the 2nd pregancy AFP test to come out
>likethe first pregancy AFP test?
>
>And is spina bifida likely to occur in the second child?
>
>--
>Sherrie Josephson
>

I hope this helps....

Each pregnancy is a unique experience. While women who have already had children with birth defects may be at higher risk than others, most birth defects occur in pregnancies of women who haven't had an affected pregnancy before. Three to four percent of all babies are born with a major birth defect. And while only some women will ever have children with birth defects, we have no way of knowing in advance which women these will be. That's why it's so important that all women stay as healthy as possible, even if they haven't had any problems before. If you have already had a baby with a birth defect, consult your doctor before trying to become pregnant again.

Any woman may have an affected pregnancy. Of SBA-affected pregnancies, 95% occur among women with no history of SBA- affected pregnancies, but women who have already had an SBA-affected pregnancy are 20 times more likely to have subsequent affected pregnancies.

Approximately 40% of all Americans may have spina bifida occulta, but because they experience little or no symptoms, very few of them ever know that they have it. The other two types of spina bifida, meningocele and myelomeningocele, are known collectively as "spina bifida manifesta," and occur in approximately one out of every thousand births. Of these infants born with "spina bifida manifesta," about 4% have the meningocele form, while about 96% have myelomeningocele form.

Each year in the United States, 2,500 to 3,000 infants are born with spina bifida or anencephaly, which are neural tube defects (NTDs) caused by the incomplete closing of the spine and skull. An estimated 1,500 pregnancies are terminated because of these defects.

The U.S. Public Health Service recommended in September 1992 that all women of childbearing age consume 400 micrograms (ug) of folic acid daily to reduce their risk of having a pregnancy affected with spina bifida or other neural tube defects. Folic acid is a B vitamin. For women, this amount of folic acid on a daily basis spina bifida or anencephaly, both of which are neural tube defects (NTDs) in the baby. In 1991, a study by British researchers found that women who already had one child with a neural tube defect could reduce by 72 percent the chance of another child being affected if they took high doses of folic acid.

The maternal serum alpha-fetoprotein (AFP) test, is a blood test for the mother at 16 to 18 weeks into the pregnancy. It was approved by FDA in the early 1980s as a prenatal test for neural tube defects (a second approved use is as an aid for a certain kind of testicular cancer).

The test measures alpha-fetoprotein, a substance produced by the fetus and secreted into the amniotic fluid, eventually entering the mother's blood. As it grows, the baby produces increased amounts of AFP. The level of AFP in mother's blood peaks at about 30 to 32 weeks.

Abnormally high amounts of AFP may indicate a baby has a neural tube defect. But the test is not perfect.

Up to 20 percent of spina bifida cases do not produce high levels of AFP, so the test does not detect them. And when the test does indicate a high level of AFP, a neural tube defect is present only 10 percent of the time. Most commonly,the AFP level is high because the pregnancy is just further along than was thought.

Other possible causes of high AFP values are that the mother is carrying twins or that there is a placental problem. Women with diabetes or liver disease also have elevated AFP levels. Birth defects in the fetus such as kidney and heart problems may produce high AFP levels as well.

If a woman has an elevated AFP test, her doctor will usually give her a second AFP test, followed by ultrasound. If still no explanation for a high AFP value can be found, the physician may perform amniocentesis. In this test, the doctor takes a sample of the amniotic fluid and measures it for AFP levels. The results of these tests together will identify a high percentage of spina bifida cases.

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