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Prenatal Screening
The Pros and Cons of Enhanced AFP
By Tamar Weiss
"I decided I wanted to know everything I could about my pregnancy and the baby I was carrying," says Leelah Gitler. "If something was wrong with my baby, I wanted to know about it, prepare myself for it and find out my options."
Pregnant women today have more options and health benefits than their mothers may have ever dreamed about. Women can now note detailed progress of their pregnancies with extreme accuracy and discover possible disorders that the fetus might have while in its earliest weeks of gestation. Conditions once seen as hopeless are now treatable with early detection.
Yet along with all of the benefits that modern medicine and genetics allow patients comes the necessity to make weighty decisions that can be frightening and disquieting.
One of the choices today's pregnant women must make is whether to have an enhanced alfa fetoprotein (XAFP) screening. The XAFP is a blood test performed generally in weeks 16 to 18 of pregnancy, and it determines the level of risk that the expectant mother is carrying a fetus with disorders such as Down syndrome (trisomy 21); open neural tube defects such as spina bifida and anencephaly; abdominal wall defects (omphalocele, gastroschisis) and Edwards syndrome (trisomy 18).
"Enhanced AFP testing can only indicate risk of an abnormality," says Dr. Jacob Canick of the AFP lab at Women and Infants Hospital of Rhode Island. "It cannot tell you with certainty that you do or do not have an affected fetus."
For this reason, many women decline to have the procedure done. Because the screening indicates the risk that a woman may be carrying an affected fetus, the results may often suggest that there is a relatively high risk while the mother is carrying a perfectly normal fetus. Some women prefer not to go through the distressful and agitating period of receiving a high-risk result and waiting to take whatever follow-up test may be suggested to obtain a clearer indication, only to learn that the baby is perfectly healthy.
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