Tests during pregnancy - AFP-screening-test- Pregnancy forum

AFP screening test and the Triple screening test
The AFP screening test is a measurement of alpha-fetoprotein. The Triple screening test is newer and combines the AFP test with measurements of two hormones, unconjugated estriol and human chorionic gonadotropin. It is often called the 'triple screen'.

Worth the worries?
An abnormal result may cause considerable worry and concern. Since most women with abnormal results will have healthy normal babies, you may decide that the test is not worth the possible anxiety. Some statistics: about 5% of women tested will have abnormal readings. About 90% of those will not have affected babies, but have abnormal values because the dates were calculated wrong, there are twins, or other reasons. So, for every 1000 women tested, about 50 will be told they have increased risk, and of the 50, about 45 or more will in fact have normal pregnancies. Some people feel that the high level of 'false-positive' readings make the test not worth the risk.

Making a decision means learning as much as possible about the possible outcomes, and thinking about what you would do in each case. Then ask: Will the results of the test (positive or negative) change what you plan to do? If not, then there is no reason to have the test and risk the anxiety that an abnormal result would bring.

Why is the age of the fetus important?
The normal ranges of AFP and the hormones of the triple screen will vary with the age of the fetus. So in order to determine if the values are in the normal range, one must have an accurate date. This can be problematic if date of conception or last menstrual period is not known. For women with cycles significantly longer or shorter than 28 days, or who don't have regular cycles at all, scheduling or interpreting the results of the screens will be difficult if not impossible without ultrasound to more accurately date the fetus.

The first thing that many doctors do when a patient has an abnormal AFP or triple screen is request an ultrasound to recalculate the age of the fetus (and to rule out twins). Often the recalculated age is enough evidence to rule the screen result normal

What should I do if the values are abnormal?
Your caregiver should recommend an ultrasound to get a more accurate dating and to rule out multiple fetuses. Over 90% of the time, abnormal AFP values are due to these or other benign factors. Then a second AFP test might be run. If that is also abnormal, a more sophisticated ultrasound and amniocentesis would be suggested.

What is apha-fetoprotein?
AFP is a protein produced by every fetus. The baby urinates it into the amniotic fluid, and it makes its way from there into the mothers blood for excretion. There is a normal range of AFP found in the mothers blood; this is determined by the age of the fetus.

A baby with an open spinal defect often leaks larger quantities of AFP into the amniotic fluid, and in turn, into the mothers bloodstream.

An elevated level of AFP does NOT diagnose a neural tube defect! Babies with such defects tend to produce more AFP, which gets into the mother's blood, but there are also other reasons for an elevated level. The most common reason for elevated AFP is that the age of the fetus was estimated incorrectly. Twin pregnancy would also tend to show elevated levels.

How are the results presented?
The results may be presented in a number of ways. It is important to understand what your numbers mean. Ask your caregiver to explain.

The triple screen might be given as a probability such as: 'based on maternal age your risk of Down's is 1/390 --- when the levels of AFP, HCG and uE3 are also taken into account, your risk is 1/14000. Based on AFP levels, your risk of neural tube defects is 1/1400.'

Or the results might simply be positive/negative, or normal/abnormal. You will probably want to know exactly what that means. Ask. In fact, there is controversy as to what 'abnormal' means. Try to find out what your lab considers abnormal. They are working from the more detailed probability information.

I think that it is becoming more common for the results to be given as probabilities, which are more meaningful than a simple 'positive/negative' which is impossible to interpret. Probabilities can still be kind of scary to interpret though.

Comments: Tests during pregnancy - AFP-screening-test

Comments 1 to 24 of about 182.
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crickette24 - 8 days ago.
I wanted to post a notice on this board so that other moms-to-be like me can take some comfort in the inherent inaccuracy of the AFP / Quad Screen / Tetra Screen test for Down Syndrome, Trisomy 18, Spinal Bifida, etc. I had the test done and was given a positive result of 1:110 for Downs. That, combined with a soft marker on ultrasound (an echogenic focus / EFI), even increased my risk by double to 1:55 for DS. We opted not to do an amnio. Now I am at 24 weeks and went in for a follow-up ultrasound yesterday. The sonographer noticed a distinct different between how my due date was noted in my file and what the baby was measuring (and had consistently been measuring). He combed through my file and found the initial measurement. Then all h#ll broke lose in the room - he got extremely agitated, started calling doctors into the room, the lab technician / head supervisor, etc. It turns out that the doctors/lab used an inaccurate due date when they ran my quad screen test...my due date based on gestational age / initial ultrasound is 12/23/08. They used the due date based on my inaccurate LMP of 12/15/08. Basically, they used a 17-week theorum to calculate the risk for a 16-week old fetus, and the results made the difference. I went from a 1:110 risk (POSITIVE for DS) to a 1:398 risk (NEGATIVE for DS). Please PLEASE make sure the doctors have the most possible and accurate information if you take this screening test. I personally am now VERY WARY of the Quad Screen /AFP test! The slightest thing can skew the results and indicate a positive result. Any test that has that drastic of a result for an 8-day time difference (when a fetus is in the womb for 9 months) cannot be very reliable. I will never have this test done again! I was so relieved at first...but now I am just upset. I went through almost two months of worry, visits to a high-risk peri, breaking the news to family/friends, and preparing myself for having a special needs child. While I never got an amnio, it's quite possible that these flawed tests could result in amnios where babies are lost or put at risk. I am not out of the woods yet...I still have a risk due to the EIF soft marker, but my risk has been significantly reduced. Again, if you opt to have this test, make sure that the information they plug into the formulas/calculations is EXTREMELY accurate. I don't want anyone else to have the needless anxiety that I have had.

Mercer - 13 days ago.
Agreed. Even though i did decide to do the amnio after a positive quad screen for downs, and the results were normal, it was such a scary thing to go through... my baby girl was born 2 weeks ago and she is perfectly healthy and amazing! There is so much hope. I have told all of my pregnant friends to not even get the triple or quad screen test. It's just worrisome.

mesi - 13 days ago.
My AFP screening came back positive for Spinal Bifida, 1/119. I was devastated at first and then I educated myself. After tons and tons of research and this site,of course, as well as the many women on this site who had gone through the same thing - I begin to handle it alot better. My daughter was fine, infact the exact words of the doctor when she was born was 'She's perfect':0) Please don't let those results get you too worried. So all you moms who received those unexplainable results - Hang In.there

amandajo03-10 - 21 days ago.
Hey I also wanted to let you all know that I too tested positive for elvated AFP with a 1/300 something chance that my baby could have a neuro-tube defect. I had an ultrasound once a month from 19 weeks till 32 weeks and everything was fine. They still wanted to monitor him which is why they continued the ultrasounds. It was great being able to see him grow every month. I just wanted to let you all know that my baby is perfectly fine, a healthy 6 month old boy!

AfricaMama - 24 days ago.
I had my triple screen test on 15 weeks 4 days and the result came back with 1/28 for Downs. That was two weeks ago. I've read alot of info, chatted with my doctor several times in trying to decide about the amnio, and decided against it. Now I'm wondering.. maybe I should have another triple screen test done at 20 weeks... ? My reasons: - I've read that if the test is done too early it could give you a false indication and I thought since mine was done during 15 weeks and I am someone who also have a 36 day menstrual cycle, and therefor the 15 weeks was possible also not as accurate???? - I've had the flu twice during the first 12 weeks and I read that viral infections could influence the reading... And the reason my doctor tells me not to have a second test is because it is just another screening test that gives you an indication of the r i s k and would still not give me any decisive answer... it might just confuse and upset me futher. Any advice or wise words that could help me...?

jlspoonylove - 26 days ago.
Just wanted to let you ladies know that my AFP screening came back positive. Our daughter is now 3 months 2 wks and there is nothing wrong with her. As a matter of fact.... she is VERY smart. So please remember that the test is only a screening.

harrison mummy - 79 days ago.
im 18 weeks and my triple test results came back within a week. the results were 1/8800 for downs but I had raised levels of AFP. I had a US the next day and they looked at the spine and all looked to be developed and closed. The brain was showing normal development (shape and brain waves etc). All the babies internal organs where in place inside the baby too. They seemed very happy with the development of my baby and it did put my mind at ease. They did say the test can be affected if you have had a bleed, But i did not!! They did say that is normal to have an internal bleed and not show any signs. If I had a bleed I knew about they would not have done the triple test untill I had stopped bleeding for 1 week as it affects the results. I go back next thursday for my 20 week scan so fingers crossed my baby is ok. I have also read that babys at risk of down tend to have a lower AFP level so I have took it as I have good odds 1/8800 and higher levels of AFP that downs is less likely (not impossible) and if there is to be a problem is more likly to be a neural tube defect. The hospital said that most major defects are detected on the u/s but some minor ones are missed but generally you can tell if your baby is to have a major disability. Best wishes to you all. x x

Mercer - 79 days ago.
Vanessa77 - unfortunately it does not mean that you will definitely have a baby without genetic disorders. Usually when they do these screenings the levels they get give them odds. Like you could have a 1/50 chance of having a baby with downs or a 1/4000 chance. Usually if the odds are below like 1/250 they consider the results to be positive for downs (or other genetic disorders depending on what they find) and if they are above 1/250 they'll say it's negative. Different doc's use different numbers. So if your risk is 1/4000 obviously you have a much smaller chance of having a baby with downs, edwards, etc, than someone who's odds are 1/50. But that doesn't necessarily mean that the person with a 1/50 chance will have a baby with chromosomal disorders or that the person with a 1/4000 chance won't. I hope that made sense! Good luck with your pregnancy!

Vanessa77 - 80 days ago.
is there any way you can have a false negative? Mine was negative, so does that mean my child 100% will not have the genetic disorders it is screening for?

Maliah - 86 days ago.
HEY guys im new. im just trying to look for some advice and comfort. I GOT A POSITIVE SCREEN FOR MY AFP TEST. SO I SAW A GC AND THEY SAID MY RISK WAS (1 IN 50) ..IM ONLY 22 YRS. OLD. SO I HAD A ULTRASOUND.. THEY SAID IT LOOKED GOOD,HEART,FEMUR BONES AND BRAIN, BUT THATS NOT 100%. SO I DID A AMNIO LAST TUESDAY, NOW IM JUST WAITING FOR THOSE RESULTS. IM SO SCARED.. HAS ANYONE ELSE BEEN THROUGH THIS TOO?? AND ARE ANY OF U THE SAME AGE AS ME??/ PLEASE NEED ADVICE

may2008 - 91 days ago.
My AFP test came back positive for downs syndrome and I was very worried and did not know what to do. I had my baby two weeks ago and she is perfect! I want to encourage any body who is going through a positive afp result, it is not 100%. Get on your knees and begin praying! It will help you get through your pregnancy and get closer to God and build up your faith. Just know the with Christ all things are possible... I am a living testimony of what could have been. Be strong and have faith.

may2008 - 91 days ago.
My AFP test came back positive for downs syndrome and I was very worried and did not know what to do. I had my baby two weeks ago and she is perfect! I want to encourage any body who is going through a positive afp result, it is not 100%. Get on your knees and begin praying! It will help you get through your pregnancy and get closer to God and build up your faith. Just know the with Christ all things are possible... I am a living testimony of what could have been. Be strong and have faith.

shellymomtobe - 100 days ago.
i had the triple screen done about 2 months ago. the test came back abnormal for trisomy 18. i paniced! they sent me to see a high risk dr. once i had the consult with the high risk dr, they did a level II u/s. after that they then decided that i was 2 weeks behind what they thought my due date was so the test was inaccurate. the dr. told me that if they are off on your due date by 3+/- days that the test is pretty much not useable. I was really upset that i had to panic over nothing. its now been 7 weeks later, and the baby is developing fine and all labs are fine. I'm actually irritated that i even had the test done if it is that much of a time dependent test, no one really discussed it thoroughly with me before i had it done. so just leting any one know who is planning on having it done, make sure you get the 100% facts about the test, because its only a screen, it doesn't mean that there is or isn't anything wrong. if/when i have another baby, i don't think i'll be having the screen done again.

Lisa72 - 110 days ago.
I had my triple screen done on Friday. I am very anxious about this. My Nuchal was normal at 13 weeks so I hope this is ok as well. I am 36 so my chances of problems are higher. My girlfriend is 31 & she had her baby on Friday as well. It was born with Spina Bifida. She did not have any of the screening tests done. Her baby has the most severe case but it is very low on her back & she should only have minimal problems. Thank God! The lab tells me my results will be back in a week. I should be good & frantic by then.

victoria duxbury - 114 days ago.
Hey all, im 19wks gone n had the triple test done in my 16th week. Its now 3 weeks since i had the test done, and i have heard nothing. Ive been calling the docs daily hopin that the results were in and they have still not come back. Does any1 mabe no of any logical explanation for this? Did it take this long for anybody? I cant help but worry. Is ther any reason they would take so long to come back? The women on reception said if they wernt in tomorrow then i should ring friday and discuss the matter with my midwife. Any comment back for reson why will be appreiciated

kelli - 124 days ago.
is this the test to see if the baby has a chance of having down syndrome? (or other things) cause my doctor sent a form home with me and told me to decide if i wanted to have it done at the time im suppose to have it done. and at first i thought i wanted to take it... butttt after i got home and talked to my man and his parents and my parents about it, i changed my decision. i know if i take it and the results are positive i will worry and be so stressed out and that could be bad for the baby. my friend took the test and her results were positive and she had a certain chance and her baby is perfectly healthy. do you think my decision is a good one or do you think i should do it? hellllllllp me

JaguarEyes - 127 days ago.
Well, I had my detailed ultrasound and it showed no markers for any issues. My AFP was 1 in 460, which is not far from the 1 in 500 that is 'normal' for my age (34). I decided to do the amnio anyway, for peace of mind reasons. It's scheduled for May16th. Please think good thoughts for me.

Heather-08-01 - 127 days ago.
I'm sorry you feel like you're suffering undue worry, I swear I wasn't pointing you out in particular callylu - it's a very common theme among many posters here. I suppose I shouldn't assume that everyone does their research beforehand and not everyone is quite as OCD as I am about all of this stuff. The test can provide a great deal of relief, but it has to be taken for what it is - a safe, non-invasive, form of testing that errs on the side of caution.

callylu - 127 days ago.
I understand your point & do agree up to a point. I had the test in my previous pregnancies so i had it again this time. I knew only basic things about the test before. What the test was for ie downs & edwards. I had not done any research as there was nothing like this forum available to me (my children are 19yrs,13yrs& 9yrs) i did the test because it was offered, with hind sight i was a little naive & ignorant as i had never had any problems before, i just wanted 'reasurrance' due to hitting 35. It was only after i received my results that i started looking into it & found so many other comments on the inaccuracy of the test. I had no idea there were so many false positive results. I also did not know about forums/information sites such as this. Of course any woman who has had a 'false positive ' will feel like they have been through so much upset & worry for no real reason just the same as any woman who has the test & gets the result they want will feel this test is valuable. My point is i wish i had researched before i had it done.

Heather-08-01 - 128 days ago.
I know the AFP testing isn't for everyone, but it always seems like the women who don't get the results they were hoping for all of the sudden change their tune and rave about how horribly inaccurate the test is. Yes, there are false positves this is so they are more likely to catch problems than not. I believe if you go in for this test you have to be prepared for the outcome that you might end up with a false positive and be willing to either accept that or continue forward with a more conclusive test such as an amnio or CVS. I knew all of these things going in and luckily our tests came back great, BUT if they didn't come back as I would have hoped I would have gone for more testing because it was all about peice of mind for us - we needed to know. As I am not considered 'at risk' my insurance would have never covered an amnio without something more conclusive to go on first. I just think that sometimes it's not the test that's the issue, it's parents not hearing exactly what they want AFTER knowing it's limitations & weak points - which I can't imagine most all if not all women know before going in (as much research as we all do - even my Dr discussed the possiblity of false positives with us before hand). Sorry if I offended anyone, but just my 2 cents.

callylu - 128 days ago.
i had the test done at 16 weeks. my midwife told me if i didn't hear from the hospital within a week then everything was probably ok but i would receive the results through the post. Three weeks later i got a phone call to tell me they had only just got the results back & the baby had a higher risk of downs. The risk for my age is 1/300 (i'm 35) but it had come back as 1/198. I was really upset at first. When i asked why did it take three weeks for the results to come back i was told there was a delay as it had been a bank holiday. I was offered an amnio but we decided against taking the risk. After all, in real terms we have a 99.5% chance of this baby being fine an amnio would give us a 1 - 2% chance of miscarriage. I have to admit to changing my mind over the course of two days several times but eventually went with our gut feeling & we had a level 2 scan done the week after. Our little boy looks healthy, no markers were found. We have decided to put it to the back of our mind & trust what fate has in store for us. We would not have considered a termination no matter what. Ater reading many other comments on numerous forums & information sites i personally would not have this test done again if i have any more children.

JaguarEyes - 128 days ago.
riknlee and Mercer, Thanks so much for your comments. I really appreciate the feedback. I'm 19 weeks tomorrow so it's too late to do the CVS test. I guess I'll just have to figure out whether to do the amnio. I'm still going to wait until the ultrasound even though I know it's not definitive, and until I see my Dr. in 2 weeks, just so I have as much info as possible before making the decision. Yikes.

Mercer - 129 days ago.
Yeah, the tests aren't completely accurate. All they can do is give you an idea of your risks. Like riknlee said, the only way to know anything for sure is to get an amnio or CVS test. The CVS they can only do early on but the amnio can be done at any point during the pregnancy. The only reason you might want to get it done earlier on is if you are planning on terminating depending on the results. My husband and I knew we wouldn't terminate regardless but wanted to know just to be prepared so I had my amnio at 22 weeks. We are very blessed and everything was normal. It's a very scary thing to go through. I don't wish it upon anybody.

riknlee - 129 days ago.
The AFP tests are notoriously incorrect with false positives and false negatives. Also ultrasound screening does not always pick up downs. I had an ultrasound and everything looked great, nothing to worry about. Luckily the AFP test was accurate in my case and an amnio revealed a downs syndrome pregnancy. You cant always be reassured by ultrasound or the AFP. If you are worried the only thing you can do is get an amnio or CVS if it is not too late

evangeline - 130 days ago.
I had the Nuchal Translucency done and had great results. Although my AFP results came back still normal, they are 1,000 less. Just curious if this is common with these tests.Thanks in advance!