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Previous Volume 351:978-986 September 2, 2004 Number 10 Next

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ABSTRACT

Background Unexplained stillbirth and the sudden infant death syndrome (SIDS) share some features. A raised maternal serum level of alpha-fetoprotein during the second trimester of pregnancy is a marker of placental dysfunction and a strong predictor of the risk of unexplained stillbirth. It is unknown whether alpha-fetoprotein levels also predict the risk of SIDS.

Methods We linked a prenatal-screening database for women in western Scotland with databases of maternity, perinatal death, and birth and death certifications to assess the association between second-trimester levels of maternal serum alpha-fetoprotein and the subsequent risk of SIDS.

Results Among 214,532 women with singleton births, there were 114 cases of SIDS (incidence, 2.7 per 10,000 births among women with alpha-fetoprotein levels in the lowest quintile and 7.5 per 10,000 births among those with levels in the highest quintile). When the lowest quintile was used as a referent, the unadjusted odds ratios for SIDS for the second through fifth quintiles were 1.7 (95 percent confidence interval, 0.8 to 3.5), 1.8 (95 percent confidence interval, 0.9 to 3.7), 2.5 (95 percent confidence interval, 1.3 to 4.8), and 2.8 (95 percent confidence interval, 1.4 to 5.4), respectively (P for trend = 0.001). The risk of SIDS varied inversely with the birth-weight percentile and the gestational age at delivery; after adjustment for these factors, the odds ratios for SIDS were 1.7 (95 percent confidence interval, 0.8 to 3.5), 1.7 (95 percent confidence interval, 0.8 to 3.5), 2.2 (95 percent confidence interval, 1.1 to 4.4), and 2.2 (95 percent confidence interval, 1.1 to 4.3), respectively (P for trend = 0.01).

Conclusions There is a direct association between second-trimester maternal serum alpha-fetoprotein levels and the risk of SIDS, which may be mediated in part through impaired fetal growth and preterm birth.

Source Information

From the Department of Obstetrics and Gynaecology, Cambridge University, Cambridge (G.C.S.S.); the Medical Research Council Biostatistics Unit, Institute of Public Health, Cambridge (A.M.W., I.R.W.); the Department of Public Health, Greater Glasgow Health Board, Glasgow (J.P.P.); the Institute of Medical Genetics, Yorkhill National Health Service Trust, Glasgow (J.A.C.); and the Information and Statistics Division, Common Services Agency, Edinburgh (R.D.) — all in the United Kingdom.

Address reprint requests to Professor Smith at the Department of Obstetrics and Gynaecology, Cambridge University, Rosie Maternity Hospital, Robinson Way, Cambridge CB2 2QQ, United Kingdom, or at gcss2{at}cam.ac.uk.

Full Text of this Article

This article has been cited by other articles:

• Mizejewski, G. J. (2007). Physiology of Alpha-Fetoprotein as a Biomarker for Perinatal Distress: Relevance to Adverse Pregnancy Outcome. Exp. Biol. Med. 232: 993-1004 [Abstract] [Full Text]  
• Smith, G. C., Shah, I., White, I. R, Pell, J. P, Crossley, J. A, Dobbie, R. (2006). Maternal and biochemical predictors of spontaneous preterm birth among nulliparous women: a systematic analysis in relation to the degree of prematurity. Int J Epidemiol 35: 1169-1177 [Abstract] [Full Text]  
• Smith, G. C.S., White, I. R. (2006). Predicting the Risk for Sudden Infant Death Syndrome From Obstetric Characteristics: A Retrospective Cohort Study of 505011 Live Births. Pediatrics 117: 60-66 [Abstract] [Full Text]  
• (2004). Maternal AFP Correlated with SIDS. JWatch Women's Health 2004: 2-2 [Full Text]