Prenatal detection of neural tube defects by maternal serum alphafetoprotein assay.

Mass screening for fetal neural tube defects using maternal serum alpha-fetoprotein assay as the initial test is financially justified in South Africa, despite the relatively low incidence of these defects in this country, using enzyme-linked immunosorbent assay. This technique is efficient and inexpensive and lends itself to mass screening. We report a pilot study in which 3153 maternal serum samples were received during a 4-month period. Of these 3102 were assayed and the outcome of pregnancy was recorded in 2069 cases. On the first assay 147 (4.7%) of the women had serum alpha-fetoprotein levels which were high for the gestational dates given, but in retrospect about half of these had been misinterpreted because of incorrect dates. Among the remainder, 6 women proved to be carrying twins, 4 aborted spontaneously, 10 delivered prematurely or had infants with intra-uterine growth retardation, and 4 had a fetus with a neural tube defect. Two affected fetuses were missed by screening, in both cases because serum was taken after 20 weeks gestation. In this sample the incidence in Indians (1/1000)and Coloureds (1/600) was as expected, but in Whites it was much higher (1/130), which probably reflects a sampling error and indicates that the epidemiology of neural tube defects in South Africa requires investigation.