To the Editor.—
The Sept 21 report of Milunsky and Alpert1 presents important information as the United States anticipates widespread implementation of maternal serum α-fetoprotein (MSAFP) screening during pregnancy. Certain aspects of the report require comment.1. Within the first group of 15,000 screened patients, the authors' protocol called for a second maternal serum sample from patients with initial AFP elevation. In the second group of 6,000 screened patients, the authors report that 49% with elevated MSAFP levels opted for ultrasonography rather than for a second blood test. The authors have not compared the efficiency of ultrasonography with a second blood protocol in reducing the need for costly clinical follow-up while maintaining detection efficiency. Studies in New York2 and North Carolina,3 both of which utilize a second blood protocol, have demonstrated a 44% and 45% reduction, respectively, in the number of mothers requiring further clinical evaluations (due
Macri JN. Results and Benefits of a Maternal Serum α-Fetoprotein Screening Program. JAMA. 1985;253(16):2364–2365. doi:10.1001/jama.1985.03350400046015
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