alpha-fetoprotein screening (AFP)

I had my AFP done on Monday. The AFP test is "a blood test that measures the level of alpha-fetoprotein in the mothers' blood during pregnancy. AFP is a protein normally produced by the fetal liver and is present in the fluid surrounding the fetus (amniotic fluid), and crosses the placenta into the mother's blood" (Info from Lucile Packard Children's Hospital at Stanford).

Abnormal levels of AFP may signal the following:

• open neural tube defects (ONTD) such as spina bifida
• Down syndrome
• other chromosomal abnormalities
• defects in the abdominal wall of the fetus
• twins - more than one fetus is making the protein
• a miscalculated due date, as the levels vary throughout pregnancy

I got a phone call yesterday in my last half hour of work from a woman who is now my Genetic Counselor, Reena Patel. I checked my message right away, but couldn't call back since I was at work, and was immediately nervous. She gave me a phone number to call her back so we could discuss my AFP results. I called her the second I got into my car, but it was 5:45pm and I figured she wouldn't answer. To my surprise she answered right away and spent the next half an hour talking about everything with me (I don't think I've mentioned how much I love Kaiser but this is a perfect example of why I love them). Reena was wonderful to speak to and explained what the test is, what it measures, and then went through my results. Essentially the AFP measures protein levels in the blood that come from me and the baby. All of my levels came back normal (yay) except for one (not yay). My levels were slightly high for the protein that marks spina bifida (2.5 is normal and I was at a 3). Reena's job is to explain this to me without freaking me out (if that's even possible), explain what we're going to do about it, and then talk to me about how I'm feeling; and she did a great job at that. She explained to me that she's seen people with levels of 6 have a totally normal and healthy baby and that the elevated levels could really be about anything, not just spina bifida (I have high blood pressure and am on medication for it during the pregnancy, and Reena said that might be a factor for my high levels), and to try not to worry about it until there's something to worry about. But that's easier said than done. She said that the next step is to bring me to San Francisco to their Prenatal Diagnostic Services building and do an in depth ultrasound where trained techs will study the baby's spine to make sure everything looks normal and healthy. Before the ultrasound I'll spend an hour with Reena in a Genetic Counseling appointment discussing the ultrasound, spina bifida, and the AFP test again. If for some reason something doesn't look quite right in the ultrasound they'll do an amnio on me for further testing. She said that specifically for spina bifida the ultrasound does a better job than the amnio because it allows us look at the spine. We made an appointment for Monday, September 13th at 2:15pm with my ultrasound at 3:15pm. This ultrasound replaces my big 20 week ultrasound that was supposed to be Sept 27th, so we'll also be finding out the sex of the baby at this appointment (which I am very excited for).

I'm nervous, and scared, and just hope everything is alright. And Scott is overly rational which is just slightly annoying when all I want to do is be scared. But I think we're fine because spina bifida occurs in the first 28 days of pregnancy and at our last ultrasound (2 weeks ago) the baby was moving like crazy. We saw it huddled up against itself, moving arms & legs, fully extending the spine, and stretching. There was nothing to indicate that something was wrong, so hopefully we're fine. I'll keep everyone posted.