The association of early-onset fetal growth restriction, elevated maternal serum alpha-fetoprotein, and the development of severe pre-eclampsia.

From Antenatal Diagnostic Center referrals over 22 months, consultations for early-onset fetal growth restriction versus skeletal dysplasia were retrospectively identified. Those with elevated maternal serum alpha-fetoprotein (MSAFP) levels are the focus of this report. All had an early ultrasound confirming menstrual dates and subsequent sonography at < 28 weeks with at least two fetal biometric measures delayed by > or = 2 standard deviations from mean values. Of the five patients identified, the mean gestational age at the time of diagnosis of fetal growth restriction was 23.3 +/- 2.9 weeks. All had normal karyotypes and normal amniotic fluid AFP. None of the patients had evidence of hypertension or pre-eclampsia at diagnosis of fetal growth restriction. All five gravidas subsequently developed severe pre-eclampsia from 5.5 to 12.5 weeks after documentation of fetal growth delay. Three developed HELLP syndrome. Pregnancies were continued a mean duration of 10-2 weeks, with all five delivering at preterm gestations (mean = 33.5 +/- 1.7 weeks) for maternal indications of severe pre-eclampsia. Unexplained early-onset fetal growth restriction in conjunction with unexplained elevations of MSAFP together consistently heralded the subsequent development of severe pre-eclampsia.