Blood tests during pregnancy?

July 20, 2012
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by Lindsey Wimmer, MSN, CPNP

When I mention the quad screen or AFP or other similar tests to my friends, most tell me that they refused them when they were pregnant.  Why?  The answer is that most women know these tests as the “Down Syndrome tests” – so they feel there isn’t a reason to have these tests done if they will continue with the pregnancy even if a genetic condition is found.

When I mention the same tests to obstetricians and midwives, most of them tell me that the majority of their patients refuse the tests – for the same reason as above.

I would like both groups to begin looking at these tests differently.  I could do an entire blog on the current value of these results – but I’m talking about how they may correlate to a risk of stillbirth.  This is a newer concept in interpreting these test results, but the studies are very intriguing.  AFP (alpha-fetoprotein) and PAPP-A (Pregnancy Associated Plasma Protein A) in particular have been related to stillbirth risks.

Recent studies have indicated that a high AFP (top 5%) have more than double the risk of stillbirth and that a low PAPP-A (lowest 5%) have a 50-x increase in stillbirth!  These are numbers that should catch everyone’s attention.  Both are indicators of placental function.  Placental function is extremely important to the heath and growth of the baby, and placental dysfunction is a factor in as many as half of all stillbirths.

While there is still much research needed, I feel it is important for health care providers to encourage more women to have these simple blood tests done.  We can learn much more than the chances of a genetic syndrome.  If a pregnancy is noted to have abnormal levels or at the extremes, then it would be prudent to simply monitor this pregnancy and the placenta more cautiously.  It will not be a magic cure for all stillbirths, but it might help some families avoid the pain of losing a child.

About the author:

Lindsey Wimmer, a Pediatric Nurse Practitioner, is Mom to four children; Garrett, stillborn in 2004, Grant, Bennett and Austyn. Lindsey is an adjunct instructor of pediatrics at the St. Catherine’s University in St. Paul, MN and also teaches Maternal Child Health at Hennepin Technical College in Eden Prairie, MN.   Lindsey and her husband Trent founded the Star Legacy Foundation shortly after Garrett’s birth when realizing that the numbers of stillbirths in the US were staggering and that very little was being done to determine the causes or find prevention initiatives. Visit the Star Legacy Foundation to learn more.


I agree! When we initially declined the AFP test, this is exactly what our doctors told us – that it can be an important indicator of placental problems during the pregnancy, and that it raises a red flag that warrants closer monitoring. I’m so glad they were on top of that!


That’s a really interesting point. I considered not having the tests at 12 weeks done, because we would continue with the pregnancy regardless of the outcome. But I have never considered that these tests would identify a risk of still birth.


Wow – great article. I am definitely going to request this test now, after losing Ruby at 38 weeks I wish I had more than “come back at 12 weeks” for my first pregnancy appointment, and no ultrasounds other than the 20-week scan. This pregnancy (I’m 6 weeks 2 days today) will be very different. Any other suggestions are totally welcome!

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