Test Catalog

Test ID: AFPA    
Alpha-Fetoprotein, Amniotic Fluid

Useful For Suggests clinical disorders or settings where the test may be helpful

Screening for open neural tube defects or other fetal abnormalities


Follow-up testing for patients with elevated serum alpha-fetoprotein results or in conjunction with cytogenetic testing

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

If alpha-fetoprotein is positive, then acetylcholinesterase will be performed at an additional charge.

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Alpha-fetoprotein (AFP) is a single polypeptide chain glycoprotein with a molecular weight of approximately 70,000 Da. Synthesis of AFP occurs primarily in the liver and yolk sac of the fetus. It is secreted in fetal serum, reaching a peak at approximately 13 weeks gestation, after which it rapidly declines until about 22 weeks gestation and then gradually declines until term. Transfer of AFP into maternal circulation is accomplished primarily through diffusion across the placenta. Maternal serum AFP levels rise from the normal non-pregnancy level of 0.20 ng/mL to about 250 ng/mL at 32 weeks gestation.


If the fetus has an open neural tube defect, AFP is thought to leak directly into the amniotic fluid causing unexpectedly high concentrations of AFP. Other fetal abnormalities such as omphalocele, gastroschisis, congenital renal disease, and esophageal atresia; and other fetal distress situations such as threatened abortion, prematurity, and fetal demise, may also show AFP elevations. Decreased amniotic fluid AFP values may be seen when gestational age has been overestimated.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

< or =2.0 multiples of median (MoM)

Interpretation Provides information to assist in interpretation of the test results

A diagnostic alpha-fetoprotein (AFP) cutoff level of 2.0 multiples of median (MoM), followed by acetylcholinesterase (AChE) confirmatory testing on positive results, is capable of detecting 96% of open spina bifida cases with a false-positive rate of only 0.06% in nonblood-stained specimens.


AChE analysis is an essential confirmatory test for all amniotic fluid specimens with positive AFP results. Normal amniotic fluid does not contain AChE, unless contributed by the fetus as a result of open communication between fetal central nervous system (eg, open neural tube defects), or to a lesser degree, fetal circulation. All amniotic fluid specimens testing positive for AFP will have the AChE test performed. False-positive AChE may occur from a bloody tap, which may cause both elevated AFP and AChE levels.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

This test is for screening only.


Increases in alpha-fetoprotein (AFP) are not specific for neural tube defects, and the test must be used in combination with other procedures such as ultrasonography and acetylcholinesterase measurements.


Elevated AFP levels also can be caused by benign factors and incorrect gestational dating.


Negative results do not guarantee the absence of defects.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Assessing the Quality of Systems for Alpha-Fetoprotein (AFP) Assays Used in Prenatal Screening and Diagnosis of Open Neural Tube Defects: Approved Guideline. NCCLS I/LA17-A Vol 17. No 5. April 1997

2. Cuckle H: Prenatal screening using maternal markers. J Clin Med. 2014 May 9;3(2):504-520. doi:10.3390/jcm3020504

3. Bernard JP, Cuckle HS, Bernard MA, Brochet C, Salomon LJ, Ville Y: Combined screening for open spina bifida at 11-13 weeks using fetal biparietal diameter and maternal serum markers. Am J Obstet Gynecol. 2013 Sep;209(3):223.e1-5

Special Instructions Library of PDFs including pertinent information and forms related to the test