Mass screening for open spina bifida needs careful consideration
Recent British experience with the use of α-fetoprotein (α-fp) levels in amniotic fluid and maternal blood to detect neural tube defects (NTDs) has confronted Americans with some difficult decisions. British studies have established that elevated α-fp levels in amniotic fluid are diagnostic for anencephaly and open spina bifida and that measurement of α-fp levels in the serum of pregnant women can also detect a high proportion of these fetal abnormalities. (Closed spina bifida is only sometimes associated with elevated α-fp levels.) However, the decision of whether to use amniocentesis in all high-risk pregnancies, to institute maternal serum screening for NTDs, or to do neither depends only partly on the sensitivity of the tests. Important nonmedical factors include financial costs and benefits of such programs, practical difficulties in implementing them, psychological benefits to parents, and the public's cooperation with the programs.