This issue of The Journal contains a review of the largest single experience yet reported in the literature of the application of amniotic fluid α-fetoprotein (AFP) measurement in the prenatal diagnosis of fetal neural tube defects (p 2731). The author of the review, Aubrey Milunsky, MD, is a pediatrician and medical geneticist, director of the Genetics Division of the Eunice Kennedy Shriver Center in Waltham, Mass. His laboratory has been involved in the prenatal diagnosis of neural tube defects using AFP measurement since the early 1970s, and this experience has given him a unique insight into the advantages, limitations, and pitfalls of this technological advance.
As Dr Milunsky points out, a defect in the closure of the embryonic neural tube (anencephaly, exencephaly, iniencephaly, encephalocele, meningocele, or meningomyelocele) occurs in one in approximately 500 liveborn infants in the United States. A couple who has had a previous infant with a neural