North American Registry of Midwives (NARM) Practice Exam

If MSAFP levels are above normal during pregnancy, what condition might this indicate?

1. High blood pressure

2. Neural tube defects, multiple gestation, or fetal demise

3. Gestational diabetes

4. Ovarian cysts

The correct answer is: Neural tube defects, multiple gestation, or fetal demise

MSAFP, or maternal serum alpha-fetoprotein, is a protein produced by the fetus that can be measured in the mother's blood during pregnancy. Elevated MSAFP levels are significant as they can be indicative of specific fetal conditions. When MSAFP levels are above normal, it often suggests the possibility of neural tube defects, such as spina bifida or anencephaly, where the neural tube does not close properly. Additionally, high MSAFP levels can indicate multiple gestations, meaning the mother is carrying more than one fetus, which naturally increases this protein's production. Moreover, elevated levels can also point towards fetal demise, where a fetus has died in utero. The other options provided do not directly relate to elevated MSAFP levels. High blood pressure, gestational diabetes, and ovarian cysts are not conditions linked with abnormal levels of MSAFP in the context of pregnancy screening; they do not typically result in changes in this specific protein's concentration in the mother’s bloodstream. Hence, recognizing the strong association between elevated MSAFP and the mentioned conditions is crucial for maternal-fetal health assessment.