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Expert Q&A:
Can you explain how the MSAFP test works?

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Margaret Freda
Answered by Margaret Freda Ed.D., R.N., C.H.E.S., F.A.A.N.
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"I've been a professional nurse working with pregnant women and parenting families since 1966," says Margaret Comerford Freda. "Pregnant women and parents need to know as much as possible about their own health and that of their children."

Margaret Comerford Freda, Ed.D., R.N., C.H.E.S., F.A.A.N., is a Professor in the Department of Obstetrics &; Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, and also serves as Director of Patient Education Programs for that department. Since 1993, Dr. Freda has been the Consultant for Nursing at the National March of Dimes Birth Defects Foundation and the Chair of the National March of Dimes Nurse Advisory Council. In addition, Dr. Freda serves as the editor of MCN, The American Journal of Maternal Child Nursing.

Dr. Freda received her Master's Degree in Nursing from New York University and her doctorate in Health Education from Columbia University. She has worked in women's health for her entire professional career. Dr. Freda has published 50 research articles in professional journals, and is a frequently invited speaker at nursing and medical conferences. She has written two books: Perinatal Patient Education, published by Lippincott Williams &; Wilkins, and Miscarriage After Infertility, published by Fairview Press, written with her daughter Carrie Semelsberger, who is also a nurse.

Dr. Freda has received several noteworthy awards, such as the Distinguished Professional Service Award and the First National Award for Excellence in Nursing Research from the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), the Woman of Distinction Award and the Maternal Child Nurse of the Year Award from the March of Dimes, the Patient Care Award for Excellence in Patient Education from the American Academy of Family Physicians, the Research Recognition Award from Molloy College, and several Outstanding Research Paper awards at national conferences. She serves on the Scientific Advisory Council for the March of Dimes, and was selected to serve on the Select Panel of the Centers for Disease Control to advise on prenatal health. Dr. Freda has developed patient education booklets and videotapes that are now distributed nationally.

Dr. Freda has been married for four decades. She has two daughters, two sons-in-law, three grandsons, and a granddaughter.
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Question


Can you explain how the MSAFP test works?

Answer


MSAFP testing confuses lots of people! The MSAFP test is a screening test, not a diagnostic test. It tells us only that there's a possibility of a problem, not that there really is a problem.

MSAFP is a substance made by the fetus that shows up in the mother's blood. If there's too much MSAFP in the mother's blood, it could mean that the baby has something like spina bifida. If there's not enough MSAFP in the mother's blood, it could mean that the baby has Down's syndrome. The MSAFP test can only be done at a certain time in pregnancy (between 14 and 19 weeks).

It's a good test, but not foolproof. First, the woman has to be sure about when she became pregnant. Second, the results are dependent on whether she's having one baby, twins, or more. There are other things that can make the test results seem wrong as well. Even when a woman is sure of her dates, in about 5 percent to 8 percent of cases the result comes back positive, but the baby has no problem. That's why, when a test comes back positive, the doctor will often repeat the test or do an amniocentesis (taking some amniotic fluid out of the uterus) to really find out what's happening. An amniocentesis is a diagnostic test, meaning that a real diagnosis can be made based on the results. I hope this helps you understand this test better.
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