الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
considerable in many countries, analysis of the epidemiological alion clearly indicates that non-communicable diseases, including ~ditary disorders and congenital malformations are rapidly becoming olems of major public health concern. Prevention of congenital malformations at the secondary level by natal diagnosis is one of the major approaches adopted by WHO. chemical prenatal screening including MSAFP test is one of the major natal diagnosis procedures used worldwide. The racial difference rding the level of MSAFP was previously documented. Therefore, the sent work aimed at illustration of the normal distribution of MSAFP ong working pregnant women at the gestational age 16-18 weeks in exandria and identification of some of its determinants. The study was conducted through both cross sectional and spective approaches. It was carried out in antenatal clinics of BIO (Lauran, Wingat and nasha), Smouha MCB center and outpatient clinic of MRI. Two samples of pregnant women were enrolled in the study: mple 1: working pregnapt females+with -co:R9,’;lri’8tofy”’”oiLocongellital: their previous pregnancies if ~U1y (504 women). This sample \Vas llsed for determination of the cutoff points of the level of MSAFP beside determination of factors affecting this level. Sample 11: working pregnant females with history of congenital anomalies III their previous pregnancies (104 women). This b:rrouP was used to predict Iheir risk of congenital anomalies and adverse outcome by applying the culotfpoints ofMSAFP obtained from sample I. Pooled sample represents sample I and sample II excluding pregnancies which ended by congenital anomalies in the present pregnancy. Interviewing of the surveyed pregnant females was carried out using a structured scheduled Questionnaire. Anthropometric measurements (weight & height) were performed to all surveyed females and the BMI was calculated. Ultrasound was performed to one woman out of four in sample I and la all pregnant females in sample n. Matemal blood sample was collected from all, surveyed women. Matemal serum a- fetoprotein was meassured using IMMULITE AFP (DPC Ltd). The values of MSAFP were presented in IU/mL, percentiles and MOM before and after adjustment for maternal weight and twin pregnancy. The delivery and outcome data were obtained from the records of the newborn unit of Gamal Abdel Naser Ros~ital and maternity inpatient unit afSmouha MCR cent er. The mean ofMSAFP for sample 1 was 53.5 ::f:: 52.0 IU/mL. The 5th percentile value at 16th week gestation was 7.43 IU/mL 1I1creased to 18.49 IU/mL at the 18th week. The value for the 95th percentile at 16th week was 64.77 IV/mL increased to 183.1 IU/mL at 18th week. Regarding the Multiples of Median (MOM), the calculated median for sample 1 was 24.7 IU/mL at 16th week, 32.7 IU/mL at the 1 ih week and 56.4 IU/mL at 18th \\’eek.