Harm or help? Maternal AFP race adjustments
October 2024—Using a race adjustment in maternal serum alpha-fetoprotein screening has physicians sitting on the fence these days. Including race in calculating risk for open neural tube defects has been a longstanding practice in medicine. Adjusting for higher rates of AFP levels seen in Black pregnant patients, proponents say, allows this population to receive equitable care. That premise lies on one side of the fence. On the other are those who maintain the practice is suspect, even harmful, and that the routine use of a race-based adjustment should stop. With the experience of dropping raced-based adjustments to estimated glomerular filtration rates still fresh in many minds, physicians are now deciding whether to keep or drop the adjustment for maternal serum AFP, even ahead of any potential changes to guidance by groups such as the CAP. Little wonder. Because as anyone who has ever sat on a fence knows, it can easily become a shaky, even painful, perch.