Maternal serum alpha-phytoprotein (MS-AFP) is a valuable test used as an indicator to diagnose some clinical abnormalities during pregnancy. The aim of this study was to investigate the role of MS-AFP measurement during mid-pregnancy in the management of prenatal care . Methods: This case-control study was conducted on two groups of singleton pregnant women, with MSAFP screening test (192 people) and without MSAFP screening test (192 people), in the 15-20th week of pregnancy referring to teaching hospitals in Ahvaz city in 2020. Based on the results of the MS-AFP test, mothers were divided into two groups with elevated levels (AFP≥2.5 MoM) and normal levels (AFP<2.5 MoM). Adverse pregnancy outcomes, including gestational diabetes, preeclampsia, intrauterine fetal death (IUFD), intrauterine growth restriction (IUGR), stillbirth, preterm birth, small for gestational age (SGA), and NICU admission, were investigated . Results: There was no significant difference in the adverse outcomes of pregnancy between the two groups; with and without MS-AFP screening (P<0.05). However, the incidence of adverse pregnancy outcome in women with elevated MS-AFP was significantly higher than in the normal MS-AFP group (38.1% vs. 11.7%; P=0.004). The incidence of preeclampsia (P=0.021), preterm birth (P=0.030), SGA (P=0.003), and hospitalization of newborns in the NICU (P=0.021) were higher in women with elevated MS-AFP than in women with normal MS-AFP. Conclusion: The results of this study showed that the increase in MS-AFP levels in mid-pregnancy was associated with increased risk of adverse pregnancy outcomes, including premature birth, preeclampsia, SGA, and NICU admission. The MS-AFP assay can help identify women at high risk of adverse outcomes early in the second trimester