Late pregnancy associated plasma protein A levels decrease in preterm labor.

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Biomarker Research

Background:

• Preterm birth remains a leading cause of neonatal morbidity and mortality.
• Identifying reliable predictors of preterm birth is crucial for timely intervention.
• Pregnancy-associated plasma protein-A (PAPP-A) is a placental hormone with potential roles in pregnancy complications.

Purpose of the Study:

• To assess the utility of late (at admission) PAPP-A levels in predicting preterm birth among women presenting with symptoms of preterm labor.
• To determine specific PAPP-A cutoff values for predicting spontaneous preterm delivery and differentiating threatened preterm labor from actual preterm birth.

Main Methods:

• A prospective cohort study included singleton gestations between 23-37 weeks presenting with preterm labor symptoms.
• PAPP-A levels were measured at admission.
• Receiver operator characteristic (ROC) curves were used to calculate predictive values for preterm delivery (<37 weeks) and threatened preterm delivery.

Main Results:

• Women who delivered preterm (<37 weeks) had significantly lower mean PAPP-A levels (33.4 mIU/ml) compared to controls (52.5 mIU/ml) (p=0.003).
• Women with threatened preterm labor had intermediate PAPP-A levels (47.6 mIU/ml), significantly lower than controls but not significantly different from those delivering preterm.
• A PAPP-A level < 29.8 mIU/ml was associated with an increased risk of preterm birth.

Conclusions:

• Late PAPP-A levels are decreased in women experiencing preterm labor.
• A PAPP-A cutoff of < 29.8 mIU/ml effectively predicts preterm birth, supporting the need for active management.
• A cutoff of 33.6 mIU/ml can help distinguish between preterm birth and threatened preterm labor reaching term.