Association between first-trimester maternal serum pregnancy-associated plasma protein-A and obstetric complications

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Reproductive Endocrinology

Background:

• First-trimester screening is crucial for identifying pregnancies at risk.
• Pregnancy-associated plasma protein-A (PAPP-A) is a biomarker used in early pregnancy assessment.
• Preeclampsia (PE), small-for-gestational age (SGA) fetus, and preterm delivery (PD) are significant adverse pregnancy outcomes.

Purpose of the Study:

• To evaluate the association between first-trimester maternal serum PAPP-A levels and the development of PE, early PE, SGA fetus, and PD.
• To determine the predictive value of PAPP-A for these adverse pregnancy outcomes.

Main Methods:

• Retrospective analysis of 12,355 deliveries between 2008 and 2011.
• Maternal serum PAPP-A multiples of the median (MoM) were categorized into percentiles.
• Statistical analysis using Mann-Whitney U-test and chi-squared test to compare outcomes.

Main Results:

• Significantly lower PAPP-A MoM levels were observed in women who developed PE, early PE, SGA fetus, and PD compared to the general study population.
• A lower PAPP-A MoM percentile was associated with increased odds ratios for developing PE, early PE, SGA fetus, and PD.
• The odds ratio for PE ranged from 1.76 to 2.41 for the lowest PAPP-A percentiles.

Conclusions:

• First-trimester maternal serum PAPP-A is significantly lower in pregnancies affected by PE, SGA fetus, and PD.
• Maternal serum PAPP-A, when used alone, demonstrates poor performance as a screening test for PE, SGA fetus, and PD.
• Further research may explore PAPP-A in combination with other biomarkers for improved screening.