Early-onset severe preeclampsia by first trimester pregnancy-associated plasma protein A and total human chorionic...

Area of Science:

• Maternal-Fetal Medicine
• Reproductive Endocrinology
• Biochemical Markers in Pregnancy

Background:

• Early-onset severe preeclampsia poses significant risks to both mother and fetus.
• Accurate prediction of early-onset severe preeclampsia is crucial for timely intervention.
• First-trimester screening markers are increasingly utilized for risk assessment in pregnancy.

Purpose of the Study:

• To evaluate the association between first-trimester serum levels of PAPP-A and total hCG and the risk of developing early-onset severe preeclampsia.
• To determine if abnormal levels of PAPP-A and total hCG in early pregnancy predict increased risk for early-onset severe preeclampsia.

Main Methods:

• A large cohort study of singleton pregnancies (n=129,488) with integrated prenatal serum screening.
• Logistic binomial regression analysis was used to estimate the relative risk (RR) of early-onset severe preeclampsia.
• Serum levels of PAPP-A and total hCG were measured in the first trimester and compared between cases and controls.

Main Results:

• Low first-trimester PAPP-A or high first-trimester total hCG levels were associated with a significantly increased risk of early-onset severe preeclampsia, regardless of parity.
• Women with low PAPP-A (≤10th percentile in nulliparous, ≤5th in multiparous) or high total hCG (≥90th percentile in nulliparous, ≥95th in multiparous) had more than a threefold increased risk.
• Relative risks (RR) were 4.2 (95% CI, 3.0-5.9) for low PAPP-A and 3.3 (95% CI, 2.1-5.2) for high total hCG.

Conclusions:

• First-trimester measurements of PAPP-A and total hCG are valuable predictors of early-onset severe preeclampsia.
• Routine biochemical screening in early pregnancy provides unique risk information for this condition.
• These markers can aid in identifying high-risk pregnancies for closer monitoring and potential intervention.