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First trimester PAPP-A2, PAPP-A and hCGβ in small-for-gestational-age pregnancies

Young Bae Hansen, Vibeke Myrhøj, Finn Stener Jørgensen

    Clinical Chemistry and Laboratory Medicine
    |November 7, 2015
    PubMed

    Insights

    First-trimester PAPP-A levels are lower in pregnancies resulting in small-for-gestational-age (SGA) neonates. However, PAPP-A2 and hCGβ levels are not altered, though PAPP-A2 may be elevated in SGA cases with severe preeclampsia.

    Area of Science:

    • Reproductive biology and endocrinology.
    • Biomarker discovery in pregnancy.

    Background:

    • Pregnancy-associated plasma protein-A2 (PAPP-A2) is a protease involved in the insulin-like growth factor (IGF) system, crucial for fetal development.
    • Establishing reference ranges for PAPP-A2, PAPP-A, and hCGβ in early pregnancy is essential for understanding fetal growth regulation.

    Purpose of the Study:

    • To establish first-trimester median curves for PAPP-A2, PAPP-A, and hCGβ in singleton pregnancies.
    • To investigate associations between altered levels of these biomarkers and the development of small-for-gestational-age (SGA) neonates, considering maternal hypertension and proteinuria.

    Main Methods:

    • A case-control study involving 985 women with normal-weight neonates and 170 women with SGA neonates.
    • PAPP-A2 was measured using ELISA, while PAPP-A and hCGβ were measured via an automatic analyzer.
    • Median curves were established from 8+1 to 14+0 weeks, with all values converted to multiples of the median (MoM).

    Main Results:

    • SGA cases showed lower PAPP-A MoM compared to controls before stratification; PAPP-A2 and hCGβ MoM were unaffected.
    • After stratification, normotensive SGA pregnancies exhibited lower PAPP-A2 MoM and PAPP-A MoM than normotensive controls.
    • Severe preeclamptic women delivering SGA neonates had higher PAPP-A2 MoM than normotensive SGA pregnancies.

    Conclusions:

    • First-trimester PAPP-A levels are lower in pregnancies complicated by SGA, while PAPP-A2 and hCGβ levels remain unchanged.
    • Elevated PAPP-A2 levels in the first trimester may be associated with pregnancies complicated by both severe preeclampsia and SGA.
    Abstract

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