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Pregnancy associated plasma protein A: An indicator of adverse obstetric outcomes in a South India population
Krupa H Shah1, Afsha Anjum1, Parvathi Nair1
1Melaka Manipal Medical College, Manipal Acedemy of Higher Education, Department of Obstetrics and Gynecology, Manipal, India.
Insights
Low pregnancy-associated plasma protein A (PAPP-A) levels in early pregnancy indicate a higher risk for adverse fetal and maternal outcomes. Closer monitoring of these pregnancies is recommended to improve outcomes.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Biochemistry in Pregnancy
Background:
- First trimester aneuploidy screening (FTAS) is standard antenatal care.
- Serum markers like PAPP-A are crucial for FTAS.
- The role of PAPP-A in specific adverse pregnancy outcomes requires further investigation.
Purpose of the Study:
- To assess the association between low maternal PAPP-A levels (≤5th percentile) during the first trimester and adverse fetal-maternal outcomes.
- To compare pregnancy outcomes in a cohort with low PAPP-A versus a control group with PAPP-A >5th percentile in Southern India.
Main Methods:
- A prospective study followed 1800 pregnancies.
- 108 pregnancies with PAPP-A ≤5th percentile formed the study group.
- A matched control group of 288 pregnancies with PAPP-A >5th percentile was compared.
Main Results:
- Low PAPP-A was associated with a significantly higher incidence of major fetal anomalies (OR: 1.87).
- Significantly increased rates of preterm delivery (OR: 2.1), small-for-gestation-age fetuses (OR: 2.3), and low birthweight babies (OR: 2.12) were observed.
- Positive likelihood ratios were found for preterm delivery and low birthweight.
Conclusions:
- Pregnancies with low PAPP-A are at increased risk for obstetric complications.
- Enhanced surveillance is recommended for pregnancies identified with low PAPP-A.
- Further research into intervention strategies for these high-risk pregnancies is warranted.
Objective:
First trimester aneuploidy screening (FTAS) has become an integral part of antenatal care in most of centers in India. The serum markers used for FTAS are pregnancy-associated plasma protein A (PAPP-A) and beta human chorionic gonadotropin. In the present study, we aimed to assess the role of PAPP-A in specific adverse fetal maternal events. To analyze pregnancy outcomes with low maternal PAPP-A (≤5th percentile) at the FTAS screening test in southern India, and them compared with a control group of >5th percentile value.
Materials And Methods:
A total of 1800 consecutive pregnancies in the first trimester were followed up with PAPP-A levels. The study group consisted 108 subjects, which was compared with a matched control group of 288 subjects. The outcomes considered were spontaneous abortions, fetal anomalies, preterm delivery (PTD), hypertension in pregnancy, intrauterine growth restriction, gestational diabetes, mode of delivery, and birthweight.
Results:
For our grouped data, the 5th percentile value for PAPP-A was 0.49 multiple of medians, (incidence-6%). The incidence of fetal major anomalies was higher in the study group [odds ratio (OR): 1.87]. The incidence of minor anomalies, gestational diabetes, and hypertensive disorders was higher in the study group but not statistically significant. The total rate of PTDs (OR:2.1), small-for-gestation-age fetuses (OR:2.3), and low birthweight babies (OR- 2.12) was significantly higher in the study group. We found positive likelihood ratio of 1.4 for PTD, 2 for <5th percentile birthweight, and 1.7 for <10th centile birthweight.
Conclusion:
Low PAPP-A pregnancies are at risk of various obstetric complications. Hence, such a pregnancy should have closer surveillance. Further research work on intervention strategy is needed.
