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Pregnancy-associated plasma protein A (PAPP-A) as a first trimester serum biomarker for preeclampsia screening: a
Ismini Tzanaki1,2, Antonis Makrigiannakis2, Charoula Lymperopoulou1
1School of Medicine, European University Cyprus, Nicosia, Cyprus.
Insights
First-trimester pregnancy-associated plasma protein A (PAPP-A) serum levels are significantly lower in women who develop preeclampsia (PE). This finding suggests PAPP-A is a promising biomarker for early PE screening and timely intervention.
Area of Science:
- Reproductive Medicine
- Biomarker Discovery
- Maternal-Fetal Medicine
Background:
- Preeclampsia (PE) is a major cause of maternal and fetal morbidity.
- Early detection of PE is crucial for effective management and improved outcomes.
- Current screening methods have limitations in predicting PE accurately.
Purpose of the Study:
- To systematically review and meta-analyze the role of pregnancy-associated plasma protein A (PAPP-A) as a first-trimester serum biomarker for preeclampsia.
- To assess the diagnostic accuracy of PAPP-A in predicting early-onset and late-onset PE.
Main Methods:
- Systematic literature search of PubMed, Medline, and Cochrane Library up to November 2022.
- Inclusion of prospective case-control and cohort studies published in English.
- Meta-analysis of PAPP-A serum levels in first-trimester pregnant women for PE screening.
Main Results:
- Analysis of 22 studies involving 33,651 pregnant women, with 2001 diagnosed with PE.
- Significantly lower PAPP-A levels were observed in women with early-onset PE (MD: -0.24), late-onset PE (MD: -0.15), and overall PE cases (MD: -0.17).
- The observed differences were statistically significant (p < 0.00001 for total cases).
Conclusions:
- PAPP-A demonstrates potential as a predictive biomarker for early preeclampsia screening.
- Early identification of women at risk for PE can facilitate individualized treatment strategies.
- Utilizing PAPP-A may lead to improved maternal and fetal outcomes through timely intervention.
Objective:
The aim of this study is to systematically examine the role of the pregnancy-associated plasma protein A (PAPP-A) serum biomarker in the first trimester screening of preeclampsia (PE).
Materials And Methods:
A systematic search of the literature was conducted on PubMed via Medline, and Cochrane Library up to 8 November 2022, for prospective studies evaluating PAPP-A serum levels in first trimester pregnant women as a screening biomarker for PE. Eligible were all prospectively designed case-control or cohort studies, published in English. Two investigators independently examined the studies and the studies' characteristics were extracted. Newcastle-Ottawa Scale (NOS) for case-control and cohort studies were applied to assess the risk of bias. For the quantitative analysis of the studies, a meta-analysis was also performed.
Results:
A total of 22 studies including 33,651 pregnant women were assessed, of whom, 2001 were diagnosed with PE. A meta-analysis was performed, showing that PAPP-A levels in the first trimester were significantly lower in early onset preeclamptic women (MD: -0.24, 95% CI: -0.37, -0.11, p = .0002), late onset (MD: -0.15, 95% CI: -0.25, -0.05, p = .03), and total preeclamptic cases (MD = -0.17, 95% CI = -0.23, -0.11, p < .00001) when compared with controls.
Conclusions:
Our results suggest that PAPP-A can be a promising predictor in early screening for PE; hence, women at risk can be diagnosed early in their pregnancy stage and benefit from individualized PE treatment before it progresses.
