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Low PAPP-A Levels and Growth in Twin Pregnancies
Ioakeim Sapantzoglou1, Dimitrios Papageorgiou2, Afroditi Maria Kontopoulou1
11st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Life (Basel, Switzerland)
|January 28, 2026
Summary
Low PAPP-A levels in early pregnancy can predict low birthweight in twins. Higher PAPP-A multiples of median (MoM) values reduce the risk of having at least one twin with low birth weight.
Area of Science:
- Maternal-fetal medicine
- Reproductive endocrinology
- Neonatal outcomes
Background:
- Multiple gestations are linked to higher rates of low birthweight compared to singletons.
- Early identification of twins at risk for low birthweight is crucial for timely intervention.
Purpose of the Study:
- To investigate the predictive potential of first-trimester biochemical markers (PAPP-A, free β-hCG) and biophysical indices (uterine artery Doppler) for low birthweight in twin pregnancies.
Main Methods:
- Retrospective cohort analysis of 400 twin pregnancies.
- Inclusion of maternal demographics, medical history, aneuploidy markers, fetal anatomy, mean arterial pressure, uterine artery assessment, and serum PAPP-A and free β-hCG.
- Outcomes assessed: Birthweight (BW) ≤ 3rd centile and BW ≤ 10th centile in one or both twins.
Main Results:
- PAPP-A multiples of the median (MoM) were significantly lower in pregnancies with BW ≤ 10th centile in one or both twins.
- PAPP-A MoM showed a statistically significant, albeit low, prognostic value for predicting BW ≤ 10th centile.
- No significant association was found between BW ≤ 3rd centile and any of the studied parameters.
Conclusions:
- Low PAPP-A levels are associated with an increased risk of low birthweight (BW ≤ 10th centile) in one or both twins.
- Higher PAPP-A MoM values were found to halve the risk of at least one twin having low birthweight.
- Maternal biophysical and other biochemical indices did not demonstrate predictive value for low birthweight in this cohort.
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