Usefulness of PAPP-A in predicting adverse pregnancy outcome

• Author Details:   
• Madhumathi ^*
• Jaya Vijayaraghavan

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Objective: The First trimester Pregnancy-associated plasma protein-A (PAPP-A) is one of the marker for the screening. The purpose of this study was to evaluate whether low levels of first trimester PAPP-A alone is predictive for adverse pregnancy outcomes such as intrauterine growth restriction, gestational hypertension, pre-eclampsia, low birth weight and preterm labour.
Study design: This study included patients with singleton pregnancies who underwent combined first trimester screening using nuchal translucency (NT) and maternal serum free beta-human chorionic gonadotrophin (free beta-hCG) and PAPP-A at 11-13+6weeks gestation. The incidence of various adverse pregnancy outcomes such as spontaneous preterm labor, fetal growth restriction (FGR), pre-eclampsia and gestational hypertension and low birth weight were correlated in relation to Abnormal PAPP-A values(<0.4MOM).
Results: In our study out of the 1100 patient were enrolled 167 women were lost to follow up and 9 were excluded.924 patients followed up for adverse pregnancy outcome. Abnormal PAPPA was found in 12.5%. IUGR was found in 10.5% (n=12;OR-5.1) preeclampsia in 8.8%(n=10;OR-2.7), Gestational hypertension 3.5% (n=4;OR-0.552), Preterm labour 15.8% (n=18;OR-2.6) and Low birth weight in 33.3% (n=38; P vlaue-0.001) women of which 25.4% delivered at term and only 7.9% delivered as preterm.
Conclusion: This study demonstrated that maternal serum PAPP-A is low in pregnancies resulting in Intrauterine growth restriction, Pre-eclampsia, Preterm labour and Low birth weight. However the sensitivity of Abnormal PAPP-A to predict adverse pregnancy outcomes is poor. Thus, PAPP-A is a good predictor for adverse pregnancy outcome mainly IUGR but hence cannot be used for screening test.

Keywords: Intrauterine growth restriction, Pregnancy associated plasma protein A, Fetal Growth restriction, Growth factor binding protein, Multiples of median, Adverse pregnancy outcome