Association between first-trimester maternal serum pregnancy-associated plasma protein-a and adverse pregnancy outcome.

Obstet Gynecol Surv. 2004 Jul;59(7):495-6.
  
Association between first-trimester maternal serum pregnancy-associated plasma 
protein-a and adverse pregnancy outcome.

Kwik M, Morris J.

University of Sydney, Department of Obstetrics and Gynaecology, Perinatal Research 
Group, North Shore Obstetric and Gynaecological Ultrasound, Kolling Institute 
and Pacific Laboratory Medicine Sevices, Royal North Shore Hospital, Sydney, 
Australia.

Pregnancy-associated plasma protein-A (PAPP-A) is a glycoprotein derived from 
trophoblasts that cleaves insulin-like growth factor-binding proteins and 
augments the action of insulin growth factor. Maternal levels of PAPP-A are 
higher in primigravid and multiple pregnancies, and correlate positively with 
placental weight. Apart from being a marker of aneuploidy, low PAPP-A levels 
could be evidence of impaired placental formation and implantation. This 
retrospective review attempted to determine whether first-trimester PAPP-A 
levels are associated with intrauterine growth restriction, preterm delivery, 
or stillbirth. Pregnancy outcomes were sought in a medical records review and 
by postal questionnaire. All 827 women having serum PAPP-A estimates had a normal 
karyotype. Along with 2 neonatal deaths and 6 intrauterine deaths, 13 newborn 
infants had a birth weight below the third percentile and 55 weighed below the 
10th percentile. Ninety-six women delivered prematurely. Four of the 6 intrauterine 
deaths were associated with a low maternal serum PAPP-A level less than 0.5 
multiples of the median (MOM). Infant mortality was 3.8% in pregnancies with a 
PAPP-A level less than 0.5 MOM and 0.27% in those with higher levels for a relative 
risk of 13.75. Low levels of PAPP-A were associated with birth weight below the 
10th percentile, but not with weight below the third percentile. Low maternal 
PAPP-A levels did not correlate with preterm delivery. This study indicates that 
low first-trimester levels of PAPP-A in maternal serum are associated with adverse 
fetal outcomes, including fetal death in utero and intrauterine growth retardation. 
An estimate of PAPP-A, by itself or combined with antenatal ultrasonography, might 
help assess the risk of such outcomes in high-risk pregnancies.

PMID: 15199254 [PubMed - in process] 


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