Association of extreme first-trimester free human chorionic gonadotropin-β, pregnancy-associated plasma protein A, and nuchal translucency with intrauterine growth restriction and other adverse pregnancy outcomes

Krantz, David; Goetzl, Laura; Simpson, Joe Leigh; Thom, Elizabeth; Zachary, Julia; Hallahan, Terrence; Silver, Richard K.; Pergament, Eugene; Platt, Lawrence D.; Filkins, Karen; Johnson, Anthony; Mahoney, Maurice J.; Hogge, W. Allen; Wilson, R. Douglas; Mohide, Patrick; Hershey, Douglas W.; Wapner, Ronald J.

doi:10.1016/j.ajog.2004.05.068

Cited by 255 publications

(275 citation statements)

References 18 publications

Supporting

Mentioning

223

Contrasting

Unclassified

Order By: Relevance

“…In this study, PAPP-A levels of ≤0.3 MoM were predictive of increased risk of low birth weight and premature birth. Increased risk of low birth weight, intrauterine growth retardation and premature birth in women with low PAPP-A has been noted by others (Dugoff et al, 2004;Kabili et al, 2004;Krantz et al, 2004). In contrast, other studies have found an association between low PAPP-A and increased risk of low birth weight or intrauterine growth retardation, but not with preterm birth (Ong et al, 2000;Yaron et al, 2002a;Kwik and Morris, 2003;Tul et al, 2003).…”

Section: Low Papp-a and Adverse Outcomesmentioning

confidence: 84%

“…This cut-off was chosen in view of work by Krantz et al (2004) and Dugoff et al (2004) who examined PAPP-A at <1st and 5th centiles in women screened with combined FTS. In these articles the 1st centile was equivalent to 0.29 and 0.28 MoM respectively and the 5th centile was equivalent to 0.44 and 0.42 MoM respectively.…”

Section: Methodsmentioning

confidence: 99%

“…Most literature has focused on the individual components of the screen; increased fetal NT (Adekunle et al, 1999;Souka et al, 2001;Cheng et al, 2004;Dugoff et al, 2004;Kabili et al, 2004;Krantz et al, 2004), low maternal PAPP-A (Ong et al, 2000;Ochshorn et al, 2001;Yaron et al, 2002a;Kwik and Morris, 2003;Dugoff et al, 2004;Kabili et al, 2004;Krantz et al, 2004) and abnormal free *Correspondence to: Sandie L. Barrett, Western Diagnostic Pathology, Symbion Health, Western Australia, Australia. E-mail: sandieb@aapt.net.au β-hCG levels (Ong et al, 2000;Yaron et al, 2002b;Dugoff et al, 2004;Kabili et al, 2004;Krantz et al, 2004) and their associations with adverse pregnancy outcomes. However, there is less information on the capacity of the combined first-trimester screen result to predict pregnancies at increased risk of adverse fetal outcome.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Use of the combined first‐trimester screen result and low PAPP‐A to predict risk of adverse fetal outcomes

Barrett¹,

Bower

Hadlow³

2008

Prenatal Diagnosis

View full text Add to dashboard Cite

ObjectivesTo investigate associations between combined first‐trimester screen result, pregnancy associated plasma protein‐A (PAPP‐A) level and adverse fetal outcomes in women.MethodsPregnancy outcomes for 10 273 women participating in a community based first‐trimester screening (FTS) programme in Western Australia were ascertained by record linkage to birth and birth defect databases. A first‐trimester risk cut‐off of ≥ 1 in 300 defined screen positive women.ResultsScreen positive pregnancies were more likely to have Down syndrome and birth defects (chromosomal or nonchromosomal) than screen negative pregnancies. When birth defects were excluded, screen positive pregnancies were at increased risk of pregnancy loss, low birth weight and preterm birth. Pregnancies with low PAPP‐A (⩽0.3 multiples of the median (MoM)) had higher risk of chromosomal abnormality, birth defect, preterm birth, low birth weight, or pregnancy loss, compared to those with PAPP‐A > 0.3 MoM. In pregnancies without birth defects, low PAPP‐A was a stronger predictor of preterm birth, low birth weight or pregnancy loss than a screen positive result.ConclusionsWomen with positive screen or low PAPP‐A were at increased risk for some adverse fetal outcomes. The sensitivity of these parameters was insufficient to support primary screening, but increased surveillance during pregnancy may be appropriate. Copyright © 2008 John Wiley & Sons, Ltd.

show abstract

Section: Low Papp-a and Adverse Outcomesmentioning

confidence: 84%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Use of the combined first‐trimester screen result and low PAPP‐A to predict risk of adverse fetal outcomes

Barrett¹,

Bower

Hadlow³

2008

Prenatal Diagnosis

View full text Add to dashboard Cite

show abstract

“…In the placenta, hCG is well known to facilitate trophoblastic differentiation (Licht et al, 2001, Malassine & Cronier, 2002, and was reported to induce the expression of specific genes such as VEGF, leukemia inhibitory factor, and MMP-9, all central to the establishment of the feto-maternal interface (Licht et al, 2007, Zygmunt et al, 2002. In human placenta, hCG is primarily produced by the syncytiotrophoblast and to a certain extent by the cytotrophoblast (Kirkegaard et al, 2011, Krantz et al, 2004, Rao & Lei, 2007, Shi et al, 1993. In normal pregnancies, detectable levels of hCG begin to appear in the maternal circulation about 2-3 weeks after conception and the peak is observed at ~8-9 wg before declining significantly in the later stages of pregnancy.…”

Section: Regulation By Human Chorionic Gonadotropin (Hcg)mentioning

confidence: 99%

Role of EG-VEGF in Human Placentation: Physiological and Pathological Implications

Hoffmann¹,

Brouillet²,

Benharouga³

et al. 2012

Recent Advances in Research on the Human Placenta

View full text Add to dashboard Cite

“…Several recent studies have shown an association between low first-trimester maternal serum pregnancy associated plasma protein-A (PAPP-A) levels and the subsequent development of pregnancy complications, including pre-eclampsia Smith et al, 2002;Yaron et al, 2002;Tul et al, 2003;Dugoff et al, 2004;Krantz et al, 2004;Spencer et al, 2005aSpencer et al, , 2006aSpencer et al, ,b, 2007aCowans and Spencer, 2007).…”

Section: Introductionmentioning

confidence: 99%

Low levels of maternal serum PAPP‐A in the first trimester and the risk of pre‐eclampsia

Spencer

Cowans²,

Nicolaides³

2007

Prenatal Diagnosis

183

113

View full text Add to dashboard Cite

Background Low levels of pregnancy associated plasma protein-A (PAPP-A) have been previously shown to be associated with pregnancies that subsequently develop pre-eclampsia. The objective of this study was to establish the relative risk for pre-eclampsia at various PAPP-A levels as an aid to counselling and follow up of pregnancies.Methods Maternal serum PAPP-A and free ß-human chorionic gonadotropin (ß-hCG) levels at 11 to 13 weeks of gestation from 224 singleton pregnancies that subsequently developed pre-eclampsia were compared to those from 47 770 normal singleton pregnancies resulting in live births after 37 weeks with birth weight greater than or equal to the 10th centile of normal for gestation. In all cases, the measured PAPP-A and free ß-hCG levels were expressed as multiple of the median (MoM). The association between metabolite levels and the incidence of pre-eclampsia was assessed by comparing the relative incidence at a number of MoM cut-offs and at various centiles. At various marker levels, the likelihood ratio for pre-eclampsia was also calculated. ResultsIn the pre-eclampsia group the median PAPP-A MoM was significantly reduced (0.772 MoM, p < 0.0001) whilst the median free β-hCG MoM was not different from controls (0.981 MoM, p = 0.26). With decreasing levels of PAPP-A, the likelihood ratio for pre-eclampsia increased. At the 5th centile of normal (PAPP-A MoM 0.415) the odds ratio was increased 4-fold and at this cut-off 15% of cases of pre-eclampsia would be identified. ConclusionsThe graphical presentation of a likelihood ratio curve for pre-eclampsia at any PAPP-A MoM level is likely to be useful in counselling women with low levels of PAPP-A and a normal karyotype. Use of low levels of PAPP-A for selecting women for further follow-up with uterine artery Doppler may further improve the clinical discrimination.

show abstract

Association of extreme first-trimester free human chorionic gonadotropin-β, pregnancy-associated plasma protein A, and nuchal translucency with intrauterine growth restriction and other adverse pregnancy outcomes

Cited by 255 publications

References 18 publications

Use of the combined first‐trimester screen result and low PAPP‐A to predict risk of adverse fetal outcomes

Use of the combined first‐trimester screen result and low PAPP‐A to predict risk of adverse fetal outcomes

Role of EG-VEGF in Human Placentation: Physiological and Pathological Implications

Low levels of maternal serum PAPP‐A in the first trimester and the risk of pre‐eclampsia

Contact Info

Product

Resources

About