Association of low levels of first trimester Pregnancy Associated Plasma Protein (PAPP-A) with adverse pregnancy outcomes: An observational study

Ranganathan, Archana; Fresen, John; Sarkar, Pampa

doi:10.15761/ogr.1000116

Cited by 4 publications

(4 citation statements)

References 45 publications

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“…Almost 17% of a newborn in the target group were small for gestational age below the 10 th percentile, higher than in Thompson study-7.44% [20]. Some studies show a significant difference in an adverse outcome in a group with PAPP-A below 0.4 MoM, probably because of different statistical power [21], [22].…”

Section: Discussionmentioning

confidence: 87%

Clinical Importance of Low Level of PAPP-A in First Trimester of Pregnancy - An Obstetrical Dilemma in Chromosomally Normal Fetus

Livrinova¹,

Petrov²,

Samardziski³

et al. 2019

Open Access Maced J Med Sci

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BACKGROUND: A variety of recent evidence exists about the clinical implication of low level of Pregnancy-associated plasma protein A (PAPP-A) in pregnancy. This glycoprotein is a protease, which releases the Insulin-like growth factor from IGFBP 4. Its role is a trophoblastic invasion of decidua, stimulation of cell mitosis and differentiation. It has an immunosuppressive effect in the placenta, inhibition of coagulation and complex role for integration of all these processes in the placenta. Level of PAPP-A (under 0.4 MoM-Multiple of Medians) in first-trimester screening in chromosomally and morphologically normal fetuses, could influence fetal weight, preeclampsia, premature birth and stillbirth. As a result of the complications mentioned above, there is implication on timing, mode of delivery and condition of the newborn. AIM: The study aims to evaluate the influence of low PAPP-A, measured in the first trimester on the outcome of pregnancy, with accent disorders which are the result of placental insufficiency. Also, gestational week, mode of delivery and condition of newborn secondary underlying conditions will be evaluated. MATERIAL AND METHODS: After given information and consultation about the expectation from the screening, pregnant women with a singleton pregnancy were tested for First Trimester Screening to estimate the risk for Trisomy 21, 13, 18- the most frequent chromosomopathies. After exclusion of chromosomopathies and congenital malformations, one hundred and fourteen patients enrolled in the study. The target group (n = 64) with PAPP-A below 0.4 MoM and control group (n = 50) with PAPP-A equal and above 0.4 MoM. An assessment of mode and time of delivery and presence of small for gestational age newborns, preeclampsia, premature birth and newborn condition at delivery was made. RESULTS: The percentage of the patients delivered in term was similar between the target group (n = 64) and the control group (n = 50), 82.81% vs 82.0% respectively. The rate of cesarean section was 29.7 % in the target group vs 32% in the control group. A significant difference was found about elective vs urgent cesarean section in favour of the target group. The difference was present about the complication in pregnancy before delivery, 56% vs 22%, p = 0.023, which were the main indication for cesarean section. The difference in newborn outcome was not significant. CONCLUSION: There is a difference in frequency of complications, in the cases with PAPP-A under 0.4 MoM, such as premature birth, preeclampsia compound with SGA fetuses versus the control group. The difference for SGA newborn and premature birth among the groups has statistical significance. The patients delivered with cesarean section were with the main indications SGA or elevated blood pressure, often occurred combined with prematurity. Apgar score and birth weight were similar in target and control group, but the newborns with a birth weight under 2500 g. were more frequent in the target group. Because these results did not show another significance among two groups, probably lower cut-off is needed, combining with another test (Doppler of uterine arteries in the first trimester, biochemical test). Presence of other diseases which could hurt placental function should be emphasised.

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Section: Discussionmentioning

confidence: 87%

Clinical Importance of Low Level of PAPP-A in First Trimester of Pregnancy - An Obstetrical Dilemma in Chromosomally Normal Fetus

Livrinova¹,

Petrov²,

Samardziski³

et al. 2019

Open Access Maced J Med Sci

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“…(2017) showed that MoM PAPP-A ≤0.4 is associated with SGA <10 th centile at P = 0.04 with a positive predictive value of 83.3% and negative predictive value of 79.3%. [ 8 ]…”

Section: Discussionmentioning

confidence: 99%

“…PAPP-A is also a glycoprotein, which is mainly produced by syncytiotrophoblast[ 8 ] and may affect placental function through insulin-like growth factors (IGFs) because PAPP-A is a protease for IGF binding protein (IGFBP) 4 and 5. The IGFBPs inhibit the action of IGFs.…”

Section: Introductionmentioning

confidence: 99%

Role of pregnancy-associated plasma protein A (PAPP-A) and human-derived chorionic gonadotrophic hormone (free β-hCG) serum levels as a marker in predicting of Small for gestational age (SGA)

Honarjoo

Zarean

Tarrahi

et al. 2021

Journal of Research in Medical Sciences

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Background: Small-for-gestational-age (SGA) is one of the most important conditions, which is associated with the risk of perinatal mortality and morbidity. The levels of pregnancy-associated plasma protein A (PAPP-A) and β-human-derived chorionic gonadotrophic (β-hCG) in the first trimester can predict this adverse outcome, considering the controversial nature of studies in this area, this cohort study was conducted to investigate the role of PAPP-A and freeβ-hCG levels for predicting SGA. Materials and Methods: In this cohort study, from 16 randomly selected health centers in Isfahan, Iran, 4605 volunteer pregnant women who had performed first-trimester fetal anomalies screening tests were chosen based on the census, from July 2016 to June 2018. The multiples of the median (MoM) PAPP-A <0.4 and MoM β-hCG >3 were considered as abnormal; the samples were followed up after childbirth. The biomarkers' serum levels, relative risk, and odds ratio (OR) of SGA were compared in both SGA and appropriate for gestational age (AGA) groups. Results: In the SGA group, the mean of MOM PAPP-A was significantly lower (0.96 vs. 1.1 with P = 0.001) and MoM βhCG was significantly higher (1.24 vs. 1.15 with P = 0.01) than the AGA group. Odds for SGA in subjects with MoM PAPP-A <0.4 were 3.213; P = 0.001 and for subjects with MoM βhCG >3 reported as 0.683; P = 0.111. Conclusion: The results of the study showed that the low levels of PAPP-A would cause 3.213 times increase in the chance of developing SGA and no association between high level of βhCG >3 with SGA. Therefore, low level of the PAPP-A is a warning indicator for SGA.

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“…Some studies show a significant difference in an adverse outcome in a group with PAPP-A below 0.4 MoM, probably because of different statistical power [21], [22].…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Histopathology of Idiopathic Epiretinal Membrane in Vietnam

Ngan¹,

Cương²,

Trung³

et al. 2019

Open Access Maced J Med Sci

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BACKGROUND: Idiopathic epiretinal membrane (iERM) is an avascular proliferation of different types of cells between the posterior vitreous cortex and the internal limiting membrane. That causes visual impairment including blurry, distortion, scotoma. Many studies of iERM were done to describe the clinical characteristics and investigate the histopathology of this disease. Nonetheless, there has not been a study of iERM histopathology in Vietnam. AIMS: To describe clinical characteristics and histopathological results of idiopathic retinal membrane and the association between them. METHODS: A cross sectional decriptive study of 35 iERMs (33 patients) in Vietnam National Institute of Ophthalmology (VNIO). RESULTS: High morbidity incidence was in group age >50 years (32/35), female gender (26/35), limited movement works (27/35), and high educational levels (28/35). Distortion was the highest (77.14%), scotoma and floater was less frequent (28.5%, 45.7%). Macular edema in all cases and PVD and exudate were high frequent (65.7%, 62.8%). Symptom duration was 8.2 ± 4.7 months, (1-21 months). Mean of central macular thickness was 468.51 ± 97.24 µm (656-274 µm). Six types of cell were detected, including glial cell (35/35), fibroblast (23/35), myofibroblast (23/35), macrophage (13/35), lymphocyte (5/35) and neutrophil (2/35). The number of cell types in one sample ranged from 1-5 types (2.85 ± 1.28 cell types). Number of cell types were correlated to symptom duration (r = 0.47, p = 0.004, Pearson's test) and central macular thickness (r = 0.72, p < 0.001, Pearson's test). CONCLUSION: There were 6 types of cells in iERM. Glial cell was the most frequent cell, inflammatory cells (macrophage, lymphocyte, neutrophil) was also detected. The number of cell types was stastitically correlated to symptom duration and CMT.

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Association of low levels of first trimester Pregnancy Associated Plasma Protein (PAPP-A) with adverse pregnancy outcomes: An observational study

Cited by 4 publications

References 45 publications

Clinical Importance of Low Level of PAPP-A in First Trimester of Pregnancy - An Obstetrical Dilemma in Chromosomally Normal Fetus

Clinical Importance of Low Level of PAPP-A in First Trimester of Pregnancy - An Obstetrical Dilemma in Chromosomally Normal Fetus

Role of pregnancy-associated plasma protein A (PAPP-A) and human-derived chorionic gonadotrophic hormone (free β-hCG) serum levels as a marker in predicting of Small for gestational age (SGA)

Clinical Characteristics and Histopathology of Idiopathic Epiretinal Membrane in Vietnam

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