Both Low and High PAPP-A Concentrations in the First Trimester of Pregnancy Are Associated with Increased Risk of Delivery before 32 Weeks in Twin Gestation

Saletra-Bielińska, Aleksandra; Kosińska-Kaczyńska, Katarzyna; Szymusik, Iwona; Kaczynski, Bartosz; Brawura-Biskupski-Samaha, Robert; Kozłowski, Szymon; Jarmużek, Patrycja; Walasik, Izabela; Wielgoś, Mirosław

doi:10.3390/jcm9072099

Cited by 3 publications

(1 citation statement)

References 21 publications

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“…In singleton pregnancies, maternal serum biomarkers such as PAPP-A (pregnancyassociated plasma protein-A) and β-hCG (β-human chorionic gonadotropin) used for first-trimester screening have been associated with adverse pregnancy outcomes such as pre-eclampsia (PE), FGR, PTB [4][5][6][7][8][9]. However, for twin pregnancies, comprehensive data on first-trimester biomarkers is lacking and some previous reports have conflicting results [10,11].…”

Section: Introductionmentioning

confidence: 99%

First-trimester serum biomarkers in twin pregnancies and adverse obstetric outcomes–a single center cohort study

Queirós,

Gomes,

Pereira

et al. 2024

Arch Gynecol Obstet

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Purpose This study aimed to determine the association of first-trimester maternal serum biomarkers with preterm birth (PTB), fetal growth restriction (FGR) and hypertensive disorders of pregnancy (HDP) in twin pregnancies. Methods This is a retrospective cohort study of twin pregnancies followed at Maternidade Dr. Alfredo da Costa, Lisbon, Portugal, between January 2010 and December 2022. We included women who completed first-trimester screening in our unit and had ongoing pregnancies with two live fetuses, and delivered after 24 weeks. Maternal characteristics, pregnancy-associated plasma protein-A (PAPP-A) and β-human chorionic gonadotropin (β-hCG) levels were analyzed for different outcomes: small for gestational age (SGA), gestational hypertension (GH), early and late-onset pre-eclampsia (PE), as well as the composite outcome of PTB associated with FGR and/or HDP. Univariable, multivariable logistic regression analyses and receiver-operating characteristic curve were used. Results 466 twin pregnancies met the inclusion criteria. Overall, 185 (39.7%) pregnancies were affected by SGA < 5th percentile and/or HDP. PAPP-A demonstrated a linear association with gestational age at birth and mean birth weight. PAPP-A proved to be an independent risk factor for SGA and PTB (< 34 and < 36 weeks) related to FGR and/or HDP. None of the women with PAPP-A MoM > 90th percentile developed early-onset PE or PTB < 34 weeks. Conclusion A high serum PAPP-A (> 90th percentile) ruled out early-onset PE and PTB < 34 weeks. Unless other major risk factors for hypertensive disorders are present, these women should not be considered candidates for aspirin prophylaxis. Nevertheless, close monitoring of all TwP for adverse obstetric outcomes is still recommended.

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Section: Introductionmentioning

confidence: 99%

First-trimester serum biomarkers in twin pregnancies and adverse obstetric outcomes–a single center cohort study

Queirós,

Gomes,

Pereira

et al. 2024

Arch Gynecol Obstet

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First-trimester biomarkers and ultrasound biometries in relation to growth discordance in monochorionic diamniotic twins

Løppke

Schou

Ekelund

et al. 2023

The Journal of Maternal-Fetal & Neonatal Medicine

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Low PAPPA and Its Association with Adverse Pregnancy Outcomes in Twin Pregnancies: A Systematic Review of the Literature and Meta-Analysis

Sapantzoglou,

Giourga,

Kontopoulou

et al. 2024

JCM

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Background: It is well established in the literature that pregnancy-associated plasma protein-A (PAPP-A) is linked to several adverse pregnancy outcomes, including pre-eclampsia (PE), fetal growth restriction (FGR), and preterm birth (PTB) in singleton pregnancies. However, data regarding such an association in twin pregnancies are lacking. The primary goal of this systematic review and meta-analysis was to assess the potential value of low PAPP-A levels in the prediction of the subsequent development of hypertensive disorders of pregnancy (HDPs), PTB, and small for gestational age (SGA)/FGR fetuses in twin pregnancies and investigate its association with the development of gestational diabetes, intrauterine death (IUD) of at least one twin, and birth weight discordance (BWD) among the fetuses. Methods: Medline, Scopus, CENTRAL, Clinicaltrials.gov, and Google Scholar databases were systematically searched from inception until 31 July 2024. All observational studies reporting low PAPP-A levels after the performance of the first-trimester combined test as part of the screening for chromosomal abnormalities with reported adverse pregnancy outcomes were included. Results: The current systematic review encompassed a total of 11 studies (among which 6 were included in the current meta-analysis) that enrolled a total of 3741 patients. Low PAPP-A levels were not associated with HDPs (OR 1.25, 95% CI 0.78, 2.02, I-square test: 13%). Low PAPP-A levels were positively associated with both the development of preterm birth prior to 32 (OR 2.85, 95% CI 1.70, 4.77, I-square test: 0%) and 34 weeks of gestational age (OR 2.09, 95% CI 1.34, 3.28, I-square test: 0%). Furthermore, low PAPP-A levels were positively associated with SGA/FGR (OR 1.58, 95% CI 1.04, 2.41, I-square test: 0%). Prediction intervals indicated that the sample size that was used did not suffice to support these findings in future studies. Conclusions: Our study indicated that low PAPP-A levels are correlated with an increased incidence of adverse perinatal outcomes in twin pregnancies. Identifying women at elevated risk for such adversities in twin pregnancies may facilitate appropriate management and potential interventions, but additional studies are required to identify the underlying mechanism linking PAPP-A with those obstetrical complications.

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Both Low and High PAPP-A Concentrations in the First Trimester of Pregnancy Are Associated with Increased Risk of Delivery before 32 Weeks in Twin Gestation

Cited by 3 publications

References 21 publications

First-trimester serum biomarkers in twin pregnancies and adverse obstetric outcomes–a single center cohort study

First-trimester serum biomarkers in twin pregnancies and adverse obstetric outcomes–a single center cohort study

First-trimester biomarkers and ultrasound biometries in relation to growth discordance in monochorionic diamniotic twins

Low PAPPA and Its Association with Adverse Pregnancy Outcomes in Twin Pregnancies: A Systematic Review of the Literature and Meta-Analysis

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