Decreased first trimester PAPP‐A is a predictor of adverse pregnancy outcome

Yaron, Yuval; Heifetz, Sigal; Ochshorn, Yifat; Lehavi, Ofer; Orr-Urtreger, Avi

doi:10.1002/pd.407

Cited by 178 publications

(154 citation statements)

References 44 publications

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“…It is well accepted that low PAPP-A is associated with subsequent pregnancy loss (Ong et al, 2000;Yaron et al, 2002a;Kwik and Morris, 2003;Dugoff et al, 2004;Kabili et al, 2004;Liu et al, 2004). Our findings are compatible with these previous studies and demonstrated that a PAPP-A ≤0.3 MoM conveyed a significant risk of pregnancy loss almost five times greater than pregnancies with a PAPP-A >0.3 MoM.…”

Section: Low Papp-a and Adverse Outcomessupporting

confidence: 83%

“…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). Furthermore, Morssink et al (1998) concluded that PAPP-A is not associated with either fetal growth restriction or preterm delivery.…”

Section: Low Papp-a and Adverse Outcomesmentioning

confidence: 72%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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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

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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.

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Section: Low Papp-a and Adverse Outcomessupporting

confidence: 83%

Section: Low Papp-a and Adverse Outcomesmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

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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

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“…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

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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.

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“…4,5 Hospitalization for preterm contractions with suspected imminent preterm delivery poses a major burden on health services, and costs and accounts for more than one-third of obstetric admissions before delivery. 6,7 Although used in prenatal genetic screening programs since the 1980s 8 and also for risk assessment of preterm labor, 9 the predictive power of pregnancy-associated plasma protein A (PAPP-A) in the second trimester for preterm delivery is still considered speculative. 10 In assessing the predictive value of first-trimester PAPP-A for preterm delivery and fetal growth restriction in a selected study group of pregnancies achieved via assisted technologies, only weak associations have been found.…”

Section: Introductionmentioning

confidence: 99%

PAPP-A levels as an early marker of idiopathic preterm birth: a pilot study

et al. 2007

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Objective: To evaluate late PAPP-A levels as predictive of preterm birth in symptomatic women.Study Design: Prospective cohort study of singleton gestations, 23 to 34 weeks, and symptoms of preterm labor. PAPP-A, IGF-I and IGF-III analysis were performed. Primary end point was delivery p7 days. Accuracy and optimally predictive PAPP-A values were based on receiver operator characteristic (ROC) curves.Result: In all, 26 women (51%) delivered p7 days post-admission (Group 1); 25 women (49%) >7 days (Group 2). Group 1 mean PAPP-A ¼ 38 000 vs 55 333 for Group 2 (P<0.04). Group 1 mean gestational age at delivery ¼ 29 weeks vs 37 weeks for Group 2 (P<0.00014). PAPP-A level p30 000 mU l À1 had highest specificity (88%), sensitivity (50%), and positive predictive (81%) and negative predictive (62%) values for delivery p7 days. ROC area under curve ¼ 0.703.Conclusion: PAPP-A levels p30 000 mU l À1 at admission was associated with increased risk for preterm birth p7 days, supporting active management and therapeutic approach in these women.

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Decreased first trimester PAPP‐A is a predictor of adverse pregnancy outcome

Abstract: We conclude that decreased levels of first trimester maternal serum PAPP-A are predictive not only of chromosome anomalies but also of adverse pregnancy outcome.

Cited by 178 publications

References 44 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

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

PAPP-A levels as an early marker of idiopathic preterm birth: a pilot study

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