Dose dependency between cigarette consumption and reduced maternal serum PAPP‐A levels at 11–13<sup>+6</sup> weeks of gestation

Kagan, Karl Oliver; Frisová, V.; Nicolaides, Kypros H.; Spencer, Kevin

doi:10.1002/pd.1793

Cited by 63 publications

(25 citation statements)

References 27 publications

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“…Several studies have also shown a higher false-positive rate for the trisomy 21 risk when disregarding the correction of the maternal smoking status [16,17] . A recently published study describes a direct dose-dependency between smoking and lower PAPP-A values [18] . The fetal NT does not seem to be influenced by the smoking status of the mother [17] .…”

Section: Discussionmentioning

confidence: 99%

Comparison of the New PRC Software with the Established Algorithm of the FMF UK for the Detection of Trisomy 21 and 18/13

Lüthgens¹

2008

Fetal Diagn Ther

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Objective: The aim of this study was to compare the newly developed Prenatal Risk Calculation (PRC) software and the established Fetal Medicine Foundation (FMF) UK algorithm for their detection and false-positive rates in prenatal screening of trisomy 21 or 18/13. Methods: Nuchal translucency was measured by FMF-certified sonographers in 39,004 pregnancies. Risks for trisomy 21 and 18/13 were calculated together with serum PAPPA and free beta-hCG in all cases. Overall, 109 cases of trisomy 21 and 39 cases of trisomy 18 or 13 occurred. The detection rates were calculated for all 109 trisomy 21 cases using both PRC and ASTRAIA, software based on the official algorithm of the FMF UK. The false-positive rate was calculated on the basis of all 39,004 cases for ASTRAIA and on the basis of 3,620 additional cases for PRC. The comparison of the algorithms was performed by the calculation of receiver-operating characteristic (ROC) curves. Results: The detection rates for trisomy 21 for a 5% false-positive rate were 91% (99/109) for PRC and 90% (98/109) for ASTRAIA. The difference was not significant. ROC curve analysis showed an area under the curve (AUC) of 0.976 for PRC and 0.975 for ASTRAIA (p = 0.80). At a cutoff of 1:300, PRC showed a slightly (nonsignificantly) higher, but nonsignificant false-positive rate (3.8% for ASTRAIA, version since 2005, 5.1% for PRC) associated with a slightly (nonsignificantly) higher, but nonsignificant detection rate of 91% (PRC) versus 88% (ASTRAIA). The false-positive rate of the biochemical risk (without NT) in PRC was significantly higher (17.7%) than with the FMF UK algorithm (9.0%) at a common risk cutoff of 1:300. A reason for the higher false-positive rates in PRC may be the missing correction for maternal weight, smoking status, and ethnicity. The detection rates for trisomy 18/13 at a risk cutoff of 1:150 were 79% for PRC and 77% for ASTRAIA. False-positive rates for trisomy 18/13 at a cutoff of 1:150 were 1.5% for PRC and 0.6% for ASTRAIA (differences were nonsignificant). Conclusion: For a 5% false-positive rate, the new PRC software detects as many trisomy 21 and trisomy 18/13 cases as the established algorithms of the FMF UK. In order to reduce the false-positive rate for the biochemical risk, the algorithm of the PRC software should be redesigned to include the maternal weight, smoking status of the mother, and the ethnicity.

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Section: Discussionmentioning

confidence: 99%

Comparison of the New PRC Software with the Established Algorithm of the FMF UK for the Detection of Trisomy 21 and 18/13

Lüthgens¹

2008

Fetal Diagn Ther

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“…We found that mean and median NT increased with increasing daily cigarette consumption. Kagan et al [2] recently investigated the impact of correcting the biochemical markers for the dose effect of smoking rather than the 'all or nil' effect, and concluded that correction made only marginal improvement on overall screening performance. Another argument for using smoking status defined as smoking versus nonsmoking is that information on daily cigarette consumption may not be reliable in pregnant women, as this information is self-reported and women may tend to underreport the daily consumption.…”

Section: Discussionmentioning

confidence: 99%

Maternal Smoking, Obesity and Male Fetal Sex Predispose to a Large Nuchal Translucency Thickness in Healthy Fetuses

et al. 2010

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Objectives: Our aim was to evaluate the effect of fetal sex, smoking and body mass index (BMI) on nuchal translucency (NT). Methods: We analyzed data from 7,357 women with a normal singleton live birth outcome with information on smoking, BMI and sex of the infant. NT measurements were converted to multiples of the median (MoM_NT) using a previously reported linear regression analysis. Results: The odds ratio (OR) for MoM_NT >95th centile was 1.5 (95% CI 1.2–1.9) for smokers compared to nonsmokers and 1.4 (95% CI 1.1–1.7) for male fetuses compared to female fetuses. Obese women (BMI ≧30) had an increased OR for a large NT of 1.7 (95% CI 1.2–2.6) compared to normal weight women. Obese smokers carrying a male fetus had an OR of 4.2 (95% CI 1.7–10.1) of a MoM_NT >95th centile compared to normal weight nonsmoking women with a female fetus. The effects of smoking, obesity status and fetal sex were independent of each other. Conclusions: Smoking, obesity and male sex are associated to a MoM_NT >95th centile. This may affect screening performance and entail unnecessary anxiety in these women. Further investigations, including fetuses with adverse outcome, are needed.

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“…In the present study, PAPP-A concentrations expressed in IU/l as well as in MoM were significantly lower in the smoking group in each trimester of pregnancy. Also a dose-related PAPP-A/cigarette smoking relationship has been found in a few studies [22, 23, 29, 37]. Some authors have observed a significant negative correlation between maternal PAPP-A levels in the first trimester and the number of cigarettes smoked per day [29].…”

Section: Discussionmentioning

confidence: 94%

“…It may result in inadequate expression of PAPP-A and IGF axis disorders, reduced active transport of essential nutrients to the fetus, and lead to disturbances of embryogenesis and in consequence fetal growth [14, 35]. It is widely accepted that serum concentrations of PAPP-A in smoking pregnant women in the first trimester are 15–25% lower than those observed in tobacco-abstinent groups [8, 9, 24, 27, 29, 32, 36], but only Spencer and Covans [23] have examined the level of this protein in the second trimester of pregnancy. The authors found a small but significant decrease of 10% in the PAPP-A MoM of smokers.…”

Section: Discussionmentioning

confidence: 99%

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Serum pregnancy-associated plasma protein A levels in the first, second and third trimester of pregnancy: relation to newborn anthropometric parameters and maternal tobacco smoking

Chełchowska¹,

Gajewska²,

Mazur³

et al. 2016

aoms

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IntroductionThe purpose of this study was to evaluate the associations of the first, second and third trimester serum pregnancy-associated plasma protein A (PAPP-A) concentrations with neonatal anthropometric parameters. The effect of tobacco smoking during pregnancy on PAPP-A level was also studied.Material and methodsOne hundred and fifty healthy pregnant women were divided into smoking and tobacco-abstinent groups. Serum PAPP-A level was measured with the KRYPTOR rapid random-access immunoassay analyzer. The relationship between PAPP-A and newborn related outcome as well as markers of estimated intensity of cigarette smoking was evaluated by univariate and multivariate linear regression.ResultsPregnancy-associated plasma protein A concentration was positively correlated with birth weight in the first (β = 31.6; p < 0.001), second (β = 10.6; p < 0.05), and third (β = 4.6; p < 0.001) trimester of gestation. A significant association between PAPP-A and birth body length and head circumference in the second (β = 0.02; p < 0.05) and third trimester (β = 0.01; p < 0.01) was also found. The serum PAPP-A levels were significantly lower in the smoking than in the tobacco-abstinent group in each trimester of pregnancy (p < 0.001). The largest impact of the number of cigarettes smoked per day on PAPP-A level was found in the second (β = –1.2; p = 0.004) and third trimester (β = –2.6; p = 0.001).ConclusionsMaternal serum PAPP-A levels during gestation might be significant predictors for birth weight. Increased PAPP-A concentrations in the second and third trimester appeared to also be predictive for newborn body length and head circumference. Smoking alters maternal PAPP-A levels in all trimesters, with the greatest impact related to the number of cigarettes smoked per day.

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Dose dependency between cigarette consumption and reduced maternal serum PAPP‐A levels at 11–13⁺⁶ weeks of gestation

Cited by 63 publications

References 27 publications

Comparison of the New PRC Software with the Established Algorithm of the FMF UK for the Detection of Trisomy 21 and 18/13

Comparison of the New PRC Software with the Established Algorithm of the FMF UK for the Detection of Trisomy 21 and 18/13

Maternal Smoking, Obesity and Male Fetal Sex Predispose to a Large Nuchal Translucency Thickness in Healthy Fetuses

Serum pregnancy-associated plasma protein A levels in the first, second and third trimester of pregnancy: relation to newborn anthropometric parameters and maternal tobacco smoking

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Dose dependency between cigarette consumption and reduced maternal serum PAPP‐A levels at 11–13+6 weeks of gestation

Cited by 63 publications

References 27 publications

Comparison of the New PRC Software with the Established Algorithm of the FMF UK for the Detection of Trisomy 21 and 18/13

Comparison of the New PRC Software with the Established Algorithm of the FMF UK for the Detection of Trisomy 21 and 18/13

Maternal Smoking, Obesity and Male Fetal Sex Predispose to a Large Nuchal Translucency Thickness in Healthy Fetuses

Serum pregnancy-associated plasma protein A levels in the first, second and third trimester of pregnancy: relation to newborn anthropometric parameters and maternal tobacco smoking

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Dose dependency between cigarette consumption and reduced maternal serum PAPP‐A levels at 11–13⁺⁶ weeks of gestation