Evaluation of the Relationship between Pregnancy-Associated Plasma Protein A (PAPP-A) and Pregnancy Outcomes

Abstract

Background: In the current study, we aimed to evaluate the association between pregnancy-related plasma protein-A (PAPP-A) levels measured in the first trimester and pregnancy outcomes. Materials and Methods: This is a descriptive-analytical study that was performed in 2019--2021 on 1061 pregnant women in their first trimester. Demographic and basic information of all women were collected. These data included age, weight, parity, and date of delivery. Then the quantity of PAPP-A was recorded in three groups including less than 0.5 MOM, 0.5 to 2.5 MOM, and more than 2.5 MOM. Results: Data of 1061 women were analyzed. 900 women (84.8%) had term delivery and 155 women (14.6%) had pre-term deliveries. PAPP-A levels were normal in 83.4% of women. BMI and number of pregnancies had significant relationships with PAPP-A ( p < 0.001, P = 0.03 respectively). The mean BMI in mothers with PAPP-A higher than 2.5 was significantly more than mothers with normal or lower PAPP-A levels (26.2 ± 31, P = 0.04). The frequency of term labor in mothers with normal PAPP-A was higher than other mothers (86.3%, P = 0.04). The frequency of preeclampsia in recent pregnancies in mothers with normal PAPP-A was significantly lower than other mothers ( p < 0.001) and the frequency of abortions in recent pregnancies in mothers with PAPP-A less than 0.5 was significantly higher than mothers with normal or elevated PAPP-A ( p < 0.001). Conclusion: Mothers with low PAPP-A levels are more likely to have poor pregnancy outcomes such as abortion, pre-term labor, and preeclampsia.

First Trimester Placental Biomarkers for Pregnancy Outcomes

“…Based on these studies, PAPP-A seems to be a valid marker in predicting adverse pregnancy outcomes. Recently, a study confirmed these results, demonstrating that low PAPP-A levels in the first trimester of pregnancy are associated with a higher risk of having poor pregnancy outcomes, such as a preterm delivery and PE [36]. In contrast, elevated PAPP-A levels in the first trimester of pregnancy have been associated with a higher risk of developing placenta accreta spectrum disorders (PASs).…”

“…PAPP-A levels increase during pregnancy, with higher concentration at term and a rapid reduction after delivery [ 34 ]. Several studies demonstrated that lower levels of PAPP-A detected during the first trimester screening were associated with a higher risk of complicated pregnancy (PE, IUGR, preterm birth) [ 35 , 36 ]. For instance, a PAPP-A of less than 0.4 multiple of the median (MoM) is predictive of third-trimester complications, such as preeclampsia, IUGR or preterm birth [ 37 ].…”