Frequency and clinical consequences of extremely high maternal serum PAPP‐A levels

Abstract

A multicentre study was carried out to determine the frequency and clinical consequences of extremely high maternal serum pregnancy-associated plasma protein (PAPP)-A. There was a total of 79 pregnancies with PAPP-A exceeding 5.0 multiples of the gestation-specific median in a series of 46 776 pregnancies tested (0.2%) at the 7 collaborating centres. Five pregnancies were lost to follow-up, one miscarried and one with Noonan's syndrome was terminated. Of the remaining 72 that ended in a live birth, one infant had gastroschisis and five pregnancies had obstetric complications: pre-eclampsia, pregnancy-induced hypertension, gestational diabetes and two with growth retardation. Among women with high PAPP-A and no complications or adverse outcomes, there was no evidence of a substantial change in the levels of other Down syndrome markers or the extent of nuchal translucency. Three analytical methods were used to assay PAPP-A and yielded different frequencies of extremely high levels (0.05%, 0.4% and 0.6%) possibly owing to cross-reaction with another substance. We conclude that women with high PAPP-A can be reassured that there is no reason to suppose that the outcome of pregnancy will differ from those with normal levels, provided other markers are normal. If, as more centres move their Down syndrome screening practice to the first trimester, additional cases emerge with Noonan's syndrome or gastroschisis and raised PAPP-A, this advice will need to be modified.

First‐trimester serum PAPP‐A and fβ‐hCG concentrations and other maternal characteristics to establish logistic regression‐based predictive rules for adverse pregnancy outcome

“…On the basis of previous studies, a cut‐off point below the fifth percentile was considered as abnormal for PAPP‐A MoM (low PAPP‐A) and fβ‐hCG MoM (low fβ‐hCG) (Smith et al , 2002; Cuckle et al , 2003; Dugoff et al , 2004; Krantz et al , 2004; Liu et al , 2004; Smith et al , 2004; Spencer et al , 2005; Smith et al , 2006).…”

Factors Predicting the Presence of Maternal Cells in Cord Blood and Associated Changes in Immune Cell Composition

“…Decreased first trimester PAPP-A concentrations are a predictor of adverse pregnancy outcome, with a significant reduction of the placental volume and its vascularization (38). Conversely, high levels of PAPP-A have generally no pregnancy consequences, except cases of placenta accretes (39). We showed that high levels of maternal serum PAPP-A concentrations at first trimester were significantly predictive of the presence of MMc at delivery in whole cord blood.…”

Pregnancy‐associated plasma protein‐A is positively correlated with first‐trimester skin microvascular reactivity

“…that microvascular dilatation is required as a compensatory mechanism to maintain sufficient circulation when larger artery constriction is present. Despite this, one previous study did not find any association between high first‐trimester PAPP‐A levels and adverse pregnancy outcome.…”