PAPP-A levels of late pregnancy in preeclampsia and HELLP syndrome

Abstract

PAPP-A level at last trimester increases in all mild-severe preeclampsia and HELLP syndrome, but is not predictive for severity of preeclampsia or HELLP syndrome.

Maternal Serum Placental Growth Factor, Pregnancy-Associated Plasma Protein-A and Free β-Human Chorionic Gonadotrophin at 30-33 Weeks in the Prediction of Pre-Eclampsia

“…The increase in serum free β-hCG, which has vasodilatory properties, observed during and in the few weeks prior to the development of the clinical signs of PE, has been attributed to hypoxia-induced hypersecretion to counteract the generalized vasoconstriction which characterizes PE [10,11,12,13,39,40]. The reported paradoxical behaviour of serum PAPP-A in PE with decrease at 11-13 weeks and increase at the time of PE [4,14,15,16,17,18,19] could be the consequence of impaired placental function for the former and global activation of inflammation for the latter. Our finding that serum PAPP-A at 30-33 weeks is normal suggests that the increase in this metabolite does not precede but coincides with the clinical onset of PE.…”

“…There is also evidence that the altered levels of these metabolites may be apparent from the first trimester of pregnancy. Serum free β-hCG is increased in PE but at 11-13 weeks it is decreased or not altered [4,10,11,12,13,14], PAPP-A is increased in PE but reduced at 11-13 weeks [4,14,15,16,17,18,19] and PlGF is reduced in both established PE and in the first trimester [4,20,21,22,23,24,25,26]. …”

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

“…Given its mechanism for inhibition of IGF action during pregnancy, a direct relationship between maternal PAPP-A and infant anthropometric parameters may have been expected. In some studies, a positive correlation was found; however, other investigators have observed no association between maternal protein A and birth weight [10, 12, 20, 21, 30, 31]. Most surprisingly, Senses et al [4] found a significant negative correlation between PAPP-A levels and birth weight, but the authors measured this protein level only in cord blood and speculated that this protein affected the length of newborns more strongly than weight.…”

“…At present, serum level of PAPP-A are widely used in prenatal screening as an indicator of certain genetic disorders in the fetus [7–10]. However, recent studies documented that pregnancy-associated plasma protein A modulates insulin-like growth factor (IGF) bioavailability by specific cleavage of antagonizing IGF-binding protein (IGFBP), especially IGFBP-4 and IGFBP-5, and thereby may promote fetal growth and development [5, 11, 12]. Low concentrations of PAPP-A during gestation may result in inadequate expression of insulin-like growth factors in the syncytiotrophoblast leading to utero-placental insufficiency, and can be a risk factor for many health complications for the mother and child [12–17].…”

“…However, recent studies documented that pregnancy-associated plasma protein A modulates insulin-like growth factor (IGF) bioavailability by specific cleavage of antagonizing IGF-binding protein (IGFBP), especially IGFBP-4 and IGFBP-5, and thereby may promote fetal growth and development [5, 11, 12]. Low concentrations of PAPP-A during gestation may result in inadequate expression of insulin-like growth factors in the syncytiotrophoblast leading to utero-placental insufficiency, and can be a risk factor for many health complications for the mother and child [12–17]. Low levels of this protein were associated with preterm delivery, placental abruption, intrauterine growth restriction, and low birth weight [17–19].…”