449 Low Maternal Levels of First Trimester Papp-A and Free β-Hcg are Associated with An Increased Risk of Adverse Neonatal Outcome

Abstract

Background and aim: Pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (β-hCG) are highly efficient in first-trimester screening for Down syndrome. In addition, studies have found them associated to preterm delivery, pre-eclampsia and low birth weight, but the association to neonatal outcomes is only sparsely elucidated. The aim of the current study was evaluate PAPP-A and free β-hCG in relation to adverse neonatal outcomes.Methods: 9450 singleton pregnant women at Aarhus University Hospital were included between January 2005 and December 2007. PAPP-A and free β-hCG were measured in the first trimester. Neonatal outcomes were obtained from specific registration forms filled out by the doctors responsible for admission and discharge from the neonatal intensive care unit (NICU). The outcomes explored in this study were admission to NICU, neonatal jaundice and hypoglycemia.Results: PAPP-A below 0.4 MoM was significantly associated with admission to NICU (OR 1.6; 95% CI, 1.2 - 2.0), and the same applied to free β-hCG below 0.4 MoM (OR 1.5; 95% CI, 1.1 - 2.1). The results could not be explained by preterm delivery or low birth weight as the results remained unchanged when restricting to deliveries in gestational weeks 39 and 40 and when adjusting for birth weight. Furthermore, we found significant associations between PAPP-A and both hypoglycemia and jaundice and between free β-hCG and jaundice.Conclusion: Both low PAPP-A and free β-hCG were associated with an increased risk of admission to NICU. The results could not be explained by either preterm delivery or low birth weight.