Association of Low Maternal Pregnancy-associated Plasma Protein A with Adverse Perinatal Outcome.

Panagiotis Antsaklis,Emmanuel N Kontomanolis,Zacharias Fasoulakis,Michail Diakosavvas,Marianna Theodora

doi:10.7759/cureus.4912

Panagiotis Antsaklis, Emmanuel N Kontomanolis + Show 3 more

Open Access

https://doi.org/10.7759/cureus.4912

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Abstract

The aim is to provide an overall view of the association of low pregnancy-associated plasma protein A (PAPP-A) levels with adverse perinatal outcomes. The available literature in PubMed/Medline regarding PAPP-A and adverse pregnancy outcomes was searched for related articles, including terms such as “PAPP-A,” “intrauterine growth restriction (IUGR),” “small for gestational age (SGA),” “stillbirth,” “adverse outcome,” and others. The fifth percentile is supported by many recent studies to be PAPP-A’s cutoff for adverse outcome detection and the increased risk seems to be extremely high below 0.2 PAPP-A MoM (multiple of the median). Apart from chromosomal abnormalities, preeclampsia, intrauterine fetal demise, and pregnancy loss have been associated with maternal serum PAPP-A. For results below the first centile, PAPP-A has a strong positive predictive value for SGA and IUGR. Except for its vital role on the cleavage of insulin-like growth factor binding proteins (IGFBP), PAPP-A has proven to be a reliable marker for prenatal screening. Even though PAPP-A as a single predictor proved to be valuable for the prediction of some adverse perinatal outcomes, in some cases, a combination of PAPP-A to other maternal serum markers led to an increase in detection rates. PAPP-A is a promising maternal serum marker for pregnancy outcome prediction with more studies needed in order for its potentials to be fully understood and exploited.

Highlights

BackgroundThe prevention and prognosis of adverse pregnancy outcomes are of great significance and, from a medical point of view, challenging for the scientific community, as well as for the family and society
The established association of low pregnancyassociated plasma protein A (PAPP-A) levels to Down syndrome has led to the wide use of PAPP-A measurement for the diagnosis and prognosis of prenatal adverse outcomes
Low maternal serum PAPP-A at 11 to 13 weeks of gestation has been tested with promising results as a prognostic factor for many adverse pregnancy outcomes

Summary

Introduction

The prevention and prognosis of adverse pregnancy outcomes are of great significance and, from a medical point of view, challenging for the scientific community, as well as for the family and society. Reports of PAPP-A < 5th centile led many researchers to combine other indicators, even the second trimesters’ markers, to increase specificity and sensitivity Such indicators usually consist of maternal risk factors, fetal routine parameters, Doppler measurements, and monitoring the development of first trimester maternal serum markers after the 14th week. Cooper et al reported in the same year a prospective interventional study in order to evaluate a possible correlation of adverse in pregnancies with low maternal serum PAPP-A level (< 0.4 MoM) and positive uterine artery Doppler (PI > 1.45) at 18 to 22 weeks of gestation [26].

Conclusions

Disclosures

Nicolaides KH

Findings

Sinosich MJ