Both Low and High PAPP-A Concentrations in the First Trimester of Pregnancy Are Associated with Increased Risk of Delivery before 32 Weeks in Twin Gestation.

Aleksandra Saletra-Bielińska,Izabela Walasik,Bartosz Kaczyński,Robert Brawura-Biskupski-Samaha,Katarzyna Kosińska-Kaczyńska,Patrycja Jarmużek,Szymon Kozłowski,Mirosław Wielgoś,Iwona Szymusik

doi:10.3390/jcm9072099

Abstract

In twin gestation, the relationship between pregnancy associated plasma protein (PAPP-A) and perinatal outcome is unclear. The aim of the study was to determine if low and high concentrations of PAPP-A in the first trimester are related to perinatal outcome in twins. A retrospective study was conducted. Medical data of women in twin pregnancies who delivered between 2013 and 2018 were analyzed. PAPP-A concentrations were measured between 10 + 0 and 13 + 6 weeks. The associations between low (<10th percentile) and high (>90th percentile) values of PAPP-A and pregnancy complications were analyzed. A total of 304 patients were included. PAPP-A <10th percentile was associated with a high risk of preterm delivery (OR 6.14; 95% CI 2.1–18), delivery <34 weeks (OR 2.39; 95% CI 1.1–5.1) or <32 weeks (OR3.06; 95% CI 1.4–6.8). Significant relations between PAPP-A >90th percentile and delivery <34 weeks (OR4.09; 95% CI 1.8–9.1) or <32 weeks (OR 2.83; 95% CI 1.2–6.6) were found. PAPP-A >90th percentile was related to high risk of intrauterine fetal demise (OR 10; 95% CI 2.4–42.5). Both low and high PAPP-A concentrations seem to be related to pregnancy outcome. Further research is needed to investigate evaluation of risk of pregnancy complications according to PAPP-A concentrations as a continuous variable.

Highlights

Twins have a three to seven-fold higher risk of perinatal morbidity and mortality than singletons [1,2]
We found a significant relation between PAPP-A
We found a significant relation between PAPP-A concentrations and preterm delivery (PTD), gestational diabetes mellitus (GDM) and intrauterine demise (IUD) risk

Summary

Introduction

Twins have a three to seven-fold higher risk of perinatal morbidity and mortality than singletons [1,2]. Several factors have been found to be effective in predicting preterm delivery (PTD) in singletons, allowing to estimate the risk in the first, as well as in the second trimester of pregnancy. They include low concentration of pregnancy associated plasma protein (PAPP-A) in the first trimester, or sonographic measurement of cervical length in the second trimester of pregnancy [4]. PAPP-A is a glycoprotein produced by placental syncytiotrophoblast and decidua It shows proteolytic activity for insulin-like binding proteins (IGFBP) 4 and 5, which play a role in the inhibition of insulin-like growth factors (IGF) 1 and 2. IGF 2 enables trophoblast invasion into the maternal decidua and glucose and amino acids transport into the villous cytotrophoblast [6]

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