Maternal PAPP-A Levels at 11 - 13 Weeks of Gestation Predict Foetal and Neonatal Growth

M Gentile,M Ciantelli,C Luchi,P Ghirri,M Schifano,F Moscuzza,S Lunardi,C Nanini,C Sergiampietri,A Boldrini,F Monacci

doi:10.4236/ojog.2015.56053

Abstract

Recent reports suggest that maternal serum levels of pregnancy-associated plasma protein A (PAPP-A) may predict perinatal outcome. PAPP-A is a syncytiotrophoblast derived protease for insulin-like growth factor binding protein (IGFBP4); its protease activity cleaves complexed growth factor binding protein increasing insulin-like growth factor I (IGF-I) bioavailability. The aim of our study was to evaluate the correlation between maternal PAPP-A serum levels and neonatal growth. We analysed 100 full term and preterm (30 - 36 weeks) small for gestational age (SGA) and adequate for gestational age (AGA) babies whose mothers had been tested for serum PAPP-A at 11 - 13 weeks of gestation. We found a significant positive correlation between maternal PAPP-A and neonatal weight, length, and head circumference at birth in both term and preterm infants. Low maternal PAPP-A serum levels (maternal PAPP-A < 0.5) were associated with small for gestational age neonates. A significant positive correlation was also evident between maternal PAPP-A and babies’ growth parameters at 6 months of age. Our results suggest that maternal levels of PAPP-A in early pregnancy affect growth during both foetal and early postnatal life.

Highlights

Recent reports suggest that maternal serum levels of pregnancy-associated plasma protein A (PAPP-A) at 9 - 14 weeks of gestation may predict foetal and neonatal outcome
Neonates were divided in 4 groups of 25 babies each according to their gestational age and weight at birth: term small for gestational age (SGA) babies, term adequate for gestational age (AGA) babies, preterm SGA babies, preterm AGA babies
SGA infants were defined by a birth weight below the 10th percentile for their gestational age (GA), whereas AGA infants were those with a birth weight between the 25th and the 75th percentile

Summary

Introduction

Recent reports suggest that maternal serum levels of pregnancy-associated plasma protein A (PAPP-A) at 9 - 14 weeks of gestation may predict foetal and neonatal outcome. Lower maternal serum PAPP-A levels were, according to a few studies, associated with maternal hypertension during pregnancy [1] [4]-[13]. Large population-based screening studies demonstrated that low levels of PAPP-A were associated with reduced foetal growth [4]-[6] [8]-[10] [12] [14]-[22]. PAPP-A’s role in foetal growth is due to its interaction with the insulin-like growth factor (IGF-1) system. PAPP-A is a syncytiotrophoblastderived protease for insulin-like growth factor binding protein [27]; its protease activity cleaves complexed growth factor enhancing its bioavailability [28] [29]. High PAPP-A concentrations lead to enhanced growth factor bioactivity which leads to enhanced growth [27] [30]

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