OC28.02: Low levels of PAPP-A in first trimester of pregnancies conceived after ART and the prediction of adverse obstetric outcome

Abstract

To evaluate the relation between low levels of maternal serum PAPP-A and the risk of adverse obstetric outcome in pregnancies conceived after IVF and ICSI. This is a nationwide prospective cohort study carried out in the period 1 April 2004—31 January 2006 in Denmark. 1000 women with singleton pregnancies following IVF and ICSI had first trimester combined screening performed. Follow up on pregnancy outcome was performed by questionnaire. MoM values of PAPP-A were calculated using either a standard median formula derived from an unselected group of pregnant women, or a median formula corrected for mode of conception established using IVF and ICSI pregnancies. Uncorrected mean MoM value of PAPP-A was 0.76. Excluding pregnancies with preterm delivery (PD = < week 37) and Small for Gestation infants (SGA = < − 2 SD) PAPP-A remained low (0.79). PAPP-A values not corrected for mode of conception were significantly lower in pregnancies with PD 0.60 MoM vs 0.79 MoM (p < 0.001), and in the group with SGA, 0.53 vs 0.77 (p < 0.001). When PAPP-A MoM values were corrected for mode of conception the difference remained significant. In logistic regression analyses uncorrected PAPP-A MoM was an independent significant predictor of SGA (< − 2 SD) with an OR: 0.41 (p = 0.027), and of preterm delivery (< 37 wks) with an OR: 0.61 (p = 0.03). However corrected MoM values could not predict adverse outcome. The higher prevalence of adverse outcome in ART pregnancies cannot explain the low levels of PAPP-A. However, only PAPP-A MoM values not corrected for mode of conception seem to be able to predict adverse outcome.