Abstract
Objective:First trimester aneuploidy screening (FTAS) has become an integral part of antenatal care in most of centers in India. The serum markers used for FTAS are pregnancy-associated plasma protein A (PAPP-A) and beta human chorionic gonadotropin. In the present study, we aimed to assess the role of PAPP-A in specific adverse fetal maternal events. To analyze pregnancy outcomes with low maternal PAPP-A (≤5th percentile) at the FTAS screening test in southern India, and them compared with a control group of >5th percentile value.Materials and Methods:A total of 1800 consecutive pregnancies in the first trimester were followed up with PAPP-A levels. The study group consisted 108 subjects, which was compared with a matched control group of 288 subjects. The outcomes considered were spontaneous abortions, fetal anomalies, preterm delivery (PTD), hypertension in pregnancy, intrauterine growth restriction, gestational diabetes, mode of delivery, and birthweight.Results:For our grouped data, the 5th percentile value for PAPP-A was 0.49 multiple of medians, (incidence-6%). The incidence of fetal major anomalies was higher in the study group [odds ratio (OR): 1.87]. The incidence of minor anomalies, gestational diabetes, and hypertensive disorders was higher in the study group but not statistically significant. The total rate of PTDs (OR:2.1), small-for-gestation-age fetuses (OR:2.3), and low birthweight babies (OR- 2.12) was significantly higher in the study group. We found positive likelihood ratio of 1.4 for PTD, 2 for <5th percentile birthweight, and 1.7 for <10th centile birthweight.Conclusion:Low PAPP-A pregnancies are at risk of various obstetric complications. Hence, such a pregnancy should have closer surveillance. Further research work on intervention strategy is needed.
Highlights
Pregnancy-associated plasma protein-A (PAPP-A) is a glycoprotein that is secreted by the syncytial trophoblast and decidua, and appears in circulation soon after the blastocyst implantation[1]
A total of 1800 pregnant women attending the antenatal clinics underwent first trimester fetal aneuploidy screening and the 1st, 3rd, 5th, 10th, 50th, 90th, 95th, and 99th percentile values for pregnancy-associated plasma protein A (PAPP-A) obtained in present cohort were 0.23, 0.33, 0.49, 0.61, 1.26, 2.4, 3.13, and 5.1 multiple of medians (MoM)
One had aneuploidy fetus, one had a spontaneous abortion (SA) at the 15th week of gestation, seven had a termination of pregnancy (TOP) in view of lethal anomaly, five had pre-gestational diabetes, and five were lost to follow-up, which were excluded for delivery outcome analysis
Summary
Pregnancy-associated plasma protein-A (PAPP-A) is a glycoprotein that is secreted by the syncytial trophoblast and decidua, and appears in circulation soon after the blastocyst implantation[1]. There is growing evidence that low PAPP-A levels in the first trimester are associated with adverse fetal and maternal outcomes such as spontaneous abortion (SA) preterm delivery (PTD), fetal growth restriction (FGR), preeclampsia (PE), and stillbirth, apart from chromosomal aneuploidy[5,6,7]. The aim of the present study was to obtain the 5th percentile value in our grouped data, and to analyze the risk of adverse pregnancy outcomes in ≤5th percentile in the PAPP-A group in reference to the >5th percentile group
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