Retraso de crecimiento intrauterino severo: ¿es posible su cribado en el primer trimestre de gestación?

Abstract

ObjectiveTo determine if there is a relationship between pregnancy-associated plasma protein-A (PAPP-A) levels, expressed in multiples of the median (MoM), and intrauterine growth retardation (IUGR) independently of other clinical or ultrasound parameters. To assess whether PAPP-A values are able to predict the risk of IUGR. Material and methodAn epidemiological, observational, analytical, case-control study was conducted between January 2012 and September 2013 in patients attending the University Hospital Complex of Ourense. The sample consisted of 138 pregnant women and their respective newborns. Differences in PAPP-A between cases and controls were determined by the Mann-Whitney U test. Graphs were plotted using GAM models with Gaussian and binary response to determine the behavior of PAPP-A values with respect to birthweight and the risk of intrauterine growth restriction, respectively. PAPP-A values were obtained from samples taken for combined first trimester screening at weeks 11 + 3 and 13 + 5 of amenorrhea. The statistical analysis was conducted with the statistical package SPSS 15.0 and Epidat 3.0. Statistical significance was set at P<.05. ResultsPAPP-A values, expressed as MoM, behaved as an independent predictor of IUGR, without being influenced by maternal factors or early fetal ultrasound parameters.A PAPP-A value (MoM) below 0.33 MoM predicted fetal weights below the 3rd percentile for a 95% confidence interval (0.24–0.56). A PAPP-A value (MoM) of less than 0.4 MoM had a relative risk of IUGR of 2.50, which was even higher than that posed by smoking during pregnancy (RR: 1,7). ConclusionCombined screening of fetal chromosomal abnormalities is currently routine practice in most hospitals. The data provided by this screening can be used to select a group of patients at increased risk of alterations of placentation, without increasing health costs, thus facilitating the optimization of material and human resources.