Pregnancy-associated plasma protein A - a level in first trimester and its impact on pregnancy outcome


  • Jyoti Malik Department of Obstetrics and Gynaecology, SHKM Government Medical College, Nalhar, Haryana, India
  • Pinki Rai Department of Anatomy, SHKM Government Medical College, Nalhar, Haryana, India
  • Ashima Das Department of Anatomy, SHKM Government Medical College, Nalhar, Haryana, India
  • Sibadatta Das Department of Physiology, SHKM Government Medical College, Nalhar, Haryana, India



PAPP-A in pregnancy, Preterm delivery, Fetal growth restriction, PIH


Background: To study the pregnancy outcome in relation to PAPP-A level in the first trimester of pregnancy.

Methods: Every patient visiting the antenatal OPD was counseled for testing of first trimester screening to assess fetal wellbeing. Patients who were registered for the delivery in the same hospital were taken into consideration for study. Blood samples were taken at 11-13 weeks of gestation and sent to lab for analysis. Results were expressed in multiple of median and the patients having MoM value less than 0.5 were carefully observed till the delivery, and a thorough neonatal examination was done by a pediatrician.

Results: 524 patients were included in the study, out of which 452 patients were found to have a normal PAPP-A level of >0.5 MoM. All these patients were followed further during the antenatal period where 18 patients developed preterm labour and few patients developed pregnancy induced hypertension (PIH). The obstetric outcome of patients with normal PAPP-A level was fairly uneventful as compared to others with a low PAPP-A level.

Conclusions: PAPP-A level in the first trimester of pregnancy (11-13 weeks) is an important predictor of further obstetrics outcome. Patients having a PAPP-A level < 0.5 MoM had a high risk for preterm delivery, fetal growth restriction and stillbirth along with increased incidence of hypertensive disorder of pregnancy. A low PAPP-A level is a useful indicator of risk of preterm delivery and future chance of development of PIH.


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