Variation of pregnancy-associated plasma protein-A: a level in the first trimester of pregnancy and its clinical outcome

Simran Virdi; Aditi; Satwant Kaur

doi:10.18203/2320-1770.ijrcog20263426

Authors

Simran Virdi Adesh Medical College and Hospital, Kurukshetra, Haryana, India
Aditi Adesh Medical College and Hospital, Kurukshetra, Haryana, India
Satwant Kaur Adesh Medical College and Hospital, Kurukshetra, Haryana, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20263426

Keywords:

PAPP-A, First trimester, Pregnancy outcome, Fetal growth restriction, Gestational hypertension, Preterm labour, Placental dysfunction

Abstract

Background: Pregnancy-associated plasma protein-A (PAPP-A) is a placental glycoprotein used in first-trimester screening and is involved in placental development through the insulin-like growth factor pathway. Low PAPP-A has been associated with placental dysfunction and adverse pregnancy outcomes. This study evaluated the association between first-trimester maternal serum PAPP-A and subsequent maternal and fetal outcomes in singleton pregnancies.

Methods: This hospital-based prospective study was conducted in the Department of Obstetrics and Gynaecology, Adesh Medical College and Hospital, Shahabad, Kurukshetra, from March 2024 to February 2025. A total of 134 low-risk singleton pregnant women aged 18–35 years, attending antenatal care and undergoing first-trimester screening at 11-13 weeks, were enrolled. Serum PAPP-A was measured by chemiluminescence and expressed as multiples of the median (MoM). Participants were followed until delivery, and outcomes were analysed using a <0.4 MoM cut-off.

Results: Mean maternal age was 28.46±3.33 years. Mean PAPP-A was 0.695±0.324 mIU/ml and 0.278±0.130 MoM. Gestational hypertension occurred in 26.9%, preterm labour in 35.8%, PROM in 11.9%, and oligohydramnios in 5.2%. Fetal growth restriction occurred in 24.6% and stillbirth in 2.2%. PAPP-A<0.4 MoM was significantly associated with gestational hypertension (p=0.002), preterm labour (p=0.013), and FGR (p=0.002). Mean PAPP-A was significantly lower in gestational hypertension and oligohydramnios.

Conclusions: Low first-trimester PAPP-A was associated with selected adverse maternal and fetal outcomes, particularly gestational hypertension and FGR. PAPP-A may support early risk stratification and closer antenatal surveillance, but should not be used as a stand-alone diagnostic or predictive test. in routine practice.

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