Associated plasma protein during the first trimester of pregnancy and pregnancy outcomes

Authors

  • Vennapusa Rama Devi Department of Obstetrics and Gynecology, Fathima Institute of Medical Sciences, Kadapa, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20180048

Keywords:

First-trimester screening, Idiopathic preterm delivery, Pregnancy-associated plasma protein A

Abstract

Background: Newborns are perhaps the most vulnerable population the world over. Preterm or babies born too early, less than 37 weeks gestation, are particularly at risk. Objective of present study were to determine the strength of relationship between PAPP-A concentrations using our own reference range and rates of idiopathic preterm delivery.

Methods: A retrospective cohort study was conducted on consecutive singleton pregnancies undergoing first-trimester screening for fetal Down syndrome between 11 weeks and 14 weeks of pregnancy.

Results: 500 patients in first trimester of pregnancy were selected in this study. 400 patients were found to have normal levels and were followed up till delivery. 20 patients developed preterm labour. Out of 100 patients who had low PAPP-A level, 35 patients had developed preterm labour. 15 patients out of 400 normal patients developed foetal growth retardation, 13 out of 100 low patients had foetal growth retardation. 5 out 400 normal patients developed PIH and no still birth was seen in normal patients. 15 out of 100 low patients had PIH and 2 patients had still birth. Most of the patients had asymmetrical FGR which concludes that there might be increased utero-placental resistance because of foetal growth restriction.

Conclusions: In the first trimester of pregnancy, PPP-A level is an important predictor of outcome of obstetrics. A low level of PAPP-A is useful in indicating the risk of pre-term delivery and chance of PIH development.

References

Wang J, Qiu Q, Haider M, Bell M, Gruslin A, Christians JK. Expression of pregnancy-associated plasma protein A2 during pregnancy in human and mouse. J Endocrinol. 2009;202(3):337-45.

Yan X, Baxter RC, Firth SM. Involvement of pregnancy- associated plasma protein-A2 in insulin-like growth factor (IGF) binding protein-5 proteolysis during pregnancy: a potential mechanism for increasing IGF bioavailability. J Clin Endocrinol Metab. 2010;95(3):1412-20.

Christians JK, Gruslin A. Altered levels of insulin-like growth factor binding protein proteases in preeclampsia and intrauterine growth restriction. Prenat Diagn. 2010;30(9):815-20.

Wagner PK, Otomo A, Christians JK. Regulation of pregnancy- associated plasma protein A2 (PAPPA2) in a human placental tro- phoblast cell line (BeWo). Reprod Biol Endocrinol. 2011;9:48.

Kramer A, Hoffman C, Lynch A, Winn VD. Maternal serum PAPP-A2 levels are elevated in early onset preeclampsia at time of diagnosis and in early gestation. Reprod Sci. 2012;19(3 suppl):87A.

Jyoti Malik, Pinki Raj, Ashima Das, Sibadatta Das; Pregnancy-associated plasma protein A - a level in first trimester and its impact on pregnancy outcome. Int J Reprod Contracept Obstretrics Gynaecol. 2016Aug;5(8):2680-3.

Kirkagard I, Uldberg N, Oxvig C. Biology of pregnancy associated plasma protein-a in relation to prenatal diagnostics; an overview. Acta obstet Gynecol Scand. 2010;89(9):1118-25..

Cowans NJ, Spencer K. First trimester ADAM 12 and PAPP-A as markers for intrauterine fetal growth restriction through their roles in the insulin like growth factor system. Prenat Diagn. 2007;27(3):264- 71.

Dugoff L, Hobbins JC, Malone FD. First trimester maternal serum PAPP-A and free beta Aubunit human chorionic gonadotrophin concentrations and nuchal translucency are associated with obstetric complications: a population based screening study (the faster trial). Am J Obstet Gynecol. 2004;19(6):1446-51.

Crosley EJ, Durland U, Seethram K, MacRae S, Gruslin A, Christians JK. First-trimester levels of pregnancy-associated plasma protein A2 (PAPP-A2) in the maternal circulation are elevated in pregnancies that subsequently develop preeclampsia. Reprod Sci. 2014 Jun;21(6):754-60.

Downloads

Published

2018-01-23

Issue

Section

Original Research Articles