Pregnancy-associated Plasma Protein A Levels with Pregnancy Outcomes: A preliminary study

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Indu Lata
Prabhakar Mishra


Objectives: In the first trimester serum screening pregnancy-associated plasma protein-A (PAPP-A) levels are estimated in pregnant women. Its low values are leading to more risk of preterm delivery, isolated intrauterine growth restriction (IUGR), intrauterine death (IUD) or neonatal death, pregnancy-induced hypertension (PIH), and intrahepatic cholestasis of pregnancy (IHCP). The objective of this study was to find the correlation of PAPP-A levels with pregnancy outcomes and complications.
Materials and Methods: This retrospective study was done on the patients visiting the antenatal outpatient department for first trimester screening (11-13 weeks). Ultrasonographic nuchal translucency scan and blood sample test for double marker were performed. Based on the multiple of median (MOM) value of PAPP-A, two groups were made. MOM value ≥ 0.5 (normal PAPP-A levels) was considered as the control group and MOM value < 0.5 (low PAPP-A levels) was considered as the study group. Data were collected and analyzed. Pregnant women were followed-up until delivery. Pregnancy outcomes and complications were recorded.
Results: A total of 141 patients qualified and included in the study, 126 patients had normal (control group) and 15 had low PAPP-A values (study group). The study group had significant higher complications when compared to control group as IHCP (46.6% vs 14.3%, p = 0.002), IUGR (26.6% vs 8.7%, p = 0.034), preterm delivery (46.67% vs 19.84%, p = 0.017), IUD (13.3% vs 0.79%, p = 0.001) and fetal distress (13.3% vs 1.58%, p = 0.009). The patients of study group having more gestational diabetes (20% vs 16.6%, p = 0.744), both PIH and oligohydramnios (13.3% vs 7.93%, p = 0.482) and premature rupture of membranes (6.66% vs 0.79%, p = 0.069) that were insignificantly higher as compared to control groups.
Conclusion: The PAPP-A levels measurement is a valuable marker during the first -trimester screening for predicting adverse outcomes and complications, as low PAPP-A level was associated with a high chance of preterm delivery, IUGR, IHCP, and adverse fetal outcome.


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