Medizinische Universität Graz - Research portal
Selected Publication:
Wachter, M.
Outcome of pregnancies in Cases of decreased PAPP-A (Pregnancy Associated Plasma Protein a) in the first trimester of pregnancy
Humanmedizin; [ Diplomarbeit ] ; 2014. pp. 65
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- Authors Med Uni Graz:
- Advisor:
- Cervar-Zivkovic Mila
- Csapo Bence Daniel
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- Abstract:
- Introduction In previous studies, reduced levels of PAPP-A (pregnancy associated plasma protein A) were shown to correlate with adverse pregnancy outcomes. PAPP-A, a placental protein shows exponential increase with a doubling time of three to four days in first trimester. Decreased levels of PAPP-A in maternal serum can be a sign of impaired placental function and implantation, or inversely, impaired placental function and implantation cause low levels of PAPP- A. The purpose of this study was to evaluate how low levels of first trimester PAPP-A correlate with adverse pregnancy outcome. Adverse outcomes were defined as: Intrauterine fetal growth restriction (IUGR), Small-for-gestational-age (SGA), Preeclampsia/pregnancy-induced-hypertension (PE/PIH), Preterm Delivery (PD) and Intrauterine fetal death (IUFD). Methods: The study collected data from 2937 patients undergoing Combined Test at the Deptartment of Obstetrics and Gynaecology, Medical University of Graz, between January 2005 and December 2012. We identified a total n=847 patients showing PAPP-A MoM levels = 0.7, which can be defined as study group. The controls were a group of 2085 women, who show PAPP-A MoM levels > 0.7. After delivery medical chart reviews were performed to collect data about adverse pregnancy outcomes, ultrasound examination and biochemistry, maternal and fetal characteristics. Results: Of the 2933 patients in the study, pregnancy complications were observed in 705 (24.04%) cases. In a total, there are 127 (4.3%) cases of IUGR, 195 (6.7%) of PD, 307 (10.4%) of SGA, 71 (2.4%) of PE/PIH and 5 cases of IUFD, which is 0.2%. The strongest correlation was observed between low PAPP-A (0.1-0.2 MoM) and IUGR with 21.4%. The smallest number of cases counts PE/ PIH with less than 1% (0.9% in 0.2-0.3 PAPP-A MoM). 2085 patients adhere to the controls, where the incidence of adverse pregnancy outcomes is much lower than in the study group. PD is the highest with 6.0% and 124 patients, the lowest is PE/PIH with 2.2% and 26 patients. Conclusion Low levels of PAPP-A in first trimester of pregnancy are in association with adverse pregnancy outcome. If the identification of patients with low PAPP-A early in pregnancy, enables individualised prenatal care reducing the risk of complications in this group.