TY - JOUR
T1 - Association of first-trimester low PAPP-A levels with preterm birth
AU - Goetzinger, Katherine R.
AU - Cahill, Alison G.
AU - Macones, George A.
AU - Odibo, Anthony O.
PY - 2010/4
Y1 - 2010/4
N2 - Objective: To determine the association of, and predictive ability of, pregnancy-associated plasma protein A (PAPP-A), free β-human chorionic gonadotrophin (β-hCG), and nuchal translucency (NT) with preterm birth (PTB). Methods: A 5-year retrospective cohort study of women who underwent first-trimester combined screening was performed. Maternal medical, antepartum, and pregnancy outcome data were obtained. PAPP-A and β-hCG were converted to multiples of the median (MoM), and primary exposure was defined as ≤10th percentile MoM for PAPP-A. Secondary exposures were defined as ≥90th percentile MoM for β-hCG and NT values of ≥20 and 25 mm. The primary outcome was PTB before 35 weeks and the secondary outcome was PTB before 32 weeks. Univariate, bivariate, multivariate, and receiver-operator analyses were used. Results: Of the 2231 patients meeting inclusion criteria with complete outcome data available, 222 had a PAPP-A level ≤10th percentile MoM. Abnormally low PAPP-A was associated with an increased risk for PTB <35 weeks [adjusted odds ratio (aOR) 2.0, 1.0-3.8] and <32 weeks (aOR 2.7, 1.1-6.4), even after adjusting for prior PTB, tobacco exposure, chronic hypertension, and body mass index. PAPP-A ≤10th percentile was not sufficiently predictive of PTB <35 weeks (area under curve = 0.63, 95% CI 0.53-0.72). Neither abnormally high β-hCG nor increased NT was associated with an increased risk for PTB. Conclusions: PAPP-A ≤10th percentile is associated with an increased risk for PTB, but is not sufficiently predictive to be used clinically.
AB - Objective: To determine the association of, and predictive ability of, pregnancy-associated plasma protein A (PAPP-A), free β-human chorionic gonadotrophin (β-hCG), and nuchal translucency (NT) with preterm birth (PTB). Methods: A 5-year retrospective cohort study of women who underwent first-trimester combined screening was performed. Maternal medical, antepartum, and pregnancy outcome data were obtained. PAPP-A and β-hCG were converted to multiples of the median (MoM), and primary exposure was defined as ≤10th percentile MoM for PAPP-A. Secondary exposures were defined as ≥90th percentile MoM for β-hCG and NT values of ≥20 and 25 mm. The primary outcome was PTB before 35 weeks and the secondary outcome was PTB before 32 weeks. Univariate, bivariate, multivariate, and receiver-operator analyses were used. Results: Of the 2231 patients meeting inclusion criteria with complete outcome data available, 222 had a PAPP-A level ≤10th percentile MoM. Abnormally low PAPP-A was associated with an increased risk for PTB <35 weeks [adjusted odds ratio (aOR) 2.0, 1.0-3.8] and <32 weeks (aOR 2.7, 1.1-6.4), even after adjusting for prior PTB, tobacco exposure, chronic hypertension, and body mass index. PAPP-A ≤10th percentile was not sufficiently predictive of PTB <35 weeks (area under curve = 0.63, 95% CI 0.53-0.72). Neither abnormally high β-hCG nor increased NT was associated with an increased risk for PTB. Conclusions: PAPP-A ≤10th percentile is associated with an increased risk for PTB, but is not sufficiently predictive to be used clinically.
KW - First-trimester screening
KW - Free β-hCG
KW - Nuchal translucency
KW - PAPP-A
KW - Preterm birth
UR - http://www.scopus.com/inward/record.url?scp=77950662608&partnerID=8YFLogxK
U2 - 10.1002/pd.2452
DO - 10.1002/pd.2452
M3 - Article
C2 - 20087924
AN - SCOPUS:77950662608
SN - 0197-3851
VL - 30
SP - 309
EP - 313
JO - Prenatal Diagnosis
JF - Prenatal Diagnosis
IS - 4
ER -