Association of first-trimester low PAPP-A levels with preterm birth

Katherine R. Goetzinger, Alison G. Cahill, George A. Macones, Anthony O. Odibo

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)309-313
Number of pages5
JournalPrenatal Diagnosis
Volume30
Issue number4
DOIs
StatePublished - Apr 1 2010

Keywords

  • First-trimester screening
  • Free β-hCG
  • Nuchal translucency
  • PAPP-A
  • Preterm birth

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    Goetzinger, K. R., Cahill, A. G., Macones, G. A., & Odibo, A. O. (2010). Association of first-trimester low PAPP-A levels with preterm birth. Prenatal Diagnosis, 30(4), 309-313. https://doi.org/10.1002/pd.2452