First trimester serum PAPP-A levels and the prediction of small-for-gestational age infants

Abstract

Objectives: The aim of this study was to detect the predictive value of PAPP-A in small-for-gestational age (SGA) infants. Materials and methods: We retrospectively searched the patient charts of our hospital for first trimester Down syndrome screening test results. PAPP-A levels less than 5th percentile were considered as predictive of SGA infants. Results: Low PAPP-A levels were associated with SGA infants, sensitivity was 3,5%, specificity 90%, positive predictive value 1,6% and negative predictive value 95%. Conclusions: The low positive predictive value of PAPP-A prevents it from being used as a screening test for the detection of SGA infants. J Clin Exp Invest 2012; 3(2): 185-188

Keywords

• Small for gestational age, PAPP-A, pregnancy

İlk trimester serum PAPP-A düzeyleri ve gebelik yaşına göre küçük bebeklerin tahmin edilmesi

Öz

Amaç: Bu çalışmanın amacı ilk trimester serum PAPP-A (pregnancy aasociated plasma protein A) seviyelerinin gebelik yaşına göre küçük (GYK) bebekleri tahmin etmede kullanılabilirliğini tespit etmektir. Gereç ve yöntem: Geriye dönük olarak hastanemizin gebe kayıtları incelendi ve ilk trimester Down sendromu tarama testlerinin sonuçları bulundu. PAPP-A seviyeleri 5. persentilin altında kalanlar GYK bebek olarak kabul edildi. Bulgular: Düşük PAPP-A seviyeleri ile GYK bebekler arasında bir ilişki mevcuttur, testin duyarlılığı %3,5, özgüllüğü %90, pozitif kestirim değeri %1,6 ve negatif kestirim değeri %95tir. Sonuç: Testin pozitif kestirim değerinin düşük olması nedeniyle GYK bebekleri tahmin etmek için kullanılması uygun değildir.

Anahtar Kelimeler

• gebelik yaşına göre küçük bebek, PAPP-A, gebelik

Kaynakça

1. Lindqvist PG, Molin J. Does antenatal identification of small-for-gestational age fetuses significantly improve their outcome? Ultrasound Obstet Gynecol 2005;25(3):258-64.
2. Kady MS, Gardosi J. Perinatal mortality and fetal growth restriction. Best Pract Res Clin Obstet Gynaecol 2004;18(3):397-410.
3. Smith GC. First trimester origins of fetal growth impairment. Semin Perinatol 2004;28(1):41-50.
4. Ong CY, Liao AW, Spencer K, Munim S, Nicolaides KH. First trimester maternal serum free beta human chorionic gonadotropin and pregnancy associated plasma protein A as predictors of pregnancy complications. BJOG 2000;107(10):1265-70.
5. Dugoff L, Hobbins JC, Malone FD, et al. First trimester maternal serum PAPP-A and free-beta subunit human chorionic gonadotropin concentrations and nuchal translucency are associated with obstetric complications: a population based screening study (the FASTER Trial). Am J Obstet Gynecol 2004;191(4):1446-51.
6. Yaron Y, Heifetz S, Ochshorn Y, Lehavi O, Orr-Urtreger A. Decreased first trimester PAPP-A is a predictor of adverse pregnancy outcome. Prenat Diagn 2002;22(9):778-82.
7. Smith GC, Stenhouse EJ, Crossley JA, Aitken DA, Cameron AD, Connor JM. Early pregnancy levels of pregnancy associated plasma protein a and the risk of intrauterine growth restriction, premature birth, preeclampsia amd stillbirth. J Clin Endocrinol Metab 2002;87(4):1762-7.
8. Morssink LP, Kornman LH, Hallahan TW, et al. Maternal serum levels of free beta-hCG and PAPP-A in the first trimester of pregnancy are not associated with subsequent fetal growth retardation or preterm delivery. Prenat Diagn 1998;18(2):147-52.

9. Kaufman P, Black S, Huppertz B. Endovascular trophoblast invasion: implications for the pathogenesis of intrauterine growth retardation and preeclampsia. Biol Reprod 2003;69(1):1-7.
10. Sun IY, Overgaard MT, Oxvig C, Giudice LC. Pregnancy-associated plasma protein A proteolytic activity is associated with the human placental trophoblast cell membrane. J Clin Endocrinol Metab 2002;87(11):5235-40.
11. Ranta JK, Raatikainen K, Romppanen J, Pulkki K, Heinonen S. Decreased PAPP-A is associated with preeclampsia, premature delivery and small for gestational age infants but not with placental abruption. Eur J Obstet Gynecol Biol 2011;157(1):48-52.
12. Barrett N, Bower C, Hadlow NC. Use of the combined first trimester screen result and low PAPP-A to predict risk of adverse fetal outcome. Prenat Diagn 2008;28(1):28-35.
13. Cowans NJ, Spencer K. First-trimester ADAM12 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.
14. Bujold E, Tapp S, Audibert F, et al. Prevention of adverse pregnancy outcomes with low-dose ASA in early pregnancy:new perspectives for future randomized trials. J Obstet Gynecol Can 2011;33(5):480-3.
15. Cooper S, Johnson JM, Metcalfe A, et al. The predictive value of 18 and 22 week uterine artery Doppler in patients with low first trimester maternal serum PAPPA.Prenat Diagn 2009;29(3):248-52.
16. Peterson SE, Simhan HN. First-trimester pregnancy-associated plasma protein A and subsequent abnormalities of fetal growth Am J Obstet Gynecol 2008;198(5):43-5.
17. Krantz D, Goetzl L, Simpson JL, et al. Association of extreme first trimester free human chroionic gonadotropin-beta, Pregnancy associated plasma protein A, and nuchal translucency with intrauterine growth restriction and other adverse pregnancy outcomes. Am J Obstet Gynecol 2004;191(4):1452-8.
18. Spencer K, Cowans NJ, Avgidou K, Molina F, Nicolaides KH. First-trimester biochemical markers of aneuploidy and the prediction of small-for-gestational age fetuses. Ultrasound Obstet Gynecol 2008;31(1):15-9.
19. Yiğiter AB, Kavak ZN, Bakirci N, Gökaslan H. Effect of smoking on pregnancy associated plasma protein A, free beta human chorionic gonadotropin, and nuchal translucency in the first trimester of pregnancy. Adv Ther 2006,23(1):131-8
20. Catov JM, Nohr EA, Olsen J, Ness RB. Chronic hypertension related to risk for preterm and term small for gestational age births. Obstet Gynecol 2008;112(2pt1):290-6.
21. Bukowski R, Uchida T, Smith GC, et al. Individualized norms of optimal fetal growth: fetal growth potential. Obstet Gynecol 2008;111(5):1065-75.