The association between low PAPP-A levels at first trimester and poor pregnancy outcomes

Objective: Pregnancy-associated plasma protein A (PAPP-A) is one of the markers recommended to identify patients at early periods of pregnancy who are under risk in terms of poor pregnancy outcomes. Our aim in this study was to analyze the association between low PAPP-A levels at first trimester and pregnancy complications. Methods: Serum PAPP-A results of pregnancies between 11 and 14 weeks of gestation who referred for first trimester chromosomal anomaly screening were analyzed retrospectively. While 0.35 MoM and higher values were considered as low PAPP-A level, the values between 0.35 and 2.07 MoM were considered as normal PAPP-A level. In order to evaluate poor pregnancy outcomes, the obstetric history of pregnant women including intrauterine growth retardation, gestational diabetes, preeclampsia, preterm labor diagnoses, delivery type, birth weight and fetal genders were recorded. Results: The study was carried out on two groups, which are low PAPP-A group including 211 (47.6%) out of 443 pregnant women (PAPP-A ≤0.35 MoM) and normal PAPP-A group including 232 (52.4%) out of 443 pregnant women (2.07 MoM > PAPP-A > 0.35 MoM). The prevalence rates for intrauterine growth retardation (p=0.01), preeclampsia (p=0.019), early-onset preeclampsia (p=0.043), preterm labor (p=0.016), preterm premature rupture of membrane (p=0.038) and iatrogenic preterm labor (p=0.040) were significantly high in the low PAPP-A group compared to the control group. The birth weight was also low (p=0.01) and cesarean section rate was high (p=0.008) in the low PAPP-A group. Conclusion: Our findings confirm that there is a significant association between poor pregnancy outcomes and low maternal serum PAPP-A levels. These observations indicate that the complications appearing at the late periods of pregnancy may be detected at the first trimester.