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Association offirst‐trimester low PAPP‐A levels with preterm birth
Author(s) -
Goetzinger Katherine R.,
Cahill Alison G.,
Macones George A.,
Odibo Anthony O.
Publication year - 2010
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.2452
Subject(s) - medicine , percentile , pregnancy associated plasma protein a , obstetrics , pregnancy , odds ratio , retrospective cohort study , gynecology , univariate analysis , receiver operating characteristic , multivariate analysis , gestation , first trimester , statistics , mathematics , biology , genetics
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. Copyright © 2010 John Wiley & Sons, Ltd.