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PAPP‐A, free β‐hCG, and early fetal growth identify two pathways leading to preterm delivery
Author(s) -
Kirkegaard Ida,
Uldbjerg Niels,
Petersen Olav Bjørn,
Tørring Niels,
Henriksen Tine Brink
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.2593
Subject(s) - medicine , fetus , gestational age , obstetrics , crown rump length , pregnancy , fetal growth , pregnancy associated plasma protein a , odds ratio , gestation , gynecology , first trimester , biology , genetics
Abstract Objective To evaluate early fetal growth and the biomarkers, pregnancy‐associated plasma protein A (PAPP‐A) and free β‐human chorionic gonadotrophin (β‐hCG), in relation to preterm delivery. Methods A cohort study of 9450 singleton pregnant women who attended the prenatal screening program at Aarhus University Hospital between January 2005 and December 2007, was conducted. PAPP‐A and free β‐hCG were measured in the first trimester. Early fetal growth was estimated by (GA 20 − GA 12 )/Days calendar , where GA 12 reflects the gestational age in days calculated from the crown‐rump length at a 12‐week scan, GA 20 reflects the gestational age in days calculated from the biparietal diameter at a 20‐week scan, and Days calendar is the number of calendar days between the two scans. Results Low PAPP‐A and low free β‐hCG were significantly associated with preterm delivery (<37 weeks). The association was even stronger when low PAPP‐A and slow early fetal growth were combined, resulting in an adjusted odds ratio of 3.8 (95% CI, 1.6–8.7). Fast early fetal growth, but neither high PAPP‐A nor high free β‐hCG, was significantly associated with preterm delivery. Conclusion Two different biological pathways leading to spontaneous preterm delivery are suggested: fast early fetal growth and the combination of low PAPP‐A and slow early fetal growth. Copyright © 2010 John Wiley & Sons, Ltd.