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Association of serum PAPP‐A levels in first trimester with small for gestational age and adverse pregnancy outcomes: systematic review and meta‐analysis
Author(s) -
Morris R. Katie,
Bilagi Ashwini,
Devani Pooja,
Kilby Mark D.
Publication year - 2017
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.5001
Subject(s) - medicine , odds ratio , obstetrics , pregnancy , small for gestational age , confidence interval , meta analysis , birth weight , pregnancy associated plasma protein a , gestational age , gynecology , gestation , first trimester , genetics , biology
Objectives To determine association, and predictive ability, of first trimester maternal serum pregnancy associated plasma protein A (PAPP‐A) with adverse pregnancy outcomes. Method Searches of Medline, Embase and CINAHL (inception September 2015) for studies including pregnant women with first trimester PAPP‐A and assessment of pregnancy outcomes. Study characteristics, quality and results extracted. Meta‐analysis of odds ratios (ORs), and likelihood ratios (LRs) and 95% confidence intervals (CI). Results Thirty‐two studies including 175 240 pregnancies. PAPP‐A <5th centile had a moderate association with: birth weight <10th centile OR 2.08 (95% CI 1.89–2.29), <5th centile OR 2.83 (95% CI 2.52–3.18); pre‐eclampsia OR 1.94 (95% CI 1.63–2.30), preterm birth <37 weeks OR 2.09 (95% CI 1.87–2.33), and composite adverse outcome OR 3.31 (95% CI 1.80–5.11). The predictive ability was poor: Birth weight <10th centile LR + ve 1.96 (95% CI 1.58–2.43), LR‐ve 0.93 (95% CI 0.89–0.98); birth weight <5th centile LR + ve 2.65 (95% CI 2.35–2.99), LR‐ve 0.85 (95% CI 0.74–0.98); PTB <37 weeks LR + ve 1.84 (95% CI 1.41–2.39), LR‐ve 0.92 (95% CI 0.87–0.98). Conclusions First trimester low maternal serum PAPP‐A is associated with adverse pregnancy outcome, but predictive values are poor. Further work should address PAPP‐A as a continuous variable in combination with other prognostic markers as a prediction model. © 2016 John Wiley & Sons, Ltd.