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).
OBJECTIVE
The purpose of this study was to determine whether maternal serum levels of pregnancy-associated plasma protein A, free-beta subunit human chorionic gonadotropin, or nuchal translucency size are associated with obstetric complications.


METHODS
Data were obtained from the First and Second Trimester Evaluation of Risk trial. Pregnancy-associated plasma protein A and free-beta subunit human chorionic gonadotropin levels were analyzed, and nuchal translucency was measured between 10 weeks 3 days and 13 weeks 6 days of gestation in 34,271 pregnancies.


RESULTS
Women with pregnancy-associated plasma protein A of < or =5th percentile were significantly more likely to experience spontaneous fetal loss at < or =24 weeks of gestation, low birth weight, preeclampsia, gestational hypertension, preterm birth ( P < .001) and stillbirth, preterm premature rupture of membranes, and placental abruption ( P < .02). Nuchal translucency at > or =99th percentile and free-beta subunit human chorionic gonadotropin at < or =1st percentile were associated with an increased risk of spontaneous loss at < or =24 weeks of gestation (adjusted odds ratios, 3.90, 3.62, respectively; P < .001).


CONCLUSIONS
Low pregnancy-associated plasma protein A levels in the first trimester were associated strongly with a number of adverse pregnancy outcomes. Low free-beta subunit human chorionic gonadotropin levels and large nuchal translucency were both associated with early fetal loss.
Dugoff
Lorraine
L
Department of Gynecology and Obstetrics, University of Colorado Health Sciences Center, Denver, CO, USA.
Hobbins
John C
JC
Malone
Fergal D
FD
Porter
T Flint
TF
Luthy
David
D
Comstock
Christine H
CH
Hankins
Gary
G
Berkowitz
Richard L
RL
Merkatz
Irwin
I
Craigo
Sabrina D
SD
Timor-Tritsch
Ilan E
IE
Carr
Steven R
SR
Wolfe
Honor M
HM
Vidaver
John
J
D'Alton
Mary E
ME
D000022:Abortion, Spontaneous / Q000097:blood*; D000037:Abruptio Placentae / Q000097:blood; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000097:blood; D006801:Humans; D008423:Maternal Age; D015337:Multicenter Studies as Topic; D048208:Nuchal Translucency Measurement; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood*; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First / Q000502:physiology*; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis*; D047928:Premature Birth / Q000097:blood
D018997:Chorionic Gonadotropin, beta Subunit, Human; D011266:Pregnancy-Associated Plasma Protein-A