title: Low maternal serum levels of pregnancy-associated plasma protein-A during the first trimester are associated with subsequent preterm delivery with preterm premature rupture of membranes.
abstract: OBJECTIVE
  To assess the relationship between the first-trimester maternal serum pregnancy-associated plasma protein-A (PAPP-A) levels and pregnancies complicated by preterm delivery.
  
  
  METHODS
  The correlation between PAPP-A levels and gestational age at delivery was analyzed by linear regression. The probabilities of low PAPP-A multiples of the median (MoM) levels between preterm delivery and control population were analyzed by logit model.
  
  
  RESULTS
  A positive correlation was noted between the first-trimester PAPP-A MoM levels and gestational age at delivery between 34-38 weeks (p < 0.001). Lower PAPP-A MoM level had a significantly higher likelihood of preterm delivery (p < 0.05). When preterm premature rupture of membranes (PPROM) and preterm labor (PTL) were analyzed separately, there was an increasing likelihood of PPROM with decreasing PAPP-A MoM levels (p < 0.05), but not for PTL with intact membranes.
  
  
  CONCLUSIONS
  Low maternal serum PAPP-A levels during the first trimester may reflect a trophoblast invasion defect in the maternal-fetal interface, resulting in subsequent preterm delivery, particularly in those of PPROM.
authors.affiliation: Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan.
authors.forename: Bo-Quing
authors.initials: BQ
authors.lastname: She
authors.forename: Su-Chee
authors.initials: SC
authors.lastname: Chen
authors.forename: Fa-Kung
authors.initials: FK
authors.lastname: Lee
authors.forename: Mei-Leng
authors.initials: ML
authors.lastname: Cheong
authors.forename: Ming-Song
authors.initials: MS
authors.lastname: Tsai
mesh_terms: D016022:Case-Control Studies; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000097:blood* / Q000209:etiology; D005865:Gestational Age; D006801:Humans; D016014:Linear Models; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000097:blood*; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D047928:Premature Birth / Q000097:blood* / Q000209:etiology; D011336:Probability
chemical_list: D011266:Pregnancy-Associated Plasma Protein-A