First trimester PAPP-A levels associated with early prediction of pregnancy induced hypertension.
OBJECTIVE
Previous studies have suggested an association between low levels of first trimester serum Pregnancy Associated Plasma Protein-A (PAPP-A) and the occurrence of hypertension in pregnancy (PIH). The purpose of this study was to determine the predictive value of maternal PAPP-A levels in the identification of women at risk of PIH.


METHODS
Maternal serum PAPP-A was measured between 11-13 + 6 wks' gestation, as part of the first trimester screening of aneuploidies. Our study included only singleton pregnancies (973 cases) over a three years period. PAPP-A levels were expressed as gestational age-specific multiples of the median (MoM). Hypertension in pregnancy was documented by standard criteria.


RESULTS
One hundred and eleven pregnant women developed hypertension (8.9%). In these patients, PAPP-A levels ranged from 0.53 to 1.08 MoM. After performing a backward stepwise regression equation and a ROC curve procedure, a PAPP-A MoM value <0.8 was able to significantly predict PIH (p < 0.001, area under the ROC curve 83%, sensitivity 68%, specificity 86%, 95 degrees CI 0.57-0.94).


CONCLUSIONS
Low levels of serum PAPP-A (?0.8 MoM) may be a potential resource in order to early screen pregnant women at increased risk of hypertension in pregnancy.
Department of General Surgery Pietro Valdoni, Policlinico Umberto I, La Sapienza University, Rome, Italy.
Paolo
P
Meloni
Ilaria
I
D'Angeli
Juan
J
Piazze
Albana
A
Cerekya
Terenzia
T
Simari
Alessandro
A
Pala
Maurizio Marco
MM
Anceschi
Mara
M
Guglietta
Paolo
P
Izzo
Luciano
L
Izzo
D000293:Adolescent; D000328:Adult; D005260:Female; D015200:Fluoroimmunoassay; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000097:blood*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000097:blood*; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D011446:Prospective Studies; D012044:Regression Analysis
D011266:Pregnancy-Associated Plasma Protein-A