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.
Meloni
Paolo
P
Department of General Surgery Pietro Valdoni, Policlinico Umberto I, La Sapienza University, Rome, Italy.
D'Angeli
Ilaria
I
Piazze
Juan
J
Cerekya
Albana
A
Simari
Terenzia
T
Pala
Alessandro
A
Anceschi
Maurizio Marco
MM
Guglietta
Mara
M
Izzo
Paolo
P
Izzo
Luciano
L
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