First-trimester serum PAPP-A and fβ-hCG concentrations and other maternal characteristics to establish logistic regression-based predictive rules for adverse pregnancy outcome.
OBJECTIVE
To determine the clinical relevance of maternal characteristics and first-trimester serum concentrations of pregnancy-associated plasma protein A (PAPP-A) and free beta human chorionic gonadotrophin (fβ-hCG) in predicting placenta-related complications, miscarriage and preterm delivery. DESIGN, SETTING AND POPULATION: A historical cohort study of data of the National Institute for Public Health and the Environment of first-trimester screening tests performed between July 2002 and May 2006 was done. Data from 28 566 (64.1%) tests were eligible for analysis.


METHODS
By logistic regression, predictive rules were made based on PAPP-A and fβ-hCG concentrations, maternal smoking, maternal weight and age, low birth weight, stillbirth and hypertensive disorders, miscarriage and preterm birth. Predictive values were analysed with the area under the curve (AUC) of receiver operating curves (ROC).


RESULTS
Predictive for placenta-related complications were low PAPP-A, low fβ-hCG, smoking and weight (AUC 54%). For miscarriage low PAPP-A, low fβ-hCG and maternal age (MA) were predictive (AUC 78%) and for preterm delivery low PAPP-A, smoking, MA and maternal weight (AUC 55%).


CONCLUSIONS
Only the predictive model for miscarriage had a clinically relevant predictive value of 28%. Results together do not justify closer surveillance of chromosomally normal pregnancies with PAPP-A or fβ-hCG levels below the fifth percentile.
van Ravenswaaij
R
R
Academic Medical Center (AMC), University of Amsterdam (UvA), The Netherlands.
Tesselaar-van der Goot
M
M
de Wolf
S
S
van Leeuwen-Spruijt
M
M
Visser
G H A
GH
Schielen
P C J I
PC
D000022:Abortion, Spontaneous / Q000175:diagnosis; D000293:Adolescent; D000328:Adult; D001835:Body Weight; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood*; D005260:Female; D005865:Gestational Age; D006801:Humans; D016015:Logistic Models; D008297:Male; D008423:Maternal Age; D008875:Middle Aged; D010922:Placenta Diseases / Q000175:diagnosis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis*; D047928:Premature Birth / Q000175:diagnosis; D012907:Smoking / Q000009:adverse effects
D018997:Chorionic Gonadotropin, beta Subunit, Human; D011266:Pregnancy-Associated Plasma Protein-A