title: Association between first-trimester maternal serum pregnancy-associated plasma protein-A and obstetric complications.
abstract: OBJECTIVE
  This study aimed to investigate the relationship between maternal serum pregnancy-associated plasma protein-A (PAPP-A) in the first trimester of pregnancy and the development of preeclampsia (PE), early PE, small-for-gestational age (SGA) fetus and preterm delivery (PD).
  
  
  METHODS
  This is a retrospective study of 12,355 pregnant women that delivered between 2008 and 2011. We define the first, third and fifth percentiles of maternal serum PAPP-A multiples of the median (MoM). The primary outcome measures were the occurrence of PE, early PE (PE requiring delivery before 34 weeks), SGA fetus (birth weight < 5th centile) and PD. The Mann-Whitney U-test and chi-squared test were used to analyze continuous and dichotomous variables, respectively.
  
  
  RESULTS
  Maternal serum PAPP-A was significantly lower in women with PE, early PE, SGA fetus and PD (0.91, 0.74, 0.80 and 0.84 MoM, respectively) than in the study population (0.99 MoM) (p < 0.05). The lower the MoM percentile of PAPP-A, the higher are the odds ratio (OR) to develop PE, early PE, SGA fetus and PD.
  
  
  CONCLUSIONS
  Maternal serum PAPP-A levels are lower in women who develop preeclampsia, those with SGA fetus and those who deliver preterm. However, on its own, maternal serum PAPP-A performs poorly (OR for PE between 1.76 and 2.41 with the lower percentile of PAPP-A) as a screening test for these conditions.
authors.affiliation: Fetal Medicine Unit, Division of Developmental Sciences, St. George's University of London, London, UK.
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Antonio
authors.forename: Claudia
authors.initials: C
authors.lastname: Rijo
authors.forename: Basky
authors.initials: B
authors.lastname: Thilaganathan
authors.forename: Ranjit
authors.initials: R
authors.lastname: Akolekar
authors.forename: Asma
authors.initials: A
authors.lastname: Khalil
authors.forename: Aris
authors.initials: A
authors.lastname: Papageourgiou
authors.forename: Amar
authors.initials: A
authors.lastname: Bhide
mesh_terms: D000328:Adult; D005260:Female; D005313:Fetal Death / Q000097:blood / Q000453:epidemiology; D005317:Fetal Growth Retardation / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D011225:Pre-Eclampsia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood* / Q000175:diagnosis; D011261:Pregnancy Trimester, First / Q000097:blood*; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis*; D047928:Premature Birth / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D011266:Pregnancy-Associated Plasma Protein-A