title: Pregnancy-associated plasma protein A levels and neonatal complications in post-date pregnancies.
abstract: OBJECTIVE
  To assess the association between serum pregnancy-associated plasma protein A (PAPP-A) and free β-human chorionic gonadotropin (free β-hCG) in the first trimester and perinatal complications in post-date pregnancies.
  
  
  METHODS
  A total of 4948 women, who delivered after 40 gestational weeks, were included. Labour was not induced routinely until 42 weeks. Serum levels of PAPP-A and free β-hCG were determined at the first-trimester screening for Down syndrome. Neonatal complications were obtained from specific registration forms filled out by senior neonatologists.
  
  
  RESULTS
  In post-date pregnancies, PAPP-A < 0.4 multiples of the median was associated with Apgar score of less than 7 at 5 min (ORadj 5.4, 95% CI 2.0-14.3), admission to the neonatal intensive care unit (ORadj 1.5, 95% CI 1.0-2.3) and newborn hypoglycaemia (ORadj 3.4, 95% CI 1.8-6.4). In small for gestation (SGA) neonates, the risk of hypoglycaemia was further increased (OR 14.6, 95% CI 3.4-58.0). Similar analyses were made with free β-hCG, but no statistically significant associations were found.
  
  
  CONCLUSIONS
  Low first-trimester serum PAPP-A was associated with increased neonatal morbidity in post-date pregnancies, particularly in newborns with SGA. Thus, PAPP-A may qualify the timing of induction of labour in these pregnancies.
authors.affiliation: Perinatal Epidemiology Research Unit, Aarhus University Hospital, Skejby, Denmark.
authors.forename: Anne R
authors.initials: AR
authors.lastname: Zizzo
authors.forename: Ida
authors.initials: I
authors.lastname: Kirkegaard
authors.forename: Tine B
authors.initials: TB
authors.lastname: Henriksen
authors.forename: Niels
authors.initials: N
authors.lastname: Ulbjerg
mesh_terms: D000328:Adult; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D007233:Infant, Postmature; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000097:blood*; D011273:Pregnancy, Prolonged / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis* / Q000378:metabolism; D011379:Prognosis; D055815:Young Adult
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; D011266:Pregnancy-Associated Plasma Protein-A