title: Early-onset severe preeclampsia by first trimester pregnancy-associated plasma protein A and total human chorionic gonadotropin.
abstract: OBJECTIVE
  This study aims to evaluate the relationship between early-onset severe preeclampsia and first trimester serum levels of pregnancy-associated plasma protein A (PAPP-A) and total human chorionic gonadotropin (hCG).
  
  
  METHODS
  The association between early-onset severe preeclampsia and abnormal levels of first trimester PAPP-A and total hCG in maternal serum were measured in a sample of singleton pregnancies without chromosomal defects that had integrated prenatal serum screening in 2009 and 2010 (n = 129,488). Logistic binomial regression was used to estimate the relative risk (RR) of early-onset severe preeclampsia in pregnancies with abnormal levels of first trimester PAPP-A or total hCG as compared with controls.
  
  
  RESULTS
  Regardless of parity, women with low first trimester PAPP-A or high total hCG were at increased risk for early-onset severe preeclampsia. Women with low PAPP-A (multiple of the median [MoM] ≤ the 10th percentile in nulliparous or ≤ the 5th percentile in multiparous) or high total hCG (MoM ≥ the 90th percentile in nulliparous or ≥ the 95th percentile in multiparous) were at more than a threefold increased risk for early-onset severe preeclampsia (RR, 4.2; 95% confidence interval [CI], 3.0-5.9 and RR, 3.3; 95% CI, 2.1-5.2, respectively).
  
  
  CONCLUSIONS
  Routinely collected first trimester measurements of PAPP-A and total hCG provide unique risk information for early-onset severe preeclampsia.
authors.affiliation: Genetic Disease Screening Program, California Department of Public Health, Richmond, California.
authors.forename: Laura L
authors.initials: LL
authors.lastname: Jelliffe-Pawlowski
authors.affiliation: Genetic Disease Screening Program, California Department of Public Health, Richmond, California.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Baer
authors.affiliation: Genetic Disease Screening Program, California Department of Public Health, Richmond, California.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Currier
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
authors.forename: Deirdre J
authors.initials: DJ
authors.lastname: Lyell
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
authors.forename: Yair J
authors.initials: YJ
authors.lastname: Blumenfeld
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
authors.forename: Yasser Y
authors.initials: YY
authors.lastname: El-Sayed
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Shaw
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
authors.forename: Maurie L
authors.initials: ML
authors.lastname: Druzin
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D006063:Chorionic Gonadotropin / Q000097:blood*; D005260:Female; D006801:Humans; D010298:Parity; D011225:Pre-Eclampsia / Q000097:blood*; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000097:blood*; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006063:Chorionic Gonadotropin; D011266:Pregnancy-Associated Plasma Protein-A; C579283:PAPPA protein, human