title: Association of first-trimester pregnancy-associated plasma protein A levels and idiopathic preterm delivery: A population-based screening study.
abstract: OBJECTIVE
  This study aims to determine the strength of relationship between pregnancy-associated plasma protein A (PAPP-A) concentrations, using a Thai-specific reference range, and rates of idiopathic preterm delivery.
  
  
  METHODS
  A retrospective cohort study was conducted on consecutive singleton pregnancies, undergoing first-trimester screening for fetal Down syndrome, between January 2007 and July 2012, at our network hospitals in the northern part of Thailand. The prospective database was assessed for the records with complete outcome information, including PAPP-A concentrations, gestational age at delivery, medical and obstetric complications, and fetal and pregnancy outcomes. Pregnancies with potential causes of preterm delivery were excluded. The recruited women were assigned to two groups; a group with normal PAPP-A levels (≥10(th) percentile) and a group with low PAPP-A levels (<10(th) percentile). The main outcome was the rate of idiopathic preterm births in the two groups.
  
  
  RESULTS
  Of 6867 screened women, 3830 were available for analysis and 670 were excluded because of potential confounders. Of the remaining 3160, 302 had low PAPP-A levels and 2858 had normal PAPP-A levels. The rates of spontaneous preterm births at ≤36 weeks, ≤34 weeks, and ≤32 weeks of gestation were significantly higher in women with low PAPP-A levels (7.6% vs. 17.9%, 3.1% vs. 11.9%, and 2.2% vs. 11.9%, respectively), with a relative risk of 2.37, 3.79, and 5.41 for preterm birth, respectively.
  
  
  CONCLUSIONS
  A PAPP-A level of ≤10(th) percentile was significantly associated with an increased risk for idiopathic preterm birth. Therefore, pregnant women with low PAPP-A levels in the first trimester should be considered at a high risk of preterm delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Piyathida
authors.initials: P
authors.lastname: Pummara
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Theera
authors.initials: T
authors.lastname: Tongsong
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Chanane
authors.initials: C
authors.lastname: Wanapirak
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Supatra
authors.initials: S
authors.lastname: Sirichotiyakul
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand. Electronic address: suleuwan@gmail.com.
authors.forename: Suchaya
authors.initials: S
authors.lastname: Luewan
mesh_terms: D000328:Adult; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D008403:Mass Screening; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000097:blood*; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D047928:Premature Birth / Q000453:epidemiology*; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013785:Thailand / Q000453:epidemiology
chemical_list: D011266:Pregnancy-Associated Plasma Protein-A
keywords: Pregnancy-associated plasma protein A (PAPP-A); Preterm labor; first trimester biomarker