title: The risk of adverse pregnancy outcome among pregnancies with extremely low maternal PAPP-A.
abstract: OBJECTIVE
  The aim of the study was to analyze the risk of adverse pregnancy outcome in three subgroups with extremely low maternal pregnancy-associated plasma protein-A (PAPP-A), that is, <0.3 multiples of median (MoM) at the first trimester screening.
  
  
  METHODS
  A cohort of 961 pregnancies with PAPP-A levels < 0.3 MoM at the first trimester combined screening was followed up during the study period of January 2009 to December 2012. The incidences of adverse outcomes was determined in three subgroups with PAPP-A levels < 0.1 MoM, 0.1 to 0.2 MoM, and 0.2 to 0.3 MoM, respectively.
  
  
  RESULTS
  The risks of aneuploidy and spontaneous abortion increased with decreasing PAPP-A levels (p < 0.001), but no difference was detected in the rate of structural anomalies among the three groups. Rates of preterm delivery (p < 0.001) and birth weight < 2 standard deviation below the mean (p < 0.001) increased with decreasing PAPP-A levels. The rates of preeclampsia, stillbirth, and cesarean delivery were not significantly different across the three subgroups.
  
  
  CONCLUSIONS
  The risks of aneuploidy, spontaneous abortion, preterm delivery, and small for gestational age newborn increased with decreasing PAPP-A. © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Marja
authors.initials: M
authors.lastname: Kaijomaa
authors.affiliation: Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Veli-Matti
authors.initials: VM
authors.lastname: Ulander
authors.affiliation: HUSLAB and Department of Clinical Chemistry, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Esa
authors.initials: E
authors.lastname: Hämäläinen
authors.affiliation: HUSLAB and Department of Clinical Chemistry, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Henrik
authors.initials: H
authors.lastname: Alfthan
authors.affiliation: HUSLAB and Department of Clinical Chemistry, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Helene
authors.initials: H
authors.lastname: Markkanen
authors.affiliation: Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Seppo
authors.initials: S
authors.lastname: Heinonen
authors.affiliation: Department of Obstetrics and Gynecology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Vedran
authors.initials: V
authors.lastname: Stefanovic
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology* / Q000378:metabolism; D000328:Adult; D000782:Aneuploidy; D015415:Biomarkers / Q000378:metabolism; D002585:Cesarean Section / Q000706:statistics & numerical data; D025063:Chromosome Disorders / Q000453:epidemiology* / Q000378:metabolism; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000453:epidemiology* / Q000378:metabolism; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000378:metabolism; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011261:Pregnancy Trimester, First; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D047928:Premature Birth / Q000453:epidemiology* / Q000378:metabolism; D012307:Risk Factors; D050497:Stillbirth / Q000453:epidemiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D011266:Pregnancy-Associated Plasma Protein-A; C579283:PAPPA protein, human