title: Low maternal pregnancy-associated plasma protein A during the first trimester of pregnancy and pregnancy outcomes.
abstract: OBJECTIVE
  To assess the association between pregnancy-associated placental protein A (PAPP-A) levels in the first trimester of pregnancy and adverse pregnancy outcomes.
  
  
  METHODS
  A retrospective study included data from a group of patients in the first trimester of pregnancy with PAPP-A levels below 0.3 multiples of median who attended the Helsinki University Hospital, Finland, between January 1, 2009 and December 31, 2012; an age-matched control group of patients with PAPP-A levels 0.9-1.1 multiples of median was also enrolled. The incidences of adverse pregnancy outcomes in the two groups were compared.
  
  
  RESULTS
  There were 961 patients included in each of the groups. Significantly increased risks of aneuploidies (odds ratio [OR] 116.0; 95% confidence interval [CI] 16.2-836.6) and spontaneous abortion (OR 7.7; 95% CI 2.7-22.0) were observed among patients with low PAPP-A (both P<0.001). Preterm delivery (OR 2.5, 95% CI 1.8-3.5), pre-eclampsia (OR 10.9, 95% CI 4.3-27.6), and small for gestational age neonates (OR 4.9, 95% CI 3.2-7.5) were also observed more frequently among patients with low PAPP-A (all P<0.001). There were 9 (0.9%) stillbirths recorded among patients with low PAPP-A and none recorded in the control group.
  
  
  CONCLUSIONS
  Low PAPP-A was associated with adverse pregnancy outcomes and aneuploidy. These risks should be considered when planning follow-up for patients with low PAPP-A pregnancies.
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: Leena
authors.initials: L
authors.lastname: Rahkonen
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; D000328:Adult; D000782:Aneuploidy; D015415:Biomarkers / Q000097:blood; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology; D005387:Finland; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011261:Pregnancy Trimester, First / Q000097:blood*; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis*; D047928:Premature Birth / Q000453:epidemiology; D012189:Retrospective Studies; D050497:Stillbirth / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D011266:Pregnancy-Associated Plasma Protein-A
keywords: Aneuploidy; PAPP-A; Pre-eclampsia; Preterm delivery; Spontaneous abortion; Stillbirth