title: Maternal serum placental growth factor and pregnancy-associated plasma protein A measured in the first trimester as parameters of subsequent pre-eclampsia and small-for-gestational-age infants: A prospective observational study.
abstract: OBJECTIVE
  To examine the first-trimester maternal serum placental growth factor (PlGF) and pregnancy-associated plasma protein A (PAPP-A) levels in pregnancies associated with pre-eclampsia (PE) or small-for-gestational-age (SGA) infants, and determine the predictive accuracy of PlGF and of PAPP-A for either PE or SGA infants.
  
  
  METHODS
  This prospective, observational study included 175 pregnant women, and of these women, due to participant withdrawal or loss to follow-up, delivery data were collected from the medical records of 155 women, including 4 who had twin pregnancies. The women's maternal history was recorded, and the PlGF and PAPP-A levels at 11 to 13 gestational weeks were measured. During the second trimester, the maternal uterine artery's systolic/diastolic ratio was measured. Multiples of the median (MoM) of PlGF and PAPP-A were determined, and the associations of these values with the risk factors of SGA and PE were evaluated. Logistic regression analysis was used to determine whether PlGF and PAPP-A are useful markers for predicting SGA infants.
  
  
  RESULTS
  The PAPP-A MoM level was significantly lower in women with advanced maternal age, multipara women, and women with gestational diabetes than in their counterparts. The PlGF and PAPP-A MoM levels were higher in women with a twin pregnancy than in those with a singleton pregnancy. There was a significant relationship between the maternal serum PAPP-A MoM level in the first trimester and the uterine artery systolic/diastolic ratio in the second trimester. Results of logistic regression analysis showed that low PlGF and PAPP-A MoM levels were predictors of SGA infants (odds ratio, 0.143; 95% confidence interval, 0.025 to 0.806; odds ratio, 0.191; 95% confidence interval, 0.051 to 0.718, respectively).
  
  
  CONCLUSIONS
  PlGF and PAPP-A are potentially useful as first-trimester markers for SGA infants and some hypertensive disorders of pregnancy.
authors.affiliation: Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
authors.forename: Kyung Uk
authors.initials: KU
authors.lastname: Sung
authors.affiliation: Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
authors.forename: Jeong A
authors.initials: JA
authors.lastname: Roh
authors.affiliation: Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
authors.forename: Kyung Jin
authors.initials: KJ
authors.lastname: Eoh
authors.affiliation: Department of Obstetrics and Gynecology, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
authors.forename: Eui Hyeok
authors.identifier: 0000-0002-3264-3620
authors.initials: EH
authors.lastname: Kim
keywords: Placental growth factor; Pre-eclampsia; Pregnancy-associated plasma protein A; Small-for-gestational-age infant