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Elmas B, Laleli Koç B, Tuğrul Ersak D, Zorlu U, Aydoğdu E, Yılmaz G, Üreyen Özdemir E, Hançerlioğulları N, Moraloğlu Tekin Ö. The relationship between the first trimester maternal serum PAPP-A and β-hCG values and newborn intensive care needs in low-risk pregnancies. Turk J Obstet Gynecol 2022; 19:287-294. [DOI: 10.4274/tjod.galenos.2022.48861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Peris M, Reid SM, Dobie S, Bonacquisto L, Shepherd DA, Amor DJ. First-trimester maternal serum biomarkers and the risk of cerebral palsy. Dev Med Child Neurol 2021; 63:183-189. [PMID: 33206412 DOI: 10.1111/dmcn.14732] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 11/30/2022]
Abstract
AIM To investigate whether combined first-trimester screening (cFTS) biomarkers are associated with cerebral palsy (CP) and to identify CP characteristics associated with abnormal biomarker levels. METHOD In this retrospective case-control data linkage study, we matched mothers of 435 singletons with CP from a population register to their cFTS records and selected 10 singleton pregnancy controls per case. We compared mean and abnormal levels (expressed as multiples of the median [MoMs]) of pregnancy-associated plasma protein-A (PAPP-A), beta subunit of human chorionic gonadotrophin (β-hCG), and nuchal translucency between cases and controls and between CP subgroups. RESULTS Compared with control pregnancies, CP pregnancies had lower mean levels of PAPP-A (0.95 vs 1.01 MoM, p=0.02) and β-hCG (0.93 vs 0.99 MoM, p=0.02). Biomarker levels in CP pregnancies were 1.8 times more likely to be associated with abnormally low levels of PAPP-A (p<0.01), 1.4 times for β-hCG (p=0.12), and 2.6 times for low PAPP-A and β-hCG together (p=0.04). In cases with CP, an abnormally low PAPP-A level was associated with moderate preterm birth, low Apgar scores, and Gross Motor Function Classification System level V. Low β-hCG was associated with very low birthweight. INTERPRETATION Low first-trimester biomarker levels suggest a role for early pregnancy factors in some causal pathways to CP. WHAT THIS PAPER ADDS Low first-trimester levels of biomarkers in maternal serum are associated with later cerebral palsy (CP). Early pregnancy factors have potential importance in causal pathways to CP. Causal pathways involving preterm birth, term neonatal encephalopathy, and genetic syndromes may be implicated.
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Affiliation(s)
- Monique Peris
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Susan M Reid
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Stephen Dobie
- Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
| | - Leo Bonacquisto
- Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
| | - Daisy A Shepherd
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - David J Amor
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
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Low First Trimester Pregnancy-Associated Plasma Protein-A Levels Are Not Associated with an Increased Risk of Intrapartum Fetal Compromise or Adverse Neonatal Outcomes: A Retrospective Cohort Study. J Clin Med 2020; 9:jcm9041108. [PMID: 32294920 PMCID: PMC7230680 DOI: 10.3390/jcm9041108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 01/12/2023] Open
Abstract
The aim of this study was to assess if women with a low first trimester maternal pregnancy-associated plasma protein-A (PAPP-A) level are at increased risk of emergency cesarean (EmCS) for intrapartum fetal compromise (IFC) and/or adverse neonatal outcomes. This was a retrospective cohort study performed at Mater Mother’s Hospital, Brisbane, Australia, between 2016 and 2018. All women with a singleton, euploid, non-anomalous fetus with a documented PAPP-A level measured between 10 +0 and 13 +6 weeks gestation during the study period were included. Data were extracted from the institution’s perinatal database and dichotomized according to PAPP-A level (≤0.4 Multiples of Medium (MoM) vs. >0.4 MoM). The primary outcomes were EmCS-IFC and a composite of severe adverse neonatal outcomes (SCNO). Nine thousand sixty-one pregnancies were included, 3.3% with a PAPP-A ≤ 0.4 MoM. Low maternal PAPP-A was not associated with an increased risk of EmCS-IFC (adjusted odds ratio (aOR) 0.77, 95% confidence interval (CI) 0.24–2.46, p = 0.66) or SCNO (aOR 0.65, 95% CI 0.39–1.07, p = 0.09). Low PAPP-A was associated with increased odds of pre-eclampsia, preterm birth and birthweight < 10th centile. In conclusion, low maternal PAPP-A level is not associated with an increased risk of EmCS IFC or adverse neonatal outcomes despite greater odds of low-birthweight infants and preterm birth.
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Ozgen G, Dincgez Cakmak B, Dundar B, Tasgoz FN, Bayram F, Karadag B. Is pregnancy associated plasma protein-A (PAPP-A) a marker for adverse perinatal outcomes in preterm isolated oligohydramnios cases? Taiwan J Obstet Gynecol 2018; 57:71-75. [PMID: 29458908 DOI: 10.1016/j.tjog.2017.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Isolated oligohydramnios is defined as an amniotic fluid index below five centimeter with no other coexisting condition. There are still controversies about the management and pregnancy outcomes. A marker predicting these is crucial. Low pregnancy associated plasma protein-A levels were reported to be related with adverse pregnancy outcomes. We aimed to determine the role of first trimester pregnancy associated plasma protein-A for poor outcomes in preterm isolated oligohydramnios cases. MATERIAL AND METHODS Fifty-one patients with singleton pregnancies diagnosed as isolated oligohydramnios at 28/0-36/6 weeks of gestation and 110 gestational age matched healthy controls between January and December 2015 were included. Maternal age, gestational age at delivery, mode of delivery, indication for cesarean section, Apgar scores at first and fifth minutes, birth weight, neonatal intensive care unit admission and mortality were recorded. Pregnancy associated plasma protein-A levels were compared between groups and its role in adverse perinatal outcomes was evaluated. RESULTS Pregnancy associated plasma protein-A levels and pregnancy outcomes were similar in two groups (p > 0.050) except birth weight, gestational age at delivery and presence of fetal distress. Pregnancy associated plasma protein-A levels did not differ in terms of delivery mode, presence of fetal distress, first and fifth minutes Apgar scores and neonatal intensive care unit admission (p = 0.323,0.650,0.990,0.112,0.853). Also, it was not determined as a risk factor for cesarean section, presence of fetal distress, low Apgar scores and neonatal intensive care unit admission. CONCLUSION Pregnancy associated plasma protein-A, a well-known prognostic factor for some of high risk pregnancy conditions, may not be used as a marker in preterm isolated oligohydramnios cases.
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Affiliation(s)
- Gulten Ozgen
- Bursa Yuksek Ihtisas Research and Training Hospital, Department of Obstetrics and Gynecology, Bursa, Turkey
| | - Burcu Dincgez Cakmak
- Bursa Yuksek Ihtisas Research and Training Hospital, Department of Obstetrics and Gynecology, Bursa, Turkey.
| | - Betul Dundar
- Bursa Yuksek Ihtisas Research and Training Hospital, Department of Obstetrics and Gynecology, Bursa, Turkey
| | - Fatma Nurgul Tasgoz
- Bursa Yuksek Ihtisas Research and Training Hospital, Department of Obstetrics and Gynecology, Bursa, Turkey
| | - Feyza Bayram
- Bursa Yuksek Ihtisas Research and Training Hospital, Department of Obstetrics and Gynecology, Bursa, Turkey
| | - Burak Karadag
- Antalya Research and Training Hospital, Department of Obstetrics and Gynecology, Antalya, Turkey
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Uysal G, Tutus S, Cagli F, Adiguzel C. Is there any relationship between low PAPP-A levels and measures of umbilical vein and placental thickness during first trimester of pregnancy? North Clin Istanb 2017; 4:60-65. [PMID: 28752144 PMCID: PMC5530159 DOI: 10.14744/nci.2017.26121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/20/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Low pregnancy-associated plasma protein A (PAPP-A) level is associated with adverse perinatal outcomes. The purpose of this study was to evaluate relationship between umbilical cord diameter (UCD), umbilical vein and artery diameters (UVD, UAD), placental thickness, and PAPP-A level at gestational age of between 11 and 14 weeks. METHODS UCD, UVD, UAD, and placental thickness of 246 women were assessed during ultrasound examination at between 11 and 14 weeks of gestation, as well as measurement of nuchal translucency (NT) and crown-rump length (CRL). Patients were divided into 2 groups according to PAPP-A percentile. Group 1 comprised 23 patients who had low PAPP-A (<0.44 multiple of medians [MoM], <10th percentile) and Group 2 was made up of 223 patients with PAPP-A of >0.44 MoM, >10th percentile. Calipers used for measurement were placed inner edge to inner edge of echogenic boundaries of the vessel. Largest sections of all vessels (UV and both arteries) were evaluated. Thickest part of the placenta was used for placental thickness measurement. RESULTS Narrow UCD (<4.5±0.6 mm) was associated with low PAPP-A level (p=0.02). There was no significant difference in UVD, UAD, or placental thickness between groups. There was no significant difference in gestational age, CRL, or NT between groups. Fetal birth weight was significantly lower in Group 1 (p=0.03). CONCLUSION Closer attention to women with low-risk, healthy pregnancies and low PAPP-A level in first trimester screening results is recommended. They should be routinely screened for background medical risk factors and umbilical cord morphology in first trimester scan.
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Affiliation(s)
- Gulsum Uysal
- Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Sadan Tutus
- Department of Radiology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Fulya Cagli
- Department of Obstetrics and Gynecology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Cevdet Adiguzel
- Department of Obstetrics and Gynecology, Adana Numune Training and Research Hospital, Adana, Turkey
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