Shridevi Gundu1, Mohan Kulkarni1, Sanjay Gupte2, Asmita Gupte2, Maitreyee Gambhir3, Prakash Gambhir4. 1. Division of Biochemistry, Department of Chemistry, Savitribai Phule Pune University, Pune, India. 2. Gupte Hospital and Research Center, Pune, India. 3. Division of Biochemistry, Department of Chemistry, Savitribai Phule Pune University, Pune, India; Birthright Genetic Clinic, Pune, India. 4. Birthright Genetic Clinic, Pune, India. Electronic address: drprakashgambhir@yahoo.com.
Abstract
OBJECTIVE: To analyze the relationship between first-trimester levels of pregnancy-associated plasma protein A (PAPP-A) and small-for-gestational-age (SGA) neonates and preterm births, and to assess predictive utility for these events. METHODS: A prospective study was conducted among women undergoing first-trimester screening between January 1, 2012, and December 31, 2013, at two centers in Pune, India. Serum PAPP-A levels, pregnancy course, and outcome were assessed. RESULTS: Overall, 1474 women were included. An association was found between the lowest quintile of PAPP-A levels (<0.4 multiples of median) for both SGA (<10th centile; 20.9% of cases in this PAPP-A quintile) and preterm birth (<37weeks; 15.8%). Women in the lowest quintile of PAPP-A concentration had a significantly increased risk of SGA (<10th centile) than did those with higher concentrations (adjusted odds ratio 2.92, 95% confidence interval 2.00-4.27). Their risk of preterm birth (<37weeks) was also increased (adjusted odds ratio 1.84, 95% confidence interval 1.25-2.72). The predictive sensitivities of the lowest quintile of PAPP-A were 35.85% for SGA (<10th centile) and 27.92% for preterm birth (<37weeks). CONCLUSION: Low levels of PAPP-A were associated with SGA and preterm births; however, poor predictive sensitivity could restrict clinical utility of this marker when used alone.
OBJECTIVE: To analyze the relationship between first-trimester levels of pregnancy-associated plasma protein A (PAPP-A) and small-for-gestational-age (SGA) neonates and preterm births, and to assess predictive utility for these events. METHODS: A prospective study was conducted among women undergoing first-trimester screening between January 1, 2012, and December 31, 2013, at two centers in Pune, India. Serum PAPP-A levels, pregnancy course, and outcome were assessed. RESULTS: Overall, 1474 women were included. An association was found between the lowest quintile of PAPP-A levels (<0.4 multiples of median) for both SGA (<10th centile; 20.9% of cases in this PAPP-A quintile) and preterm birth (<37weeks; 15.8%). Women in the lowest quintile of PAPP-A concentration had a significantly increased risk of SGA (<10th centile) than did those with higher concentrations (adjusted odds ratio 2.92, 95% confidence interval 2.00-4.27). Their risk of preterm birth (<37weeks) was also increased (adjusted odds ratio 1.84, 95% confidence interval 1.25-2.72). The predictive sensitivities of the lowest quintile of PAPP-A were 35.85% for SGA (<10th centile) and 27.92% for preterm birth (<37weeks). CONCLUSION: Low levels of PAPP-A were associated with SGA and preterm births; however, poor predictive sensitivity could restrict clinical utility of this marker when used alone.