School of Medicine and Health Sciences Poster Presentations

Title

Low PAPP-A Levels and Pregnancy Outcomes

Poster Number

343

Document Type

Poster

Status

Medical Student

Abstract Category

Women/Child Health

Keywords

Pregnancy, PAPP-A, labor dysfunction

Publication Date

Spring 2018

Abstract

Introduction: Pregnancy-associated plasma protein A, or PAPP-A, is a high molecular weight glycoprotein used as an analyte for first trimester aneuploidy screening along with hCG. There is significant association between low PAPP-A and adverse pregnancy outcomes, such as: preterm birth, intrauterine growth restriction, stillbirth, and preeclampsia.1 A recent retrospective study further supports an association of low PAPP-A with aneuploidy and adverse pregnancy outcomes.2 A systematic review also suggested an association between low serum PAPP-A and adverse pregnancy outcome, but indicated that the predictive values of low PAPP-A remain poor and that further studies should focus on PAPP-A as a prediction model.3 Because PAPP-A affects placental function, it may affect labor. The objective of this study was to determine if low PAPP-A is associated with labor dysfunction. Methods: This is a retrospective study of pregnant women who gave birth at GW Hospital between July 2013 and July 2016. Women with PAPP-A in the 5th percentile (5%ile) were compared to women with PAPP-A less than or equal to the 1st percentile (≤1%ile). The primary outcome examined was cesarean delivery (CD) rate and the secondary outcomes were indication for CD and perinatal outcomes. Women with fetuses with known or suspected aneuploidy were excluded from the study. Results: 139 women were included in the study; 91 women with PAPP-A in 5%ile and 48 women with PAPP-A ≤1%ile. Demographics were similar except for gestational age at delivery (38.6 ± 3.6 weeks in the 5%ile group vs. 35.9 ± 7.4 weeks in the 1%ile group, p = 0.004). There was no difference in CD rate (27/91 (29.7%) vs. 12/48 (25%), p = 0.6), fetal indication for CD (8/27 (29.6%) vs. 4/12 (33.3%), p = 0.8). Birth weight was significantly higher in the 5%ile group vs. the 1%ile group (3264.6 ± 580.8 grams vs. 2935.4 ± 715.3 grams, p = 0.004). Neonatal morbidity composite score was different between groups; (18/91 (19.8 %) in the 5%ile group vs. 18/48 (37.5%) in the 1%ile group p = 0.02). Conclusion: PAPP-A levels less than or equal to the 1st percentile does not seem associated with delivery mode or indication for cesarean delivery in comparison to PAPP-A levels in the 5th percentile. However, PAPP-A levels less than or equal to the 1st percentile may be associated with increased neonatal morbidity during labor, as well as lower birth weight and preterm birth in comparison to PAPP-A in the 5th percentile.

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Low PAPP-A Levels and Pregnancy Outcomes

Introduction: Pregnancy-associated plasma protein A, or PAPP-A, is a high molecular weight glycoprotein used as an analyte for first trimester aneuploidy screening along with hCG. There is significant association between low PAPP-A and adverse pregnancy outcomes, such as: preterm birth, intrauterine growth restriction, stillbirth, and preeclampsia.1 A recent retrospective study further supports an association of low PAPP-A with aneuploidy and adverse pregnancy outcomes.2 A systematic review also suggested an association between low serum PAPP-A and adverse pregnancy outcome, but indicated that the predictive values of low PAPP-A remain poor and that further studies should focus on PAPP-A as a prediction model.3 Because PAPP-A affects placental function, it may affect labor. The objective of this study was to determine if low PAPP-A is associated with labor dysfunction. Methods: This is a retrospective study of pregnant women who gave birth at GW Hospital between July 2013 and July 2016. Women with PAPP-A in the 5th percentile (5%ile) were compared to women with PAPP-A less than or equal to the 1st percentile (≤1%ile). The primary outcome examined was cesarean delivery (CD) rate and the secondary outcomes were indication for CD and perinatal outcomes. Women with fetuses with known or suspected aneuploidy were excluded from the study. Results: 139 women were included in the study; 91 women with PAPP-A in 5%ile and 48 women with PAPP-A ≤1%ile. Demographics were similar except for gestational age at delivery (38.6 ± 3.6 weeks in the 5%ile group vs. 35.9 ± 7.4 weeks in the 1%ile group, p = 0.004). There was no difference in CD rate (27/91 (29.7%) vs. 12/48 (25%), p = 0.6), fetal indication for CD (8/27 (29.6%) vs. 4/12 (33.3%), p = 0.8). Birth weight was significantly higher in the 5%ile group vs. the 1%ile group (3264.6 ± 580.8 grams vs. 2935.4 ± 715.3 grams, p = 0.004). Neonatal morbidity composite score was different between groups; (18/91 (19.8 %) in the 5%ile group vs. 18/48 (37.5%) in the 1%ile group p = 0.02). Conclusion: PAPP-A levels less than or equal to the 1st percentile does not seem associated with delivery mode or indication for cesarean delivery in comparison to PAPP-A levels in the 5th percentile. However, PAPP-A levels less than or equal to the 1st percentile may be associated with increased neonatal morbidity during labor, as well as lower birth weight and preterm birth in comparison to PAPP-A in the 5th percentile.