Abstract
Objective
To evaluate first trimester pregnancy-associated plasma protein-A (PAPP-A) and birth
weight percentile.
Study design
Included were women who underwent first trimester prenatal screening through the California
Prenatal Screening Program with expected dates of delivery between August 2009 and
December 2010, linked birth certificate and hospital discharge records, known birth
weight, and no chromosomal abnormality (n = 134.105). PAPP-A results were reported as multiples of the median. The frequency of
small or large for gestational age (SGA, ≤10%; LGA, ≥90%) versus appropriately grown
for gestational age birth was examined by PAPP-A percentile. Patterns were studied
by gestational age at delivery. Relative risks (RRs) and their 95% confidence intervals
were adjusted for race/ethnicity.
Results
Women with PAPP-A ≤10th percentile and an infant born after 32 weeks were increasingly
more likely to have an SGA infant (adjRRs 1.5–4.6) as the PAPP-A percentile declined, and were increasingly less like to
have an LGA infant born at term (adjRRs 0.5–0.7) compared to women with PAPP-A measurement >10th to <90th percentile.
PAPP-A ≥90th percentile was protective for SGA among infants born after 32 weeks gestation
(adjRRs 0.3–0.7) and was associated with LGA among infants born at term (adjRRs 1.2–8.2).
Conclusion
Women with PAPP-A ≤10th percentile are more likely to have an SGA infant at all gestational
ages. PAPP-A ≥90th percentile is protective against SGA and is associated with an
increased risk of LGA for infants born after 32 weeks gestation.
Keywords
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References
- Perinatal outcome and later implications of intrauterine growth restriction.Clin Obstet Gynecol. 2006; 49: 257-269
- Effects of being born small for gestational age on long-term intellectual performance.Best Pract Res Clin Endocrinol Metab. 2008; 22: 477-488
- Brain development, intelligence and cognitive outcome in children born small for gestational age.Horm Res Paediatr. 2010; 73: 6-14
- Intrauterine growth restriction – diagnosis and management.Aust Fam Phys. 2005; 34: 717-723
- Fetal macrosomia: risk factors and outcome. A study of the outcome concerning 100 cases >4500 g.Eur J Obstet Gynecol Reprod Biol. 1998; 77: 51-59
- Prediction and prevention of the macrosomic fetus.Eur J Obstet Gynecol Reprod Biol. 2012; 162: 125-130
- Integrated and first trimester prenatal screening in California: program implementation and patient choice for follow-up services.Prenat Diagn. 2012; 32: 1077-1083
- First-trimester maternal serum PAPP-A and free-beta subunit human chorionic gonadotropin concentrations and nuchal translucency are associated with obstetric complications: a population-based screening study (the FASTER Trial).Am J Obstet Gynecol. 2004; 191: 1446-1451
- Association of early-preterm birth with abnormal levels of routinely collected first- and second-trimester biomarkers.Am J Obstet Gynecol. 2013; 208: 492-511
- Early-onset severe preeclampsia by first trimester pregnancy-associated plasma protein A and total human chorionic gonadotropin.Am J Perinatol. 2015; 32: 703-712
- First-trimester pregnancy-associated plasma protein A and subsequent abnormalities of fetal growth.Am J Obstet Gynecol. 2008; 198: e43-e45
- Placental volume at 11–13 weeks’ gestation in the prediction of birth weight percentile.Fetal Diagn Ther. 2011; 30: 23-28
- Correlation of neonatal weight with maternal serum levels of pregnancy-associated plasma protein-A during the first trimester of pregnancy: a retrospective study.J Perinat Med. 2015; 43: 227-232
- Elevated first trimester PAPP–a is associated with increased risk of placenta accreta.Prenat Diagn. 2014; 34: 159-162
- Role of the IGF system in trophoblast invasion and pre-eclampsia.Hum Reprod. 1999; 14: 90-96
- First-trimester placental volume and vascularization measured by 3-dimensional power Doppler sonography in pregnancies with low serum pregnancy-associated plasma protein a levels.J Ultrasound Med. 2009; 28: 1615-1622
- The secretion of PAPP-A, ADAM12, and PP13 correlates with the size of the placenta for the first month of pregnancy.Placenta. 2011; 32: 999-1003
- Detection rate of quadruple-marker screening determined by clinical follow-up and registry data in the statewide California program, July 2007 to February 2009.Prenat Diagn. 2011; 31: 901-906
- Triple-marker prenatal screening program for chromosomal defects.Obstet Gynecol. 2009; 114: 50-58
- A United States national reference for fetal growth.Obstet Gynecol. 1996; 87: 163-168
- International Classification of Diseases: ICD-9-CM 2008 Physician.9 ed. 2008
- First-trimester prediction of birth weight.Am J Perinatol. 2013; 30: 665-672
- Association between birth weight and first-trimester free beta-human chorionic gonadotropin and pregnancy-associated plasma protein A.Fertil Steril. 2008; 89: 174-178
- Biology of pregnancy-associated plasma protein-A in relation to prenatal diagnostics: an overview.Acta Obstet Gynecol Scand. 2010; 89: 1118-1125
- The insulin-like growth factor (IGF)-dependent IGF binding protein-4 protease secreted by human fibroblasts is pregnancy-associated plasma protein-A.Proc Natl Acad Sci U S A. 1999; 96: 3149-3153
- Identification and regulation of the IGFBP-4 protease and its physiological inhibitor in human trophoblasts and endometrial stroma: evidence for paracrine regulation of IGF-II bioavailability in the placental bed during human implantation.J Clin Endocrinol Metab. 2002; 87: 2359-2366
- Significance of IGFBP-4 in the development of fetal growth restriction.J Clin Endocrinol Metab. 2012; 97: E1429-E1439
- Obstetrical complications associated with abnormal maternal serum markers analytes.J Obstet Gynaecol Can. 2008; 30: 918-949
- Association between first-trimester maternal serum pregnancy-associated plasma protein-A and obstetric complications.Prenat Diagn. 2013; 33: 839-847
- Management of fetal growth restriction.Arch Dis Child Fetal Neonatal Ed. 2007; 92: F62-F67
Article info
Publication history
Published online: December 30, 2015
Accepted:
December 21,
2015
Received in revised form:
October 26,
2015
Received:
June 30,
2015
Identification
Copyright
© 2016 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
