Highlights
- •High PAPP-A or free β-hCG levels lead to anxiety despite low risk for trisomies.
- •The significance of extremely high PAPP-A or free β-hCG remains unclear.
- •Most pregnancies with extremely increased PAPP-A or free β-hCG have good outcomes.
- •Counselling in patients with extremely high PAPP-A or free β-hCG should be favorable.
Abstract
Introduction
Extreme levels of either PAPP-A or free β-hCG may be a serious clinical concern. A
multicentre study was carried out to determine the frequency and clinical consequences
of high (minimum 2,0 MoM) maternal (PAPP)-A and free beta hCG.
Methods
A total number of 8591 patients with singleton pregnancies between 11 + 0–13 + 6 weeks
of gestation were enrolled. A total number of 612 cases with first trimester serum
level of PAPP-A corresponding to ≥ 2,0 MoM and/or free β-hCG to ≥ 2,0 MoM were included
in the statistical analysis. All serum samples were analysed with Roche (Cobas) or
Kryptor (Brahms) devices. A retrospective analysis of perinatal outcomes was conducted.
Results
Values of PAPP-A ≥ 2,0 MoM and free β-hCG < 2.0 MoM were detected in 48,5% of patients
(n = 297), free β-hCG ≥ 2,0 MoM and PAPP-A concentration < 2,0 MoM in 38,1% of patients
(n = 233) and both PAPP-A and free β-hCG ≥ 2,0 multiple of median in 13,4% of patients
(n = 82). The highest PAPP-A and free β-hCG concentrations were 19,2 MoM and 16,3
MoM respectively. Patients with both PAPP-A and free β-hCG above 2,0 MoM had a slightly
higher (but statistically not significant) prevalence of history of low birthweight
(8,3%).
Discussion
Pregnancy outcomes in women with normal ultrasound findings and high PAPP-A /free
β-hCG concentration are good. Higher prevalence of pregnancy complications was not
detected in either extremely high PAPP-A and free β-hCG concentration groups. In cases
of normal ultrasound and isolated high (even extreme) biochemical markers levels the
counselling should be comforting.
Keywords
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Article info
Publication history
Published online: January 20, 2023
Accepted:
January 18,
2023
Received in revised form:
January 14,
2023
Received:
December 16,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
