Low PAPP-A Levels and Pregnancy Outcomes [21J]

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Abstract

INTRODUCTION:

Pregnancy-associated plasma protein A (PAPP-A) is associated with adverse pregnancy outcomes: preterm birth, growth restriction, stillbirth and preeclampsia. 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:

Retrospective study of pregnant women between July 2013 and July 2016. Women with PAPP-A in the 5 percentile were compared to women with PAPP-A ≤1 percentile. Primary outcome: cesarean delivery (CD) rate. Secondary outcomes: indication for CD, perinatal outcomes. Exclusion: women with fetuses with known or suspected aneuploidy.

RESULTS:

One hundred thirty-nine women were included; 91 women with PAPP-A in 5 percentile and 48 women with PAPP-A ≤1 percentile. Demographics were similar except for gestational age at delivery (38.6±3.6 weeks in the 5 percentile group versus 35.9±7.4 in the 1 percentile group, P=.004). There was no difference in CD rate (27/91 [29.7%] versus 12/48 [25%], P=.6), fetal indication for CD (8/27 [29.6%] versus 4/12 [33.3%], P=.8). Birth weight was significantly higher in the 5 percentile group versus the 1 percentile group (3,264.6±580.8 versus 2,935.4±715.3, P=.004). Neonatal morbidity composite score was different between groups; (18/91 [19.8%] in the 5 percentile group versus 18/48 [37.5%] in the 1 percentile group P=.02).

CONCLUSION:

PAPP-A ≤1 percentile does not seem associated with delivery mode or indication for cesarean delivery in comparison to <5 percentile. PAPP-A ≤1 percentile may be associated with increased neonatal morbidity during labor, as well as lower birth weight and preterm birth in comparison to PAPP-A <5 percentile.

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