Yaron Yuval, Heifetz Sigal, Ochshorn Yifat, Lehavi Ofer, Orr-Urtreger Avi
Prenatal Diagnosis Unit, Genetic Institute, Sourasky Medical Center, Tel Aviv, Israel.
Prenat Diagn. 2002 Sep;22(9):778-82. doi: 10.1002/pd.407.
Low levels of maternal serum pregnancy associated plasma protein-A (PAPP-A) have been linked to chromosome anomalies such as trisomy 21, 13 and 18, triploidy and sex chromosome aneuploidy. Low levels of PAPP-A have also been implicated in spontaneous miscarriage. The purpose of this study was to evaluate whether low levels of first trimester PAPP-A are predictive of other adverse pregnancy outcomes.
The study included patients with singleton pregnancies who underwent combined first trimester screening using nuchal translucency (NT) and maternal serum free beta-human chorionic gonadotrophin (free beta-hCG) and PAPP-A at 10-13 weeks' gestation. Patients with chromosome aberrations or fetal anomalies were excluded. Serum marker levels were expressed as gestational age-specific multiples of the median (MoMs). The incidences of various adverse pregnancy outcomes (spontaneous preterm labor, fetal growth restriction (FGR), proteinuric and non-proteinuric pregnancy induced hypertension (PIH), intrauterine fetal demise, oligohydramnios, spontaneous miscarriage and placental abruption) were evaluated, according to maternal PAPP-A MoM levels.
Of the 1622 patients in the study, pregnancy complications were observed in 184 (11.3%). Patients with PAPP-A < or =0.25 MoM had significantly higher rates of FGR (RR = 3.12), proteinuric PIH (RR = 6.09), spontaneous miscarriage (RR = 8.76). No statistically significant differences were noted for other adverse outcomes evaluated Women with PAPP-A < or =0.50 MoM also had significantly higher rates of FGR (RR = 3.30) and spontaneous miscarriage (RR = 3.78).
We conclude that decreased levels of first trimester maternal serum PAPP-A are predictive not only of chromosome anomalies but also of adverse pregnancy outcome.
孕妇血清妊娠相关血浆蛋白-A（PAPP-A）水平降低与21-三体、13-三体、18-三体、三倍体及性染色体非整倍体等染色体异常有关。PAPP-A水平降低还与自然流产有关。本研究旨在评估孕早期PAPP-A水平降低是否可预测其他不良妊娠结局。
本研究纳入单胎妊娠患者，这些患者在孕10-13周时接受了联合孕早期筛查，包括颈部透明带（NT）、孕妇血清游离β-人绒毛膜促性腺激素（游离β-hCG）和PAPP-A检测。排除染色体异常或胎儿畸形的患者。血清标志物水平以孕周特异性中位数倍数（MoM）表示。根据孕妇PAPP-A MoM水平评估各种不良妊娠结局（自然早产、胎儿生长受限（FGR）、蛋白尿性和非蛋白尿性妊娠高血压综合征（PIH）、胎儿宫内死亡、羊水过少、自然流产和胎盘早剥）的发生率。
本研究的1622例患者中，184例（11.3%）出现妊娠并发症。PAPP-A≤0.25 MoM的患者FGR发生率（RR = 3.12）、蛋白尿性PIH发生率（RR = 6.09）、自然流产发生率（RR = 8.76）显著更高。评估的其他不良结局未发现统计学显著差异。PAPP-A≤0.50 MoM的女性FGR发生率（RR = 3.30）和自然流产发生率（RR = 3.78）也显著更高。
我们得出结论，孕早期孕妇血清PAPP-A水平降低不仅可预测染色体异常，还可预测不良妊娠结局。
