Pummara Piyathida, Tongsong Theera, Wanapirak Chanane, Sirichotiyakul Supatra, Luewan Suchaya
Department of Obstetrics and Gynecology, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand.
Department of Obstetrics and Gynecology, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand.
Taiwan J Obstet Gynecol. 2016 Feb;55(1):72-5. doi: 10.1016/j.tjog.2015.12.007.
This study aims to determine the strength of relationship between pregnancy-associated plasma protein A (PAPP-A) concentrations, using a Thai-specific reference range, and rates of idiopathic preterm delivery.
A retrospective cohort study was conducted on consecutive singleton pregnancies, undergoing first-trimester screening for fetal Down syndrome, between January 2007 and July 2012, at our network hospitals in the northern part of Thailand. The prospective database was assessed for the records with complete outcome information, including PAPP-A concentrations, gestational age at delivery, medical and obstetric complications, and fetal and pregnancy outcomes. Pregnancies with potential causes of preterm delivery were excluded. The recruited women were assigned to two groups; a group with normal PAPP-A levels (≥10(th) percentile) and a group with low PAPP-A levels (<10(th) percentile). The main outcome was the rate of idiopathic preterm births in the two groups.
Of 6867 screened women, 3830 were available for analysis and 670 were excluded because of potential confounders. Of the remaining 3160, 302 had low PAPP-A levels and 2858 had normal PAPP-A levels. The rates of spontaneous preterm births at ≤36 weeks, ≤34 weeks, and ≤32 weeks of gestation were significantly higher in women with low PAPP-A levels (7.6% vs. 17.9%, 3.1% vs. 11.9%, and 2.2% vs. 11.9%, respectively), with a relative risk of 2.37, 3.79, and 5.41 for preterm birth, respectively.
A PAPP-A level of ≤10(th) percentile was significantly associated with an increased risk for idiopathic preterm birth. Therefore, pregnant women with low PAPP-A levels in the first trimester should be considered at a high risk of preterm delivery.
本研究旨在使用泰国特定的参考范围，确定妊娠相关血浆蛋白A（PAPP-A）浓度与特发性早产发生率之间的关联强度。
对2007年1月至2012年7月期间在泰国北部我们的网络医院进行孕早期胎儿唐氏综合征筛查的连续单胎妊娠进行回顾性队列研究。对前瞻性数据库进行评估，以获取具有完整结局信息的记录，包括PAPP-A浓度、分娩时的孕周、医学和产科并发症以及胎儿和妊娠结局。排除有早产潜在原因的妊娠。招募的女性被分为两组；一组PAPP-A水平正常（≥第10百分位数），另一组PAPP-A水平低（<第10百分位数）。主要结局是两组中的特发性早产发生率。
在6867名接受筛查的女性中，3830名可供分析，670名因潜在混杂因素被排除。在其余的3160名中，302名PAPP-A水平低，2858名PAPP-A水平正常。PAPP-A水平低的女性在妊娠≤36周、≤34周和≤32周时的自然早产发生率显著更高（分别为7.6%对17.9%、3.1%对11.9%、2.2%对11.9%），早产的相对风险分别为2.37、3.79和5.41。
PAPP-A水平≤第10百分位数与特发性早产风险增加显著相关。因此，孕早期PAPP-A水平低的孕妇应被视为早产的高危人群。
