Luewan Suchaya, Teja-Intr Monrudee, Sirichotiyakul Supatra, Tongsong Theera
Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand.
Singapore Med J. 2018 Jan;59(1):55-59. doi: 10.11622/smedj.2017034. Epub 2017 Apr 28.
Low levels of pregnancy-associated plasma protein-A (PAPP-A) might be associated with abnormal placentation, leading to the development of preeclampsia during late gestation. We aimed to determine the association between low serum PAPP-A levels and rates of preeclampsia in Thai women with otherwise low-risk pregnancies.
A cohort study was conducted on consecutive singleton pregnancies undergoing first trimester screening for fetal Down syndrome at a tertiary centre hospital. A prospective database was assessed for patient records, including PAPP-A levels, pregnancy outcomes and obstetrics complications. Pregnancies with potential causes of preeclampsia were excluded. Enrolled women were categorised into two groups: women with normal PAPP-A levels (≥ 10th percentile; control group); and those with low PAPP-A levels (< 10th percentile; study group). The main outcome measure was rate of preeclampsia.
Of 6,887 women screened, 3,830 were available for analysis and 167 were excluded due to potential confounders. Of the remaining 3,663 women enrolled, 357 women were categorised as having low PAPP-A levels and 3,306 had normal PAPP-A levels. The prevalence of preeclampsia (8.4% vs. 2.6%) and early-onset preeclampsia (i.e. before 34 weeks of gestation) (1.1% vs. 0.1%) was significantly higher (relative risk 3.27 and 9.26, respectively) in women from the study group than in the control group.
Pregnancy with PAPP-A levels < 10th percentile was significantly associated with an increased risk of preeclampsia that tended toward early development. Therefore, pregnant women with low PAPP-A levels in the first trimester should be considered to be at increased risk of preeclampsia.
妊娠相关血浆蛋白-A（PAPP-A）水平较低可能与胎盘形成异常有关，进而导致妊娠晚期子痫前期的发生。我们旨在确定泰国低风险妊娠女性血清PAPP-A水平低与子痫前期发生率之间的关联。
在一家三级中心医院对连续的单胎妊娠进行队列研究，这些妊娠在孕早期接受了胎儿唐氏综合征筛查。对一个前瞻性数据库进行评估以获取患者记录，包括PAPP-A水平、妊娠结局和产科并发症。排除有子痫前期潜在病因的妊娠。纳入的女性被分为两组：PAPP-A水平正常（≥第10百分位数；对照组）的女性；以及PAPP-A水平低（<第10百分位数；研究组）的女性。主要结局指标是子痫前期的发生率。
在6887名接受筛查的女性中，3830名可供分析，167名因潜在混杂因素被排除。在其余纳入的3663名女性中，357名女性被归类为PAPP-A水平低，3306名女性PAPP-A水平正常。研究组女性子痫前期（8.4%对2.6%）和早发型子痫前期（即妊娠34周前）（1.1%对0.1%）的患病率显著高于对照组（相对风险分别为3.27和9.26）。
PAPP-A水平<第10百分位数的妊娠与子痫前期风险增加显著相关，且倾向于早期发病。因此，孕早期PAPP-A水平低的孕妇应被视为子痫前期风险增加。
