Agarwal Rachna, Kumari Radhika, Mehndiratta Mohit, Radhakrishnan Gita, Faridi M M A, Chandra Nilesh
Department of Obstetrics and Gynaecology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, 110095 India.
Department of Biochemistry, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, 110095 India.
J Obstet Gynaecol India. 2017 Aug;67(4):247-252. doi: 10.1007/s13224-016-0954-3. Epub 2016 Dec 8.
We aimed to investigate the association of pregnancy associated plasma protein A (PAPP-A) levels in late first trimester with small for gestational age (SGA) neonates and adverse pregnancy outcomes in a low-income setting.
The inclusion criteria were late first trimester (11-13 + 6 weeks) women with singleton and non-anomalous pregnancy. Enrolled participants were sampled for PAPP-A and prospectively followed up for delivery outcome and antenatal complications. A multiple of median (MoM) was calculated and statistically compared between groups.
Out of total 284 subjects, 14.54% delivered SGA babies and formed cases (Group A), 66.5% delivered appropriate for gestational age (AGA) neonates with uneventful antenatal period (controls, Group B), and 19.3% were AGA group with adverse pregnancy complications (Group C). The late first trimester median PAPP-A MoM was significantly lower (0.61) in Group A compared to Group B (1.47). Using receiver operating characteristic (ROC) curve for PAPP-A MoM, optimal cutoff value was found at 0.45 MoM, with positive predictive value of 56.2%, specificity of 92.6% and sensitivity of 45%. The median interquartile range (IQR) of PAPP-A MoM value in Group C in comparison with Group B was significantly lower except for abruption. At PAPP-A MoM cutoff value <1, <0.8, <0.6 and <0.4, the odds ratio for adverse pregnancy outcome was 8.30, 7.29, 10.97 and 10.60, respectively, indicating an inverse relationship.
With 0.45 MoM cutoff of PAPP-A, the detection rate, specificity and positive predictive value for SGA were 45, 92.6 and 56.2%, respectively. As PAPP-A MoM values decreased, the odds ratio of having adverse pregnancy outcomes increased.
我们旨在研究妊娠早期晚期妊娠相关血浆蛋白A（PAPP-A）水平与低收入环境下小于胎龄（SGA）新生儿及不良妊娠结局之间的关联。
纳入标准为妊娠早期晚期（11-13⁺⁶周）单胎且无异常妊娠的女性。纳入的参与者采集PAPP-A样本，并对分娩结局和产前并发症进行前瞻性随访。计算中位数倍数（MoM）并在组间进行统计学比较。
在总共284名受试者中，14.54%分娩出SGA婴儿并构成病例组（A组），66.5%分娩出适于胎龄（AGA）的新生儿且孕期无异常（对照组，B组），19.3%为有不良妊娠并发症的AGA组（C组）。与B组（1.47）相比，A组妊娠早期晚期PAPP-A MoM中位数显著更低（0.61）。使用PAPP-A MoM的受试者工作特征（ROC）曲线，发现最佳截断值为0.45 MoM，阳性预测值为56.2%，特异性为92.6%且敏感性为45%。除胎盘早剥外，C组与B组相比，PAPP-A MoM值的中位数四分位数间距（IQR）显著更低。在PAPP-A MoM截断值<1、<0.8、<0.6和<0.4时，不良妊娠结局的比值比分别为8.30、7.29、10.97和10.60，表明呈负相关。
PAPP-A截断值为0.45 MoM时，SGA的检出率、特异性和阳性预测值分别为45%、92.6%和56.2%。随着PAPP-A MoM值降低，发生不良妊娠结局的比值比增加。
