Pakniat Hamideh, Bahman Atieh, Ansari Iman
1Department of Obstetrics and Gynecology, Qazvin University of Medical Sciences, Qazvin, Iran.
2Department of Gynecologic Oncology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Obstet Gynaecol India. 2019 Oct;69(5):412-419. doi: 10.1007/s13224-019-01217-3. Epub 2019 Apr 11.
This prospective study investigated the relationship between pregnancy-associated plasma protein A (PAPP-A) and human chorionic gonadotropin (hCG) and adverse pregnancy outcomes in the Iranian population.
Overall, 994 singleton pregnant mothers of 18-35-year old were referred for first-trimester screening tests, including PAPP-A and β-hCG, at the age of 6 days and 11-13 weeks, and were followed until the end of their pregnancy. The adverse pregnancy outcomes, PAPP-A, and β-hCG serum levels were recorded and analyzed. The sensitivity and specificity of the test were measured by calculating the area under the curve of receiver operating characteristic curve (ROC).
The mean serum level of PAPP-A and β-hCG was 1.10 ± 0.69 and 1.09 ± 0.8 MoM, respectively. Pregnancy-associated plasma protein A, regardless of its percentile, showed a significant relationship with the incidence of preeclampsia, preterm birth, and fetal low birth weight ( < 0.001 for each). However, the relationship between PAPP-A and abortion was not significant ( > 0.05). According to ROC, the results indicated that PAPP-A had a significant relationship with the incidence of preeclampsia, preterm birth, and fetal low birth weight ( < 0.001). However, β-hCG levels showed no significant relationship with adverse pregnancy outcomes.
The result of this study revealed that lower level of PAPP-A and β-hCG could be a predictive factor in preterm labor. Also, this study indicated that PAPP-A measurements could be a screening test for adverse pregnancy outcomes, such as preeclampsia, low birth weight and preterm labor.
本前瞻性研究调查了伊朗人群中妊娠相关血浆蛋白A（PAPP-A）和人绒毛膜促性腺激素（hCG）与不良妊娠结局之间的关系。
总体而言，994名年龄在18至35岁的单胎妊娠母亲在妊娠6周和11至13周时接受了孕早期筛查测试，包括PAPP-A和β-hCG，并随访至妊娠结束。记录并分析不良妊娠结局、PAPP-A和β-hCG血清水平。通过计算受试者工作特征曲线（ROC）的曲线下面积来测量该测试的敏感性和特异性。
PAPP-A和β-hCG的平均血清水平分别为1.10±0.69和1.09±0.8 MoM。妊娠相关血浆蛋白A，无论其百分位数如何，均与子痫前期、早产和胎儿低出生体重的发生率呈显著关系（每项均P<0.001）。然而，PAPP-A与流产之间的关系不显著（P>0.05）。根据ROC分析，结果表明PAPP-A与子痫前期、早产和胎儿低出生体重的发生率呈显著关系（P<0.001）。然而，β-hCG水平与不良妊娠结局无显著关系。
本研究结果显示，较低水平的PAPP-A和β-hCG可能是早产的预测因素。此外，本研究表明，测量PAPP-A可作为子痫前期、低出生体重和早产等不良妊娠结局的筛查测试。
