College of Clinical Medicine, Jining Medical University, Jining, Shandong, China.
Department of Obstetric, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China.
Arch Gynecol Obstet. 2021 Mar;303(3):645-652. doi: 10.1007/s00404-020-05960-1. Epub 2021 Jan 30.
Our objective of this study was to investigate whether first trimester serum pregnancy-associated plasma protein-A (PAPP-A) differed amongst pregnancies with placenta previa-accreta and non-adherent placenta previa and healthy pregnancies by a retrospective cohort analysis.
A total of 177 pregnant females were included in the study, as follows: 35 cases of placenta previa-accreta, 30 cases of non-adherent placenta previa, and 112 cases of BMI and age matched, healthy pregnant controls. PAPP-A multiples of the median (MoM) were acquired from laboratory data files in 1 January 2017-30 September 2019. The probable maternal serum biochemical predictor of placenta accreta was analyzed by using multiple logistic regression analysis.
PAPP-A MoM of placenta previa-accreta group was significantly higher than those of the non-adherent placenta previa group and control group (p = 0.009 < 0.05, p < 0.001). Serum PAPP-A was found to be significantly positively associated with placenta accreta after adjusted gestational week at time of blood sampling, BMI, age, smoking, and previous cesarean section history (OR: 3.51; 95% CI: 1.77-6.94; p = 0.0003 < 0.05). In addition, smoking (OR: 9.17; 95% CI: 1.69-49.62; p = 0.010 < 0.05) and previous cesarean section history (OR: 2.75; 95% CI: 1.23-6.17; p = 0.014 < 0.05) were also significantly associated with placenta accreta.
Increased first trimester serum PAPP-A was significantly positively associated with placenta accreta, suggesting that the potential role of PAPP-A in identifying pregnancies at high risk for placenta accreta. Smoking and previous cesarean section history may be the risk factors for accreta in placenta previa patients.
本研究通过回顾性队列分析，旨在探讨早孕期妊娠相关血浆蛋白 A（PAPP-A）在胎盘前置伴植入和非粘连性胎盘前置与健康妊娠中的差异。
本研究共纳入 177 名孕妇，分为胎盘前置伴植入 35 例、非粘连性胎盘前置 30 例和 BMI 及年龄匹配的健康妊娠对照组 112 例。2017 年 1 月 1 日至 2019 年 9 月 30 日，从实验室数据文件中获取 PAPP-A 中位数倍数（MoM）。采用多因素 logistic 回归分析胎盘植入的可能母体血清生化预测因子。
胎盘前置伴植入组 PAPP-A MoM 明显高于非粘连性胎盘前置组和对照组（p=0.009<0.05，p<0.001）。调整采血时孕周、BMI、年龄、吸烟和既往剖宫产史后，血清 PAPP-A 与胎盘植入呈显著正相关（OR：3.51；95%CI：1.77-6.94；p=0.0003<0.05）。此外，吸烟（OR：9.17；95%CI：1.69-49.62；p=0.010<0.05）和既往剖宫产史（OR：2.75；95%CI：1.23-6.17；p=0.014<0.05）与胎盘植入也显著相关。
早孕期血清 PAPP-A 升高与胎盘植入显著正相关，提示 PAPP-A 可能在识别胎盘植入高危妊娠方面具有一定作用。吸烟和既往剖宫产史可能是胎盘前置患者发生植入的危险因素。
