Honarjoo Maryam, Zarean Elahe, Tarrahi Mohammad Javad, Kohan Shahnaz
Midwifery and Reproductive Health Department, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Obstetrics and Gynecology, Fetal Medicine Unit, Isfahan University of Medical Sciences, Isfahan, Iran.
J Res Med Sci. 2021 Nov 29;26:104. doi: 10.4103/jrms.JRMS_560_20. eCollection 2021.
Small-for-gestational-age (SGA) is one of the most important conditions, which is associated with the risk of perinatal mortality and morbidity. The levels of pregnancy-associated plasma protein A (PAPP-A) and β-human-derived chorionic gonadotrophic (β-hCG) in the first trimester can predict this adverse outcome, considering the controversial nature of studies in this area, this cohort study was conducted to investigate the role of PAPP-A and freeβ-hCG levels for predicting SGA.
In this cohort study, from 16 randomly selected health centers in Isfahan, Iran, 4605 volunteer pregnant women who had performed first-trimester fetal anomalies screening tests were chosen based on the census, from July 2016 to June 2018. The multiples of the median (MoM) PAPP-A <0.4 and MoM β-hCG >3 were considered as abnormal; the samples were followed up after childbirth. The biomarkers' serum levels, relative risk, and odds ratio (OR) of SGA were compared in both SGA and appropriate for gestational age (AGA) groups.
In the SGA group, the mean of MOM PAPP-A was significantly lower (0.96 vs. 1.1 with = 0.001) and MoM βhCG was significantly higher (1.24 vs. 1.15 with = 0.01) than the AGA group. Odds for SGA in subjects with MoM PAPP-A <0.4 were 3.213; = 0.001 and for subjects with MoM βhCG >3 reported as 0.683; = 0.111.
The results of the study showed that the low levels of PAPP-A would cause 3.213 times increase in the chance of developing SGA and no association between high level of βhCG >3 with SGA. Therefore, low level of the PAPP-A is a warning indicator for SGA.
小于胎龄儿（SGA）是最重要的情况之一，与围产期死亡率和发病率风险相关。孕早期妊娠相关血浆蛋白A（PAPP-A）和β-人绒毛膜促性腺激素（β-hCG）水平可预测这一不良结局，鉴于该领域研究存在争议性，开展了这项队列研究以调查PAPP-A和游离β-hCG水平对预测SGA的作用。
在这项队列研究中，从伊朗伊斯法罕随机选取的16个健康中心，根据普查从2016年7月至2018年6月选择了4605名进行过孕早期胎儿异常筛查测试的志愿孕妇。PAPP-A的中位数倍数（MoM）<0.4且MoM β-hCG>3被视为异常；样本在分娩后进行随访。比较了SGA组和适于胎龄（AGA）组中生物标志物的血清水平、SGA的相对风险和比值比（OR）。
在SGA组中，MOM PAPP-A的平均值显著低于AGA组（0.96对1.1，P = 0.001），MoM βhCG显著高于AGA组（1.24对1.15，P = 0.01）。MoM PAPP-A<0.4的受试者发生SGA的几率为3.213；P = 0.001，而MoM βhCG>3的受试者报告的几率为0.683；P = 0.111。
研究结果表明，PAPP-A水平低会使发生SGA的几率增加3.213倍，而β-hCG>3的高水平与SGA之间无关联。因此，PAPP-A水平低是SGA的一个警示指标。
