Department of Obstetrics, Perinatology and Gynecology, Medical University of Warsaw, Poland; "Club 35", Scientific Group of Polish Society of Obstetricians and Gynaecologists, Poland.
Department of Obstetrics and Gynecology, University Clinic of Carl Gustav Carus Dresden, Technische Universität Dresden, Germany.
Eur J Obstet Gynecol Reprod Biol. 2023 Mar;282:101-104. doi: 10.1016/j.ejogrb.2023.01.016. Epub 2023 Jan 21.
Extreme levels of either PAPP-A or free β-hCG may be a serious clinical concern. A multicentre study was carried out to determine the frequency and clinical consequences of high (minimum 2,0 MoM) maternal (PAPP)-A and free beta hCG.
A total number of 8591 patients with singleton pregnancies between 11 + 0-13 + 6 weeks of gestation were enrolled. A total number of 612 cases with first trimester serum level of PAPP-A corresponding to ≥ 2,0 MoM and/or free β-hCG to ≥ 2,0 MoM were included in the statistical analysis. All serum samples were analysed with Roche (Cobas) or Kryptor (Brahms) devices. A retrospective analysis of perinatal outcomes was conducted.
Values of PAPP-A ≥ 2,0 MoM and free β-hCG < 2.0 MoM were detected in 48,5% of patients (n = 297), free β-hCG ≥ 2,0 MoM and PAPP-A concentration < 2,0 MoM in 38,1% of patients (n = 233) and both PAPP-A and free β-hCG ≥ 2,0 multiple of median in 13,4% of patients (n = 82). The highest PAPP-A and free β-hCG concentrations were 19,2 MoM and 16,3 MoM respectively. Patients with both PAPP-A and free β-hCG above 2,0 MoM had a slightly higher (but statistically not significant) prevalence of history of low birthweight (8,3%).
Pregnancy outcomes in women with normal ultrasound findings and high PAPP-A /free β-hCG concentration are good. Higher prevalence of pregnancy complications was not detected in either extremely high PAPP-A and free β-hCG concentration groups. In cases of normal ultrasound and isolated high (even extreme) biochemical markers levels the counselling should be comforting.
无论是 PAPP-A 还是游离 β-hCG 的极高水平都可能是严重的临床问题。进行了一项多中心研究，以确定高（最低 2.0MoM）母体（PAPP）-A 和游离β-hCG 的频率和临床后果。
共纳入 8591 例 11+0-13+6 周妊娠的单胎妊娠患者。共纳入 612 例妊娠早期血清 PAPP-A 水平相应为≥2.0MoM 和/或游离β-hCG≥2.0MoM 的病例进行统计学分析。所有血清样本均采用罗氏（Cobas）或 Kryptor（Brahms）设备分析。对围产结局进行回顾性分析。
48.5%（n=297）的患者检测到 PAPP-A≥2.0MoM 和游离β-hCG<2.0MoM，38.1%（n=233）的患者游离β-hCG≥2.0MoM 和 PAPP-A 浓度<2.0MoM，13.4%（n=82）的患者 PAPP-A 和游离β-hCG 均≥2.0MoM。最高的 PAPP-A 和游离β-hCG 浓度分别为 19.2MoM 和 16.3MoM。PAPP-A 和游离β-hCG 均高于 2.0MoM 的患者，其低出生体重史的发生率略高（但统计学上无显著性差异）（8.3%）。
超声检查正常且 PAPP-A/游离β-hCG 浓度高的孕妇妊娠结局良好。在极高的 PAPP-A 和游离β-hCG 浓度组中，并未发现妊娠并发症的发生率更高。在超声检查正常且孤立的高（甚至极高）生化标志物水平的情况下，应提供安慰性咨询。
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