Pregnancy Associated Plasma Protein A: An Indicator of Adverse Obstetric Outcome in South India Population.

Introduction: The first trimester aneuploidy screening (FTAS) has become an integral part of antenatal care in most of the centres in India. The serum markers used for FTAS are pregnancy associated plasma protein A (PAPP-A) and Beta human chorionic gonadotropin (β hCG). In the present study, we aimed to assess the role of PAPP-A in specific adverse fetal maternal events.
Objective: The aim of the study was to analyse the pregnancy outcome with low maternal PAPP-A (≤ 5th centile) at the first trimester aneuploidy screen test in southern India, and that was compared with control group of >5th centile value.
Method: A total of 1800 consecutive pregnancies in first trimester were followed up with PAPP-A levels. The study group consisted 108 subjects and compared to the matched control group of 288 subjects. The outcome considered was spontaneous abortions, fetal anomalies, preterm delivery, hypertension in pregnancy, intrauterine growth restriction, gestational diabetes, mode of delivery and birthweight.
Results: For our grouped data, 5th centile value for PAPP-A was 0.49 MoM, (incidence - 6 %). The incidence of fetal major anomaly was higher in the study group (OR-1.87). The incidence of minor anomalies, gestational diabetes and hypertensive disorders were higher in study group but not statistically significant. The total preterm deliveries (OR-2.1), small for gestation age foetuses (OR-2.3), and low birthweight babies (OR-2.12) were significantly higher in the study group. We found positive likelihood ratio of 1.4 for PTD, 2 for <5th centile birth weight, 1.7 for <10th centile birthweight.
Conclusion: The low PAPP-A pregnancies are at risk of various obstetric complications. Hence, such a pregnancy should have closer surveillance. Further research work on intervention strategy is needed.