Pregnancy associated plasma protein A: An indicator of adverse obstetric outcomes in a South India population/Gebelige bagli plazma proteini A: Guney Hindistan nufusunda olumsuz obstetrik sonuclarin bir gostergesi

• Published in: Turkish journal of obstetrics and gynecology Vol. 17; no. 1; p. 40
• Main Authors: Shah, Krupa H, Anjum, Afsha, Nair, Parvathi, Bhat, Parvati, Bhat, Rajeshwari G, Bhat, Shashikala
• Format: Journal Article
• Language: English
• Published: Galenos Yayinevi Tic. Ltd 01.03.2020
• Subjects: Abortion; Blood proteins; Chorionic gonadotropins; Comparative analysis; Gestational diabetes; Gestational hypertension; Glycoproteins; Gonadotropins; Health screening; Hypertension; Infants; Medical research; Medical tests; Obstetrics; Placental hormones; Pregnancy; Pregnant women; India
• ISSN: 2149-9322
• DOI: 10.4274/tjod.galenos.2020.05695

Objective: First trimester aneuploidy screening (FTAS) has become an integral part of antenatal care in most of centers in India. The serum markers used for FTAS are pregnancy-associated plasma protein A (PAPP-A) and beta human chorionic gonadotropin. In the present study, we aimed to assess the role of PAPP-A in specific adverse fetal maternal events. To analyze pregnancy outcomes with low maternal PAPP-A ([less than or equal to]5th percentile) at the FTAS screening test in southern India, and them compared with a control group of >5th percentile value. Materials and Methods: A total of 1800 consecutive pregnancies in the first trimester were followed up with PAPP-A levels. The study group consisted 108 subjects, which was compared with a matched control group of 288 subjects. The outcomes considered were spontaneous abortions, fetal anomalies, preterm delivery (PTD), hypertension in pregnancy, intrauterine growth restriction, gestational diabetes, mode of delivery, and birthweight. Results: For our grouped data, the 5th percentile value for PAPP-A was 0.49 multiple of medians, (incidence-6%). The incidence of fetal major anomalies was higher in the study group [odds ratio (OR): 1.87]. The incidence of minor anomalies, gestational diabetes, and hypertensive disorders was higher in the study group but not statistically significant. The total rate of PTDs (OR:2.1), small-for-gestation-age fetuses (OR:2.3), and low birthweight babies (OR-2.12) was significantly higher in the study group. We found positive likelihood ratio of 1.4 for PTD, 2 for <5th percentile birthweight, and 1.7 for <10th centile birthweight. Conclusion: 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. Keywords: Pregnancy-associated plasma protein a, dual marker test, first trimester aneuploidy screening, adverse pregnancy outcomes, growth restriction of fetus Amac: Ilk trimester anoploidi taramasi (FTAS), Hindistan'daki merkezlerin cogunda dogum oncesi bakimin ayrilmaz bir parcasi haline gelmistir. FTAS icin kullanilan serum belirtecleri hamilelikle iliskili plazma protein A (PAPP-A) ve beta insan koryonik gonadotropindir. Bu calismada spesifik olumsuz fetal maternal olaylarda PAPP-A'nin rolunu degerlendirmeyi amacladik. Guney Hindistan'da FTAS tarama testinde dusuk maternal PAPP-A ([less than or equal to]5 persentil) ile gebelik sonuclarini analiz etmek ve bunlari >5 persentil degerine sahip bir kontrol grubu ile karsilastirmak Gerec ve Yontemler: Ilk trimesterde toplam 1800 ardisik gebelik PAPP-A duzeyleri ile takip edildi. Calisma grubu 108 denekten olusmaktaydi ve 288 denekle eslesen kontrol grubu ile karsilastirildi. Degerlendirilen sonuclar spontan dusukler, fetal anomaliler, erken dogum (ED), gebelikte hipertansiyon, intrauterin buyume kisitlamasi, gestasyonel diyabet, dogum sekli ve dogum agirligi idi. Bulgular: Gruplandirilmis verilerimiz icin, PAPP-A icin 5. persentil degeri 0.49 medyanlarin katlari idi (insidans: %6). Fetal major anomali insidansi calisma grubunda daha yuksekti [olasilik orani (OR): 1,87]. Kucuk anomaliler, gestasyonel diyabet ve hipertansif bozukluklarin gorulme sikligi calisma grubunda daha yuksekti ancak istatistiksel olarak anlamli degildi. ED'lerin (OR: 2,1), gebelik yasi icin kucuk fetuslerin (OR: 2,3) ve dusuk dogum agirlikli bebeklerin (OR: 2,12) toplam orani calisma grubunda anlamli olarak daha yuksekti. Pozitif OR ED icin 1,4, <5. persentil dogum kilosu icin 2 ve <10. centil dogum kilosu icin 1,7 idi. Sonuc: Dusuk PAPP-A gebelikleri cesitli obstetrik komplikasyon riski altindadir. Bu nedenle, boyle bir hamileligin daha yakindan izlenmesi gerekir. Mudahale stratejisi uzerinde daha fazla arastirma yapilmasi gerekmektedir. Anahtar Kelimeler: Gebelige bagli plazma proteini a, ikili markor testi, ilk trimester anoploidi taramasi, olumsuz gebelik sonuclari, fetusun buyume kisitlamasi