Determining the Role of Pregnancy-associated Plasma Protein-A Level in the First Trimester of Pregnancy and Clinical Outcome in an Urban Referral Centre, South India

Introduction: Screening for aneuploidy in the first trimester, which includes nuchal translucency (NT), pregnancy-associated plasma protein-A (PAPP-A), and free-beta subunit human chorionicgonadotrophin (fhCG), has become a standard element of prenatal care. Estimating serum PAPP-A levels has also been extensively researched in terms of other prediction factors for unfavourable neonatal outcomes. This case-control study also aims to determine if there is a link between low PAPP-A levels in pregnant women and a poor maternal foetal outcome.


The primary goal of this study was to see if a low PAPP-A level in the first trimester of pregnancy was linked to poor mother and foetal outcomes.

Secondary goal: Determine the predictive significance of a low PAPP-A level in predicting negative perinatal outcomes.

Methods: This is a case-control study of women delivered at Mehta Multispecialty Hospitals India Pvt. Ltd.’s Department of OBG between August 2017 and May 2018. Women who underwent a PAPP-A level screening in the first trimester gave birth in the labour room. After receiving informed consent (Annexure II & III), the study was explained to the participants, and a questionnaire with full prenatal history, birth mode, and infant data was input into Annexure II. The subjects are divided into case and control groups depending on the outcome. Out of the 264 people in the study, 88 patients with complications were designated as cases, while 176 patients with no issues were designated as controls, and both the case and control group studies were conducted.

The study found no statistically significant link between the case and control groups for characteristics such as maternal age, parity, marital history, family history, and previous obstetric difficulty.

Mode of conception (ART, IUI, Ovulation induction) represented substantially larger number in the case group compared to the control group, which was statistically shown (p 0.05).

In the case group, 78 percent of the babies were born at 37 weeks, whereas only 18 percent were born at term, a statistically significant difference from the control group.

In our study, the most common complications were PIH and Pre-Eclampsia (17%), Preterm (9.1%), and IUGR (6.8%), with normal outcomes in 66.7 percent.

In our study, the LSCS rate was higher than the normal delivery rate out of 264 deliveries. Normal deliveries account for 28% of all deliveries, while LSCS deliveries account for more than 72%.

In our research, low PAPP-A levels (0.5MoM) are associated with a higher risk of PIH and Preeclampsia, followed by IUGR and Preterm birth. When PAPP-A levels are greater than 0.5MoM, the normal outcome outweighs the unfavourable outcome. PAPP-A levels varied by a statistically significant amount.

Low birth weight was observed to be statistically significant in women with a low PAPP A level as compared to those with a 0.5 PAPP A level. The relationship between NICU admission and APGAR was not found to be statistically significant. LBW newborns have a significant prevalence of low PAPP A levels.

PAPP A levels had a sensitivity of 17.04 percent and a specificity of 98.85 percent in identifying difficult outcomes in the current investigation. Predicting complications had a positive predictive value of 88.23 percent and a negative predictive value of 70.44 percent.

Conclusion: Based on the findings of the above study, low PAPP-A levels detected during the first trimester of pregnancy are linked to unfavourable maternal and foetal outcomes such as PIH, preeclampsia, preterm birth, IUGR, and LBW. As a result, anytime an obstetrician encounters a patient with low PAPP-A levels, he or she should be cautious and vigilant, which can also assist with self-preparation.

Author (S) Details

T. Lavanya
Pranav Speciality Clinic & SLP Scan Center, Urapakkam, Chennai, India.

Nandita A. Thakkar
Dept. of OBG Dr. Mehtas Multi Speciality Hospitals, Chetpet. Chennai, India.

R. Premalatha
Dept. of OBG Dr. Mehtas Multi Speciality Hospitals, Chetpet. Chennai, India.

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