First trimester maternal serum free β human chorionic gonadotrophin and pregnancy associated plasma protein A as predictors of pregnancy complications

TLDR

The study aimed to evaluate whether first‑trimester maternal serum free β‑hCG and PAPP‑A levels predict pregnancy complications. Researchers measured free β‑hCG and PAPP‑A at 10–14 weeks in 5,584 singleton pregnancies and compared the values between women with normal outcomes and those who later experienced miscarriage, preterm delivery, hypertension, growth restriction, or diabetes. Low first‑trimester PAPP‑A and β‑hCG (<10th centile) were significantly associated with miscarriage, pregnancy‑induced hypertension, fetal growth restriction, and gestational diabetes, with 20–27% of affected pregnancies showing such low levels, whereas spontaneous preterm delivery was not linked to low PAPP‑A.

Abstract

To examine the value of first trimester maternal serum free beta human chorionic gonadotrophin (beta hCG) and pregnancy associated plasma protein A (PAPP-A) as predictors of pregnancy complications.Screening study.Antenatal clinics.Singleton pregnancies at 10-14 weeks of gestation.Maternal serum free beta hCG and PAPP-A were measured at 10-14 weeks of gestation in 5,584 singleton pregnancies. In the 5,297 (94.9%) pregnancies with complete follow up free beta hCG and PAPP-A were compared between those with normal outcome and those resulting in miscarriage, spontaneous preterm delivery, pregnancy induced hypertension or fetal growth restriction and in those with pre-existing or gestational diabetes.Maternal serum PAPP-A increased and beta hCG decreased with gestation. The multiple of median maternal serum PAPP-A was significantly lower in those pregnancies resulting in miscarriage, pregnancy induced hypertension, growth restriction and in those with pre-existing or gestational diabetes mellitus, but not in those complicated by spontaneous preterm delivery. The level was < 10th centile of the reference range in about 20% of the pregnancies that subsequently resulted in miscarriage or developed pregnancy induced hypertension or growth restriction, and in 27% of those that developed gestational diabetes. Maternal serum free beta hCG was < 10th centile of the reference range in about 15% of the pregnancies that subsequently resulted in miscarriage or developed pregnancy induced hypertension or growth restriction, and in 20% of those that developed gestational diabetes.Low maternal serum PAPP-A or beta hCG at 10-14 weeks of gestation are associated with subsequent development of pregnancy complications.