Maternal Pregnancy Associated Plasma Protein-A Levels in Late First Trimester as a Predictor of MiscarriageA Cross-sectional Study
Indroduction: Miscarriage is the most common complication of pregnancy. Defective implantation is one of the common causes of miscarriage. Pregnancy Associated Plasma Protein-A (PAPP-A) is secreted from syncytiotrophoblast and it enables trophoblast invasion. Few studies have shown association o...
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| Autores principales: | , , , , |
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| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
JCDR Research and Publications Private Limited
2021
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| Materias: | |
| Acceso en línea: | https://doaj.org/article/0832d794d7814c008122e55f890ecfc1 |
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| Sumario: | Indroduction: Miscarriage is the most common complication of
pregnancy. Defective implantation is one of the common causes
of miscarriage. Pregnancy Associated Plasma Protein-A (PAPP-A)
is secreted from syncytiotrophoblast and it enables trophoblast
invasion. Few studies have shown association of PAPP-A with
miscarriage. However, there is limited data available to establish
the role of PAPP-A as a predictive marker of miscarriage, especially
in Indian population.
Aim: To determine the potential of maternal PAPP-A level
estimation in asymptomatic women in late first trimester (10-13
weeks) with viable foetus in predicting subsequent miscarriage.
Materials and Methods: This was an observational, cross-sectional
study conducted from November 2016 to April 2018 at University
College of Medical Science and Guru Teg Bahadur Hospital,
Delhi, India. Asymptomatic pregnant women (N=500) at 10-13
weeks of gestation were recruited from an antenatal clinic after
confirmation of foetal viability. A 2 mL of blood sample was
collected and serum PAPP-A level was measured. Independent
t-test and Chi-square test was used to compare continuous
data and Mann-Whitney U test was used to compare PAPP-A
Multiple of Median (MOM). Logistic regression was used to
estimate risk of miscarriage.
Results: Out of 500 participants, 9 were lost to follow-up. From
remaining N=491, 32 (6.5%) women had a miscarriage. PAPP-A
levels were significantly decreased in miscarriage group compared
to ongoing pregnancy group with median MOM 0.116 (0.080-0.17)
and 1.25 (0.665-3.249) respectively (p-value <0.001). PAPP-A MOM
value of ≤10th percentile sensitivity and specificity of detection
of miscarriage was 81.25% and 94.98% and at ≤5th percentile
sensitivity and specificity was 40.62% and 97.82%, respectively.
Lower the percentile cut-off of serum PAPP-A value, higher was
the specificity and positive predictive value for prediction of
miscarriage. By applying logistic regression we found that if PAPP-A
MOM decreases by 1 unit the chances of miscarriage increased
by 1.2 times. By this model 63.2% of cases could be explained
(Nagelkerke R Square=0.632). For prediction of pregnancies likely
to miscarry, the area under Receiver Operator Characteristic (ROC)
curve (95% CI) was 0.969 (0.955-0.983).
Conclusion: Low serum PAPP-A levels from asymptomatic
women in late 1st trimester is a good predictive marker of
miscarriage. |
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