Second-trimester fetal growth as a predictor of poor obstetric and neonatal outcome in patients with low first-trimester serum pregnancy-associated plasma protein-A and a euploid fetus

Objective To examine if fetal growth during the second trimester predicts poor pregnancy and neonatal outcome in patients with low first-trimester serum pregnancy-associated plasma protein-A (PAPP-A) and a euploid fetus. Methods We identified all patients with first-trimester PAPP-A < 5(th) centile who had undergone first- and second-trimester ultrasound examination. We excluded multiple pregnancies and those with aneuploidy or major anomalies identified before or after birth. We compared pregnancies with and without ultrasound markers for fetal growth restriction at 18-24 weeks. Results We identified 239 patients with low PAPP-A, 25 (10.5%) of whom had evidence of fetal growth restriction at 18-24 weeks. These 25 cases had significantly higher rates of third-trimester small-for-gestational age (SGA) fetus, gestational hypertension, preterm birth, indicated preterm birth, low birth weight and birth weight centiles, 1-min Apgar score < 7, neonatal intensive care unit admission and fetal or neonatal death. Conclusion Among patients with low first- trimester PAPP-A and a euploid fetus, fetal growth in the second trimester can predict poor obstetric and neonatal outcome. Copyright (C) 2008 ISUOG. Published by John Wiley & Sons, Ltd.