First trimester pregnancy associated plasma protein-A as a marker for poor pregnancy outcome in patients with early-onset fetal growth restriction

Objective To determine whether pregnancy associated plasma protein-A (PAPP-A) can be used to identify pregnancies at risk for poor perinatal outcomes among patients with second trimester fetal growth restriction (FGR). Methods We analyzed outcomes for singleton pregnancies of patients with evidence of FGR in the second trimester who also had first trimester serum PAPP-A measured for aneuploidy risk assessment. We excluded pregnancies with aneuploidy, major anomalies, fetal infection, or second trimester premature rupture of membranes (PPROM). Results One hundred and ninety eight pregnancies with second trimester FGR and first trimester serum PAPP-A measurements were identified. PAPP-A below the fifth percentile was associated with an increased rate of third trimester SGA (50% vs 11%, p = 0.012), preterm birth (33.3% vs 8%, p = 0.039), NICU admission (33.3% vs 8%, p = 0.039), intrauterine or neonatal death (20% vs 0%, p = 0.002), smaller median birth weight (2975g vs 3085g, p = 0.026), and earlier median gestational age at delivery (38.14 weeks vs 39.86 weeks, p = 0.004). PAPP-A values below the 10th percentile and below the 25th percentile were also associated with poor outcomes. Conclusion PAPP-A appears to be a useful marker for neonatal outcome in patients diagnosed with second trimester FGR. Copyright (C) 2009 John Wiley & Sons, Ltd.