Association of Low Maternal Pregnancy-associated Plasma Protein A with Adverse Perinatal Outcome

• Published in: Curēus (Palo Alto, CA) CA), 2019-06, Vol.11 (6), p.e4912-e4912
• Main Authors: Antsaklis, Panagiotis, Fasoulakis, Zacharias, Theodora, Marianna, Diakosavvas, Michail, Kontomanolis, Emmanuel N
• Format: Article
• Language: English
• Subjects: Biomarkers; Clinical outcomes; Health risk assessment; Insulin-like growth factors; Miscarriage; Obstetrics/Gynecology; Pediatrics; Plasma; Preeclampsia; Pregnancy; Pregnancy complications; Preventive Medicine; Proteins; Stillbirth; Womens health
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.4912

The aim is to provide an overall view of the association of low pregnancy-associated plasma protein A (PAPP-A) levels with adverse perinatal outcomes. The available literature in PubMed/Medline regarding PAPP-A and adverse pregnancy outcomes was searched for related articles, including terms such as "PAPP-A," "intrauterine growth restriction (IUGR)," "small for gestational age (SGA)," "stillbirth," "adverse outcome," and others. The fifth percentile is supported by many recent studies to be PAPP-A's cutoff for adverse outcome detection and the increased risk seems to be extremely high below 0.2 PAPP-A MoM (multiple of the median). Apart from chromosomal abnormalities, preeclampsia, intrauterine fetal demise, and pregnancy loss have been associated with maternal serum PAPP-A. For results below the first centile, PAPP-A has a strong positive predictive value for SGA and IUGR. Except for its vital role on the cleavage of insulin-like growth factor binding proteins (IGFBP), PAPP-A has proven to be a reliable marker for prenatal screening. Even though PAPP-A as a single predictor proved to be valuable for the prediction of some adverse perinatal outcomes, in some cases, a combination of PAPP-A to other maternal serum markers led to an increase in detection rates. PAPP-A is a promising maternal serum marker for pregnancy outcome prediction with more studies needed in order for its potentials to be fully understood and exploited.