Retrospective Analysis of Pregnancy and Neonatal Outcome With Low and Very Low PAPP-A on First Trimester Screen [27N]. (May 2016)

• Record Type: Journal Article
• Authors: Lozovyy, Violetta; Bradke, Daniel; Schubert, Finn D.; Fitzpatrick, Kevin J.; Singh, Shailini
• Is Part Of: Obstetrics and gynecology. Volume 127(2016)Supplement 1
• Publication Date: 2016-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000483496.04757.bc
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: Low PAPP-A is a marker for Trisomies 21, 13 and 18. Some studies have found an association between low PAPP-A and poor intrauterine fetal growth, preeclampsia and stillbirth, although the positive predictive value is low. Our objective was to determine whether differences in PAPP-A among patients with PAPP-A under the 5th and 1st percentile are clinically significant in predicting perinatal and pregnancy outcomes in order to change our fetal surveillance policy. METHODS: We identified 2, 588 patients who underwent first-trimester risk assessment from November 2011 to March 2015. PAPP-A levels of less than 5th percentile was included. Biochemical risk assessment was performed from 9 0/7–13 6/7 weeks. Pregnancy outcome was determined from electronic medical records and New York Department of Health Birth Registry. Chi-square and regression techniques to compare outcomes between 5% and 1% PAPP-A groups. RESULTS: A cohort of 236 women was subjected to statistical analysis. Preterm birth was observed in 11.3% and 20.3% in 5th and 1st percentile groups respectively with total of cumulative rate of 13.6%. However, after controlling for gestational age, average APGAR, birth weight ( P =.556), development of preeclampsia ( P =.695) and mode of delivery ( P =.377) were not significantly associated with low compared with very low PAPP-A. CONCLUSION: In our study PAPP-A levels below 5% and 1% percentile had no statistically significant adverse perinatal outcomes except in preterm birth. The national average of preterm birth rate is 11.2% vs 13.6% in our population. At present we will continue with our current management till further data analysis of preterm birth.