The Relationship of Pregnancy-Associated Plasma Protein A and Human Chorionic Gonadotropin with Adverse Pregnancy Outcomes: A Prospective Study

Purpose This prospective study investigated the relationship between pregnancy-associated plasma protein A (PAPP-A) and human chorionic gonadotropin (hCG) and adverse pregnancy outcomes in the Iranian population. Materials Overall, 994 singleton pregnant mothers of 18-35-year old were referred for first-trimester screening tests, including PAPP-A and beta-hCG, at the age of 6 days and 11-13 weeks, and were followed until the end of their pregnancy. The adverse pregnancy outcomes, PAPP-A, and beta-hCG serum levels were recorded and analyzed. The sensitivity and specificity of the test were measured by calculating the area under the curve of receiver operating characteristic curve (ROC). Results The mean serum level of PAPP-A and beta-hCG was 1.10 +/- 0.69 and 1.09 +/- 0.8 MoM, respectively. Pregnancy-associated plasma protein A, regardless of its percentile, showed a significant relationship with the incidence of preeclampsia, preterm birth, and fetal low birth weight (p < 0.001 for each). However, the relationship between PAPP-A and abortion was not significant (p > 0.05). According to ROC, the results indicated that PAPP-A had a significant relationship with the incidence of preeclampsia, preterm birth, and fetal low birth weight (p < 0.001). However, beta-hCG levels showed no significant relationship with adverse pregnancy outcomes. Conclusions The result of this study revealed that lower level of PAPP-A and beta-hCG could be a predictive factor in preterm labor. Also, this study indicated that PAPP-A measurements could be a screening test for adverse pregnancy outcomes, such as preeclampsia, low birth weight and preterm labor.