First-trimester maternal serum biomarkers and the risk of cerebral palsy

Aim To investigate whether combined first-trimester screening (cFTS) biomarkers are associated with cerebral palsy (CP) and to identify CP characteristics associated with abnormal biomarker levels. Method In this retrospective case-control data linkage study, we matched mothers of 435 singletons with CP from a population register to their cFTS records and selected 10 singleton pregnancy controls per case. We compared mean and abnormal levels (expressed as multiples of the median [MoMs]) of pregnancy-associated plasma protein-A (PAPP-A), beta subunit of human chorionic gonadotrophin (beta-hCG), and nuchal translucency between cases and controls and between CP subgroups. Results Compared with control pregnancies, CP pregnancies had lower mean levels of PAPP-A (0.95 vs 1.01 MoM, p=0.02) and beta-hCG (0.93 vs 0.99 MoM, p=0.02). Biomarker levels in CP pregnancies were 1.8 times more likely to be associated with abnormally low levels of PAPP-A (p<0.01), 1.4 times for beta-hCG (p=0.12), and 2.6 times for low PAPP-A and beta-hCG together (p=0.04). In cases with CP, an abnormally low PAPP-A level was associated with moderate preterm birth, low Apgar scores, and Gross Motor Function Classification System level V. Low beta-hCG was associated with very low birthweight. Interpretation Low first-trimester biomarker levels suggest a role for early pregnancy factors in some causal pathways to CP.

Automated summary

The study found that CP pregnancies had lower levels of PAPP-A and beta-hCG compared to control pregnancies. Abnormally low biomarker levels in CP pregnancies were associated with factors such as low Apgar scores, moderate preterm birth, and low birthweight.