Recent studies have consistently found pregnancy-associated plasma protein A2 (PAPP-A2) to be upregulated in preeclamptic placentae at term. We tested whether first-trimester circulating PAPP-A2 levels differed between complicated and uncomplicated pregnancies. We measured maternal PAPP-A2 levels at 10 to 14 weeks of gestational age in 17 pregnancies resulting in small-for-gestational-age (SGA) infants, 6 which developed preeclampsia (PE), 1 which developed PE and resulted in an SGA infant, and 37 gestational age-matched controls. The concentration of the PAPP-A2 isoform corresponding to the full-length protein was significantly higher in pregnancies that developed PE (35 ng/mL) compared with those that did not (23 ng/mL; P < .044). In contrast, we found no difference in PAPP-A2 levels between pregnancies that did or did not result in an SGA infant. The upregulation of PAPP-A2 that has previously been observed in PE at term appears to begin early in pregnancy, well before the symptoms develop.
RESULTS: 391 singleton pregnancies conceived following autologous IVF cycles met inclusion criteria and were included in the analyses. The mean patient age was 32.8 and 88.5% were white. There was a significant association between increasing rates of first trimester pregnancy loss and decreasing mGSD-CRL (p<0.001). The combined loss rate in the entire sample was 16.6%, and the highest loss rate of 61.3% was seen with mGSD-CRL <5mm. For pregnancies that progressed beyond the first trimester, there was no association between mGSDÀCRL difference and gestational age at time of delivery or infant birth weight. CONCLUSIONS: Risk of first trimester pregnancy loss in IVF-conceived pregnancies is inversely proportional to mGSD-CRL. A similar association between mGSD-CRL and risk of preterm delivery or low birthweight was not seen. First trimester measurement of mGSD-CRL may be a useful sonographic marker of early pregnancy loss in the infertile population. References: 1. Doubilet PM, Benson CB, Bourne T, et al. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med 2013;369:1443-51. 2. Dickey RP, Olar TT, Taylor SN, et al. Relationship of small gestational sac-crown-rump length differences to abortion and abortus karyotypes.
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