Higher PAPP-A Values in Pregnant Women Complicated with Preeclampsia Than with Gestational Hypertension

Abstract

The purpose of this study is to compare the levels of maternal serum pregnancy–associated plasma protein-A at the first trimester in pregnancies complicated by impaired placental diseases, such as preeclampsia (PE), intrauterine fetal growth restriction (IUGR), and gestational hypertension (GH), with those in pregnancies without the development of any of these outcomes to expand the knowledge of how this protein behaves in the different impaired placental diseases. This current work is an observational study based on a prospective cohort. Pregnancy-associated plasma protein-A was measured in 422 patients who had completed maternal-perinatal outcomes. Comparisons of pregnancy characteristics and the biomarker between outcome groups (PE, IUGR, gestational hypertension, and not impaired placental outcomes) were analyzed. PAPP-A MoM in the IUGR (0.8 IQR: 0.6–0.9) and GH groups (0.5 IQR: 0.3–1.4) compared to the PE group (1.06 IQR: 0.66–1.52) was significantly lower (p < 0.005). Pregnant women who developed early-onset PE (1.11 IQR 1.08–1.18) presented significant differences with the IUGR group (0.83 IQR: 0.59–0.98; p = 0.002) and those who developed preterm-PE (1.19 IQR: 0.66–1.58; p = 0.045). The results demonstrate that the levels of PAPP-A at first trimester in the sample of women who developed PE, and specially term-PE, were higher than those in women who developed GH or IUGR. The GH group had the lowest PAPP-A values in this sample of pregnant women. Research in a population with a high prevalence of preeclampsia is still lacking and deserves more extended studies to define if these patients could have different rates of PAPP-A.

Meta-analysis for the relationship between circulating pregnancy-associated plasma protein A and placenta accreta spectrum

“…[8] On the other hand, the growing body of evidence suggests that despite the availability of imaging modalities to confirm the diagnosis of PAS, [9] biomarkers are also important in predicting the risk of PAS during pregnancy because these markers are convenient to test and compare with standard threshold, and could be repeated during pregnancy. [10] Among them, the pregnancy-associated plasma protein A (PAPP-A), a zinc-binding metalloproteinase, has been associated with various adverse clinical outcomes in pregnancy, such as preeclampsia, [11] gestational diabetes mellitus, [12] fetal growth restriction, [13] and even fetal loss. [14] More importantly, preclinical studies suggest that PAPP-A may be involved in trophoblast invasion and placental growth, raising the hypothesis that PAPP-A changes may be a PAS biomarker.…”