Obstet Gynecol Sci.  2017 Mar;60(2):154-162. 10.5468/ogs.2017.60.2.154.

Maternal serum placental growth factor and pregnancy-associated plasma protein A measured in the first trimester as parameters of subsequent pre-eclampsia and small-for-gestational-age infants: A prospective observational study

• Sung KU
• Roh JA
• Eoh KJ
• Kim EH

• KMID: 2372799
• DOI: http://doi.org/10.5468/ogs.2017.60.2.154

Abstract

OBJECTIVE
To examine the first-trimester maternal serum placental growth factor (PlGF) and pregnancy-associated plasma protein A (PAPP-A) levels in pregnancies associated with pre-eclampsia (PE) or small-for-gestational-age (SGA) infants, and determine the predictive accuracy of PlGF and of PAPP-A for either PE or SGA infants.
METHODS
This prospective, observational study included 175 pregnant women, and of these women, due to participant withdrawal or loss to follow-up, delivery data were collected from the medical records of 155 women, including 4 who had twin pregnancies. The women's maternal history was recorded, and the PlGF and PAPP-A levels at 11 to 13 gestational weeks were measured. During the second trimester, the maternal uterine artery's systolic/diastolic ratio was measured. Multiples of the median (MoM) of PlGF and PAPP-A were determined, and the associations of these values with the risk factors of SGA and PE were evaluated. Logistic regression analysis was used to determine whether PlGF and PAPP-A are useful markers for predicting SGA infants.
RESULTS
The PAPP-A MoM level was significantly lower in women with advanced maternal age, multipara women, and women with gestational diabetes than in their counterparts. The PlGF and PAPP-A MoM levels were higher in women with a twin pregnancy than in those with a singleton pregnancy. There was a significant relationship between the maternal serum PAPP-A MoM level in the first trimester and the uterine artery systolic/diastolic ratio in the second trimester. Results of logistic regression analysis showed that low PlGF and PAPP-A MoM levels were predictors of SGA infants (odds ratio, 0.143; 95% confidence interval, 0.025 to 0.806; odds ratio, 0.191; 95% confidence interval, 0.051 to 0.718, respectively).
CONCLUSION
PlGF and PAPP-A are potentially useful as first-trimester markers for SGA infants and some hypertensive disorders of pregnancy.

Keyword

Placental growth factor; Pre-eclampsia; Pregnancy-associated plasma protein A; Small-for-gestational-age infant

MeSH Terms

Diabetes, Gestational
Female
Follow-Up Studies
Humans
Infant*
Logistic Models
Maternal Age
Medical Records
Observational Study*
Odds Ratio
Plasma*
Pre-Eclampsia*
Pregnancy
Pregnancy Trimester, First*
Pregnancy Trimester, Second
Pregnancy, Twin
Pregnancy-Associated Plasma Protein-A
Pregnant Women
Prospective Studies*
Risk Factors
Staphylococcal Protein A*
Uterine Artery
Pregnancy-Associated Plasma Protein-A
Staphylococcal Protein A

Figure

• 

  Fig. 1 Relationship between the maternal serum placental growth factor (PlGF) and pregnancy-associated plasma protein A (PAPP-A). The PlGF multiples of the median (MoM) level was significantly positively correlated with the PAPP-A MoM level (r=0.467, P<0.001).

• 

  Fig. 2 Relationship between the placental growth factor (PlGF) and uterine artery systolic/diastolic (S/D) ratio. The PlGF multiples of the median (MoM) level in the first trimester was not significantly correlated with the uterine artery S/D ratio in the second trimester (r=-0.179, P=0.200).

• 

  Fig. 3 Relationship between the pregnancy-associated plasma protein A (PAPP-A) and uterine artery systolic/diastolic (S/D) ratio. The PAPP-A multiples of the median (MoM) level in the first trimester was significantly associated with the uterine artery S/D ratio in the second trimester (r=-0.029, P=0.017).

• 

  Fig. 4 Receiver operating characteristics curves for the placental growth factor (PlGF) and pregnancy-associated plasma protein A (PAPP-A) multiples of the median (MoM). According to receiver operating characteristics analysis, the area under the curves (AUCs) for PAPP-A MoM (AUC, 0.728; 95% confidence interval, 0.628 to 0.828; P=0.002) and PlGF MoM (AUC, 0.662; 95% confidence interval, 0.532 to 0.792; P=0.026) were calculated.

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