Association of low pregnancy associated plasma protein-A with increased umbilical artery pulsatility index in cases of fetal weight between the 3rd and 10th percentiles: a retrospective cohort study

Carolina Dias da Silva; Inês Sarmento Gonçalves; Carla Ramalho

doi:10.1515/jpm-2023-0156

Article

Association of low pregnancy associated plasma protein-A with increased umbilical artery pulsatility index in cases of fetal weight between the 3rd and 10th percentiles: a retrospective cohort study

Carolina Dias da Silva , Inês Sarmento Gonçalves and Carla Ramalho

Published/Copyright: October 20, 2023

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From the journal Journal of Perinatal Medicine Volume 52 Issue 1

Abstract

Objectives

This study aims to evaluate if low levels of serum maternal pregnancy associated plasma protein-A (PAPP-A) during the first trimester are related to increased umbilical artery pulsatility index (UA PI) later in pregnancy, in cases of estimated fetal weight between the 3rd and 10th percentiles, in order to establish PAPP-A as a predictor of this particular cases of fetal growth restriction (FGR).

Methods

An observational, retrospective cohort study, conducted at a tertiary University Hospital located in Oporto, Portugal. Pregnant women who did the first trimester combined screening, between May 2013 and June 2020 and gave birth in the same hospital, with an estimated fetal weight (EFW) between the 3rd and 10th percentiles were included. The primary outcome is the difference in increased UA PI prevalence between two groups: PAPP-A<0.45 MoM and PAPP-A≥0.45 MoM. As secondary outcomes were evaluated differences in neonatal weight, gestational age at delivery, cesarean delivery, neonatal intensive care unit hospitalization, 5-min Apgar score below 7 and live birth rate between the same two groups.

Results

We included 664 pregnancies: 110 cases of PAPP-A<0.45 MoM and 554 cases with PAPP-A≥0.45 MoM. Increased UA PI prevalence, which was the primary outcome of this study, was significantly different between the two groups (p=0.005), as the PAPP-A<0.45 MoM group presents a higher prevalence (12.7 %) when compared to the PAPP-A≥0.45 MoM group (5.4 %). The secondary outcome cesarean delivery rate was significantly different between the groups (p=0.014), as the PAPP-A<0.45 MoM group presents a higher prevalence (42.7 %) than the PAPP-A≥0.45 MoM group (30.1 %). No other secondary outcomes showed differences between the two groups.

Conclusions

There is an association of low serum maternal PAPP-A (<0.45 MoM) during the first trimester and increased UA PI (>95th percentile) later in pregnancy, in cases of EFW between the 3rd and 10th percentiles. However, this association is not strong enough alone for low PAPP-A to be a reliable predictor of increased UA PI in this population.

Keywords: pregnancy associated plasma protein-A; small for gestational age; constitutionally small fetuses; fetal growth restriction; umbilical artery Doppler; Doppler ultrasound

Corresponding author: Carolina Dias da Silva, Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200–319, Porto, Portugal, Phone: +351927814305, E-mail: carolina.1411@hotmail.com

Funding source: Centro Hospitalar Universitário de São João Ethics Committee

Award Identifier / Grant number: (project number 189/22)

Research ethics: Ethical approval was obtained from the Centro Hospitalar Universitário de São João Ethics Committee (project number 189/22). The research protocol is under European Union Genral Data Protection Regulation and respects the Declaration of Helsinki.
Informed consent: Informed written consent was waived because this study solely used the data obtained from clinical practice.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: The authors state no conflict of interest.
Research funding: None declared.
Data availability: The raw data can be obtained on request from the corresponding author.

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Received: 2023-04-14

Accepted: 2023-09-04

Published Online: 2023-10-20

Published in Print: 2024-01-29

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Articles in the same Issue

https://doi.org/10.1515/jpm-2023-0156

Keywords for this article

pregnancy associated plasma protein-A; small for gestational age; constitutionally small fetuses; fetal growth restriction; umbilical artery Doppler; Doppler ultrasound