First trimester pregnancy associated plasma protein-A as a marker for poor pregnancy outcome in patients with early-onset fetal growth restriction

Objective: To determine whether pregnancy associated plasma protein-A (PAPP-A) can be used to identify pregnancies at risk for poor perinatal outcomes among patients with second trimester fetal growth restriction (FGR). Methods: We analyzed outcomes for singleton pregnancies of patients with evidence of FGR in the second trimester who also had first trimester serum PAPP-A measured for aneuploidy risk assessment. We excluded pregnancies with aneuploidy, major anomalies, fetal infection, or second trimester premature rupture of membranes (PPROM). Results: One hundred and ninety eight pregnancies with second trimester FGR and first trimester serum PAPPA measurements were identified. PAPP-A below the fifth percentile was associated with an increased rate of third trimester SGA (50% vs 11%, p = 0.012), preterm birth (33.3% vs 8%, p = 0.039), NICU admission (33.3% vs 8%, p = 0.039), intrauterine or neonatal death (20% vs 0%, p = 0.002), smaller median birth weight (2975g vs 3085g, p = 0.026), and earlier median gestational age at delivery (38.14 weeks vs 39.86 weeks, p = 0.004). PAPP-A values below the 10th percentile and below the 25th percentile were also associated with poor outcomes. Conclusion: PAPP-A appears to be a useful marker for neonatal outcome in patients diagnosed with second trimester FGR.