Publication:

Serum PAPP-A and uterine artery Doppler as predictors of preeclampsia

Background Preeclampsia (PE) is a disorder that happens during pregnancy. It is marked primarily by symptoms such as high blood pressure and problems with organs that develop after 20 weeks of gestation. Recently, biomarkers like pregnancy-associated plasma protein A (PAPP-A) and uterine artery Doppler pulsatility index (PI) have been identified as new predictors of PE because they reflect the condition and throughput of the placenta. Therefore, the goal of this research was to determine how accurate maternal serum PAPP-A levels and uterine artery PI predict PE when used not only separately but also together.

Methods This prospective cohort study was carried out in Department of Obstetrics and Gynecology and the Fetal-Maternal Medicine Department of Bangladesh Medical University (BMU) Dhaka during January 2024 to December 2024. The sample of the study consisted of 99 pregnant women who visited outpatient departments, their gestational age was between 12 and 20 weeks and they were normotensive. Statistical analysis was done through SPSS version 26.0. The association between PAPP-A levels and the development of PE, which was illustrated through odds ratios (ORs) with 95% confidence intervals (CIs), and a p-value less than 0.05 was regarded as statistically significant.

Results ROC analysis showed that PAPP-A has moderate predictive ability for preeclampsia, with an AUC of 0.742 (95% CI:0.638-0.846, p=0.03). A cut-off value of ≥0.55 yielded good sensitivity (72.73-81.82%) and moderate specificity (68.18%), with a high negative predictive value (95.24-95.28%) but low positive predictive value (22.22%) and overall accuracy of 68.69%. Most PE cases (8 of 11) occurred in participants with PAPP-A <0.55, supporting its role as a predictor. Similarly, elevated uterine artery PI (≥1.61) was observed in 7 of 11 PE cases and showed high specificity (93.18%), high negative predictive value (95.35%), moderate sensitivity (63.64%), and overall accuracy of 89.90%, indicating a strong association between increased PI and the development of preeclampsia.

Conclusions Low PAPP-A and high uterine artery PI show solid early signs of preeclampsia. Tracking these markers in first trimester pregnancies helps spot at-risk women. Early detection allows actions to be taken before complications arise. Interventions can reduce harm to mother and baby. The data supports real-time risk assessment without waiting for symptoms to appear.