Publication:

Variation of pregnancy-associated plasma protein-A: a level in the first trimester of pregnancy and its clinical outcome

Background Pregnancy-associated plasma protein-A (PAPP-A) is a placental glycoprotein used in first-trimester screening and is involved in placental development through the insulin-like growth factor pathway. Low PAPP-A has been associated with placental dysfunction and adverse pregnancy outcomes. This study evaluated the association between first-trimester maternal serum PAPP-A and subsequent maternal and fetal outcomes in singleton pregnancies.

Methods This hospital-based prospective study was conducted in the Department of Obstetrics and Gynaecology, Adesh Medical College and Hospital, Shahabad, Kurukshetra, from March 2024 to February 2025. A total of 134 low-risk singleton pregnant women aged 18–35 years, attending antenatal care and undergoing first-trimester screening at 11-13 weeks, were enrolled. Serum PAPP-A was measured by chemiluminescence and expressed as multiples of the median (MoM). Participants were followed until delivery, and outcomes were analysed using a <0.4 MoM cut-off.

Results Mean maternal age was 28.46±3.33 years. Mean PAPP-A was 0.695±0.324 mIU/ml and 0.278±0.130 MoM. Gestational hypertension occurred in 26.9%, preterm labour in 35.8%, PROM in 11.9%, and oligohydramnios in 5.2%. Fetal growth restriction occurred in 24.6% and stillbirth in 2.2%. PAPP-A<0.4 MoM was significantly associated with gestational hypertension (p=0.002), preterm labour (p=0.013), and FGR (p=0.002). Mean PAPP-A was significantly lower in gestational hypertension and oligohydramnios.

Conclusions Low first-trimester PAPP-A was associated with selected adverse maternal and fetal outcomes, particularly gestational hypertension and FGR. PAPP-A may support early risk stratification and closer antenatal surveillance, but should not be used as a stand-alone diagnostic or predictive test. in routine practice.