Maternal Pregnancy Associated Plasma Protein-A Levels in Late First Trimester as a Predictor of Miscarriage- A Cross-sectional Study
Published: September 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/50626.15444
Nivedita Sinha, Alpana Singh, BD Banerjee, Rachna Agarwal, Himsweta Srivastva
1. Senior Resident, Department of Obstetrics and Gynaecology, University College of Medical Science and Guru Teg Bahadur Hospital, Delhi, India.
2. Associate Professor, Department of Obstetrics and Gynaecology, University College of Medical Science and Guru Teg Bahadur Hospital, Delhi, India.
3. Professor, Department of Biochemistry, University College of Medical Science and Guru Teg Bahadur Hospital, Delhi, India.
4. Professor, Department of Obstetrics and Gynaecology, University College of Medical Science and Guru Teg Bahadur Hospital, Delhi, India.
5. Assistant Professor, Department of Obstetrics and Gynaecology, University College of Medical Science and Guru Teg Bahadur Hospital, Delhi, India.
Correspondence
Dr. Alpana Singh,
87B, Pocket-F, GTB Enclave, Delhi, India.
E-mail: ajitshail90@gmail.com
Indroduction: Miscarriage is the most common complication of pregnancy. Defective implantation is one of the common causes of miscarriage. Pregnancy Associated Plasma Protein-A (PAPP-A) is secreted from syncytiotrophoblast and it enables trophoblast invasion. Few studies have shown association of PAPP-A with miscarriage. However, there is limited data available to establish the role of PAPP-A as a predictive marker of miscarriage, especially in Indian population.
Aim: To determine the potential of maternal PAPP-A level estimation in asymptomatic women in late first trimester (10-13 weeks) with viable foetus in predicting subsequent miscarriage.
Materials and Methods: This was an observational, cross-sectional study conducted from November 2016 to April 2018 at University College of Medical Science and Guru Teg Bahadur Hospital, Delhi, India. Asymptomatic pregnant women (N=500) at 10-13 weeks of gestation were recruited from an antenatal clinic after confirmation of foetal viability. A 2 mL of blood sample was collected and serum PAPP-A level was measured. Independent t-test and Chi-square test was used to compare continuous data and Mann-Whitney U test was used to compare PAPP-A Multiple of Median (MOM). Logistic regression was used to estimate risk of miscarriage.
Results: Out of 500 participants, 9 were lost to follow-up. From remaining N=491, 32 (6.5%) women had a miscarriage. PAPP-A levels were significantly decreased in miscarriage group compared to ongoing pregnancy group with median MOM 0.116 (0.080-0.17) and 1.25 (0.665-3.249) respectively (p-value <0.001). PAPP-A MOM value of ≤10th percentile sensitivity and specificity of detection of miscarriage was 81.25% and 94.98% and at =5th percentile sensitivity and specificity was 40.62% and 97.82%, respectively. Lower the percentile cut-off of serum PAPP-A value, higher was the specificity and positive predictive value for prediction of miscarriage. By applying logistic regression we found that if PAPP-A MOM decreases by 1 unit the chances of miscarriage increased by 1.2 times. By this model 63.2% of cases could be explained (Nagelkerke R Square=0.632). For prediction of pregnancies likely to miscarry, the area under Receiver Operator Characteristic (ROC) curve (95% CI) was 0.969 (0.955-0.983).
Conclusion: Low serum PAPP-A levels from asymptomatic women in late 1st trimester is a good predictive marker of miscarriage.
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