HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Smith, G. C. S. Articles by Dobbie, R. Search for Related Content PubMed PubMed Citation Articles by Smith, G. C. S. Articles by Dobbie, R.

Pregnancy-Associated Plasma Protein A and Alpha-fetoprotein and Prediction of Adverse Perinatal Outcome

From the ¹Department of Obstetrics and Gynaecology, Cambridge University, Cambridge; ²Institute of Medical Genetics, Yorkhill National Health Service Trust, Glasgow; ³Department of Public Health, Greater Glasgow National Health Service Board, Glasgow; ⁴Department of Obstetrics and Gynaecology, Glasgow University, Glasgow; and ⁵Information & Statistics Division, Common Services Agency, Edinburgh, United Kingdom.

OBJECTIVE: To describe the association between pregnancy associated plasma protein A (PAPP-A), alpha-fetoprotein (AFP) and adverse perinatal outcome.

METHODS: We conducted a multicenter prospective cohort study of 8,483 women attending for prenatal care in southern Scotland between 1998 and 2000. The risk of delivering a small for gestational age infant, delivering preterm, and stillbirth were related to maternal serum levels of PAPP-A and AFP.

RESULTS: Women with a low PAPP-A were not more likely to have elevated levels of AFP. Compared with women with a normal PAPP-A and a normal AFP, the odds ratio for delivering a small for gestational age infant for women with a high AFP was 0.9 (95% confidence interval [CI] 0.5–1.6), for women with a low PAPP-A was 2.8 (95% CI 2.0–4.0), and for women with both a high AFP and a low PAPP-A was 8.5 (95% CI 3.6–20.0). The odds ratio for delivering preterm for women with a high AFP was 1.8 (95% CI 1.3–2.7), for women with a low PAPP-A was 1.9 (95% CI 1.3–2.7), and for women with both a low PAPP-A and a high AFP was 9.9 (95% CI 4.4–22.0). These interactions were statistically significant for both outcomes (P = .03 and .04, respectively). There was a nonsignificant trend toward a similar interaction in relation to stillbirth risk. Of the women with the combination of a low PAPP-A and high AFP, 32.1% (95% CI 15.9–52.4) delivered a low birth weight infant.

CONCLUSION: Low maternal serum levels of PAPP-A between 10 and 14 weeks and high levels of AFP between 15 and 21 weeks gestation are synergistically associated with adverse perinatal outcome.

LEVEL OF EVIDENCE: II-2

This article has been cited by other articles:

				U. M. Reddy Prediction and Prevention of Recurrent Stillbirth Obstet. Gynecol., November 1, 2007; 110(5): 1151 - 1164. [Abstract] [Full Text] [PDF]

				G. J. Mizejewski Physiology of Alpha-Fetoprotein as a Biomarker for Perinatal Distress: Relevance to Adverse Pregnancy Outcome Experimental Biology and Medicine, September 1, 2007; 232(8): 993 - 1004. [Abstract] [Full Text] [PDF]