Pregnancy-associated plasma protein A and alpha-fetoprotein and prediction of adverse perinatal outcome

被引:103
作者
Smith, GCS
Shah, M
Crossley, JA
Aitken, DA
Pell, FP
Nelson, SM
Cameron, AD
Connor, MJ
Dobbie, R
机构
[1] Univ Cambridge, Dept Obstet & Gynaecol, Cambridge, England
[2] Yorkhill Natl Hlth Serv Trust, Inst Med Genet, Glasgow, Lanark, Scotland
[3] Greater Glasgow Natl Hlth Serv Board, Dept Publ Hlth, Glasgow, Lanark, Scotland
[4] Univ Glasgow, Dept Obstet & Gynaecol, Glasgow, Lanark, Scotland
[5] Common Serv Agcy, Informat & State Div, Edinburgh, Midlothian, Scotland
关键词
D O I
10.1097/01.AOG.0000191302.79560.d8
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
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.
引用
收藏
页码:161 / 166
页数:6
相关论文
共 19 条
[1]  
[Anonymous], 2000, APPL LOGISTICS REGRE
[2]  
COLE SK, 1980, PERINATAL AUDIT SURV, P39
[3]   Metalloproteinase pregnancy-associated plasma protein A is a critical growth regulatory factor during fetal development [J].
Conover, CA ;
Bale, LK ;
Overgaard, MT ;
Johnstone, EW ;
Laursen, UH ;
Füchtbauer, EM ;
Oxvig, C ;
van Deursen, J .
DEVELOPMENT, 2004, 131 (05) :1187-1194
[4]   Combined ultrasound and biochemical screening for Down's Syndrome in the first trimester: a Scottish multicentre study [J].
Crossley, JA ;
Aitken, DA ;
Cameron, AD ;
McBride, E ;
Connor, JM .
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 2002, 109 (06) :667-676
[5]   First-trimester maternal serum PAPP-A and free-beta subunit human chorionic gonadotropin concentrations and nuchal translucency are associated with obstetric complications: A population-based screening study (The FASTER Trial) [J].
Dugoff, L ;
Hobbins, JC ;
Malone, FD ;
Porter, TF ;
Luthy, D ;
Comstock, CH ;
Hankins, G ;
Berkowitz, RL ;
Merkatz, I ;
Craigo, SD ;
Timor-Tritsch, IE ;
Carr, SR ;
Wolfe, HM ;
Vidaver, J ;
D'Alton, ME .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2004, 191 (04) :1446-1451
[6]  
*INF STAT DIV NHS, 2001, SCOTT PER INF MORT R
[7]   Role of the IGF system in trophoblast invasion and pre-eclampsia [J].
Irwin, JC ;
Suen, LF ;
Martina, NA ;
Mark, SP ;
Giudice, LC .
HUMAN REPRODUCTION, 1999, 14 :90-96
[8]   Association of extreme first-trimester free human chorionic gonadotropin-β, pregnancy-associated plasma protein A, and nuchal translucency with intrauterine growth restriction and other adverse pregnancy outcomes [J].
Krantz, D ;
Goetzl, L ;
Simpson, JL ;
Thom, E ;
Zachary, J ;
Hallahan, TW ;
Silver, R ;
Pergament, E ;
Platt, LD ;
Filkins, K ;
Johnson, A ;
Mahoney, M ;
Hogge, WA ;
Wilson, RD ;
Mohide, P ;
Hershey, D ;
Wapner, R .
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 2004, 191 (04) :1452-1458
[9]   Pregnancy-associated plasma protein-A (PAPP-A) cleaves insulin-like growth factor binding protein (IGFBP)-5 independent of IGF: implications for the mechanism of IGFBP-4 proteolysis by PAPP-A [J].
Laursen, LS ;
Overgaard, MT ;
Soe, R ;
Boldt, HB ;
Sottrup-Jensen, L ;
Giudice, LC ;
Conover, CA ;
Oxvig, C .
FEBS LETTERS, 2001, 504 (1-2) :36-40
[10]   DEPRIVATION AND MORTALITY IN SCOTLAND, 1981 AND 1991 [J].
MCLOONE, P ;
BODDY, FA .
BRITISH MEDICAL JOURNAL, 1994, 309 (6967) :1465-1470