Association of maternal serum PAPP-A levels in first trimester and adverse pregnancy outcomes: systematic review and retrospective cohort study

Bilagi, Ashwini (2017). Association of maternal serum PAPP-A levels in first trimester and adverse pregnancy outcomes: systematic review and retrospective cohort study. University of Birmingham. M.Sc.

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Abstract

Adverse pregnancy outcomes such as preterm delivery, hypertensive disorders of pregnancy, small for age neonates and stillbirths are major determinants of perinatal mortality and morbidity. As the pathology of these complications of late pregnancy may be established in the first half of pregnancy, it seems reasonable to focus on this period to identify women at increased risk of poor outcomes. This thesis focuses on one of the placenta-derived serum markers, pregnancy associated plasma protein -A (PAPP-A). It is a well-established biomarker for Down’s syndrome screening. The main purpose of this thesis is to conduct a systematic review of the literature regarding the association between first trimester serum PAPP-A levels and adverse pregnancy outcomes and to investigate the same in a retrospective cohort study in a tertiary hospital. The systematic review included 32 studies involving a total of 175,240 pregnancies. It showed that low maternal serum PAPP-A in the first trimester has an association with adverse pregnancy outcome but predictive values are poor. The retrospective cohort study of 12,592 pregnancies identified statistically significant lower odds of SGA, PTD, PE and stillbirth as PAPP-A increases. There was no statistically significant association between miscarriage, perinatal or neonatal death with PAPP-A. Further work should address PAPP-A in combination with other predictors as a prediction model to foresee adverse pregnancy outcomes.

Type of Work:

Thesis (Masters by Research > M.Sc.)

Award Type:

Masters by Research > M.Sc.

Supervisor(s):