PAPP-A, free β-hCG, and early fetal growth identify two pathways leading to preterm delivery

TY - JOUR

T1 - PAPP-A, free β-hCG, and early fetal growth identify two pathways leading to preterm delivery

AU - Kirkegaard, Ida

AU - Uldbjerg, Niels

AU - Petersen, Olav Bjørn

AU - Tørring, Niels

AU - Henriksen, Tine Brink

N1 - © 2010 John Wiley & Sons, Ltd.

PY - 2010/10

Y1 - 2010/10

N2 - Objective: To evaluate early fetal growth and the biomarkers, pregnancy-associated plasma protein A (PAPPA) and free β-human chorionic gonadotrophin (β-hCG), in relation to preterm delivery. Methods: A cohort study of 9450 singleton pregnant women who attended the prenatal screening program at Aarhus University Hospital between January 2005 and December 2007, was conducted. PAPP-A and free β-hCG were measured in the first trimester. Early fetal growth was estimated by (GA20 - GA12)/ Dayscalendar, where GA12 reflects the gestational age in days calculated from the crown-rump length at a 12-week scan, GA20 reflects the gestational age in days calculated from the biparietal diameter at a 20-week scan, and Dayscalendar is the number of calendar days between the two scans. Results: Low PAPP-A and low free β-hCG were significantly associated with preterm delivery (<37 weeks). The association was even stronger when low PAPP-A and slow early fetal growth were combined, resulting in an adjusted odds ratio of 3.8 (95% CI, 1.6-8.7). Fast early fetal growth, but neither high PAPP-A nor high free β-hCG, was significantly associated with preterm delivery. Conclusion: Two different biological pathways leading to spontaneous preterm delivery are suggested: fast early fetal growth and the combination of low PAPP-A and slow early fetal growth.

AB - Objective: To evaluate early fetal growth and the biomarkers, pregnancy-associated plasma protein A (PAPPA) and free β-human chorionic gonadotrophin (β-hCG), in relation to preterm delivery. Methods: A cohort study of 9450 singleton pregnant women who attended the prenatal screening program at Aarhus University Hospital between January 2005 and December 2007, was conducted. PAPP-A and free β-hCG were measured in the first trimester. Early fetal growth was estimated by (GA20 - GA12)/ Dayscalendar, where GA12 reflects the gestational age in days calculated from the crown-rump length at a 12-week scan, GA20 reflects the gestational age in days calculated from the biparietal diameter at a 20-week scan, and Dayscalendar is the number of calendar days between the two scans. Results: Low PAPP-A and low free β-hCG were significantly associated with preterm delivery (<37 weeks). The association was even stronger when low PAPP-A and slow early fetal growth were combined, resulting in an adjusted odds ratio of 3.8 (95% CI, 1.6-8.7). Fast early fetal growth, but neither high PAPP-A nor high free β-hCG, was significantly associated with preterm delivery. Conclusion: Two different biological pathways leading to spontaneous preterm delivery are suggested: fast early fetal growth and the combination of low PAPP-A and slow early fetal growth.

KW - Adult

KW - Biomarkers/blood

KW - Chorionic Gonadotropin, beta Subunit, Human/blood

KW - Cohort Studies

KW - Crown-Rump Length

KW - Denmark/epidemiology

KW - Female

KW - Fetal Development/physiology

KW - Gestational Age

KW - Humans

KW - Maternal Age

KW - Pregnancy/blood

KW - Pregnancy-Associated Plasma Protein-A/metabolism

KW - Premature Birth/blood

U2 - 10.1002/pd.2593

DO - 10.1002/pd.2593

M3 - Journal article

C2 - 20721873

SN - 0197-3851

VL - 30

SP - 956

EP - 963

JO - Prenatal Diagnosis

JF - Prenatal Diagnosis

IS - 10

ER -