The Association Between Low Pregnancy-Associated Plasma Protein-A levels and Adverse Pregnancy Outcomes
Issued Date
2026-01-01
Resource Type
ISSN
08576084
eISSN
26730871
Scopus ID
2-s2.0-105027813541
Journal Title
Thai Journal of Obstetrics and Gynaecology
Volume
34
Issue
1
Start Page
70
End Page
81
Rights Holder(s)
SCOPUS
Bibliographic Citation
Thai Journal of Obstetrics and Gynaecology Vol.34 No.1 (2026) , 70-81
Suggested Citation
Saengsiriwudh R., Yapan P., Wataganara T., Surasereewong S., Pinnington T.R. The Association Between Low Pregnancy-Associated Plasma Protein-A levels and Adverse Pregnancy Outcomes. Thai Journal of Obstetrics and Gynaecology Vol.34 No.1 (2026) , 70-81. 81. Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/114674
Title
The Association Between Low Pregnancy-Associated Plasma Protein-A levels and Adverse Pregnancy Outcomes
Author's Affiliation
Corresponding Author(s)
Other Contributor(s)
Abstract
Objective: The primary objective was to evaluate the association between low pregnancy-associated plasma protein-A (PAPP-A) levels and preterm birth. The secondary objectives included assessing the relationship between low PAPP-A levels and other adverse pregnancy outcomes, as well as analyzing factors affecting PAPP-A levels. Materials and Methods: Medical records of all women with singleton pregnancies undergoing the combined first trimester Down syndrome screening test between 11-14 weeks of gestation from January 2014 to December 2023 were reviewed. Baseline characteristics and pregnancy outcomes, including miscarriage, stillbirth, gestational diabetes mellitus, gestational hypertension, preeclampsia, preterm delivery, and fetal growth restriction were compared between women with normal and low PAPP-A levels (< 0.4 multiples of median (MoM)). Results: A total number of 2,023 women were enrolled, of whom 120 (5.9%) had low PAPP-A levels. Higher body mass index, multiparity, diabetes mellitus and hypertension negatively influenced PAPP-A levels. Women with low PAPP-A levels had significantly higher rates of preterm birth (15.8% vs 7.2%), gestational hypertension (12.5% vs 5.3%), and fetal growth restriction (10.8% vs 3.7%). At the 0.4 MoM cutoff, the sensitivity, specificity, NPV, and PPV for predicting preterm birth were 12.18%, 94.64%, 92.72%, and 16.10%, respectively. The area under the receiver operative characteristic curve was 0.597 for preterm birth, 0.578 for gestational hypertension, and 0.585 for fetal growth, respectively. Conclusion: Low PAPP-A levels were significantly associated with preterm birth, gestational hypertension, and fetal growth restriction. However, the overall predictive performance was limited so PAPP-A should not be used as the sole indicator for clinical decision-making.