TY - JOUR
T1 - Eliminating first trimester markers
T2 - Will replacing PAPP-A and βhCG miss women at risk for small for gestational age?
AU - Dukhovny, Stephanie
AU - Zera, Chloe
AU - Little, Sarah E.
AU - McElrath, Thomas
AU - Wilkins-Haug, Louise
N1 - Publisher Copyright:
© 2014 Informa UK Ltd.
PY - 2014/11/1
Y1 - 2014/11/1
N2 - Objective: Placental analytes are traditionally used for aneuploidy screening, although may be replaced by cell-free fetal DNA. Abnormal analytes also identify women at risk for small for gestational age (SGA). We sought to quantify the proportion of women at risk for SGA by low pregnancy-associated plasma protein-A (PAPP-A) or βhCG who would not otherwise be identified by maternal risk factors. Methods: We studied first-trimester PAPPA-A and βhCG from 658 euploid singleton pregnancies from a prospective longitudinal cohort. Analytes were standardized for gestational age in multiples of the median (MoM). SGA was defined as birthweight z-score ≤-1.28. Maternal risk factors included chronic hypertension, pre-gestational diabetes and age ≥40. Results: Mean GA was 38.8 ± 1.9 weeks; 6.8% had a SGA infant. Low PAPP-A and βhCG were identified in 48 (7.4%) and 9 (1.4%) of pregnancies, respectively, of whom 18.9% were SGA (OR 3.0, 95% CI 1.4-6.3). 88% did not have risk factors for SGA. Among women with no risk factors, low PAPP-A was a significant predictor of SGA (OR 3.3, 95% CI 1.5-7.4). Conclusion: Most women with abnormal analytes did not have risk factors for SGA. Eliminating PAPP-A and βhCG may present missed opportunities to identify women at risk for SGA.
AB - Objective: Placental analytes are traditionally used for aneuploidy screening, although may be replaced by cell-free fetal DNA. Abnormal analytes also identify women at risk for small for gestational age (SGA). We sought to quantify the proportion of women at risk for SGA by low pregnancy-associated plasma protein-A (PAPP-A) or βhCG who would not otherwise be identified by maternal risk factors. Methods: We studied first-trimester PAPPA-A and βhCG from 658 euploid singleton pregnancies from a prospective longitudinal cohort. Analytes were standardized for gestational age in multiples of the median (MoM). SGA was defined as birthweight z-score ≤-1.28. Maternal risk factors included chronic hypertension, pre-gestational diabetes and age ≥40. Results: Mean GA was 38.8 ± 1.9 weeks; 6.8% had a SGA infant. Low PAPP-A and βhCG were identified in 48 (7.4%) and 9 (1.4%) of pregnancies, respectively, of whom 18.9% were SGA (OR 3.0, 95% CI 1.4-6.3). 88% did not have risk factors for SGA. Among women with no risk factors, low PAPP-A was a significant predictor of SGA (OR 3.3, 95% CI 1.5-7.4). Conclusion: Most women with abnormal analytes did not have risk factors for SGA. Eliminating PAPP-A and βhCG may present missed opportunities to identify women at risk for SGA.
KW - Cell-free fetal DNA
KW - Intrauterine growth restriction
KW - Placental analytes
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U2 - 10.3109/14767058.2013.879703
DO - 10.3109/14767058.2013.879703
M3 - Article
C2 - 24460472
AN - SCOPUS:84911937432
SN - 1476-7058
VL - 27
SP - 1761
EP - 1764
JO - Journal of Maternal-Fetal and Neonatal Medicine
JF - Journal of Maternal-Fetal and Neonatal Medicine
IS - 17
ER -