Subscribe to RSS
DOI: 10.1055/s-0034-1396697
Early-Onset Severe Preeclampsia by First Trimester Pregnancy-Associated Plasma Protein A and Total Human Chorionic Gonadotropin
Publication History
23 July 2014
22 October 2014
Publication Date:
17 December 2014 (online)
Abstract
Objective This study aims to evaluate the relationship between early-onset severe preeclampsia and first trimester serum levels of pregnancy-associated plasma protein A (PAPP-A) and total human chorionic gonadotropin (hCG).
Study Design The association between early-onset severe preeclampsia and abnormal levels of first trimester PAPP-A and total hCG in maternal serum were measured in a sample of singleton pregnancies without chromosomal defects that had integrated prenatal serum screening in 2009 and 2010 (n = 129,488). Logistic binomial regression was used to estimate the relative risk (RR) of early-onset severe preeclampsia in pregnancies with abnormal levels of first trimester PAPP-A or total hCG as compared with controls.
Results Regardless of parity, women with low first trimester PAPP-A or high total hCG were at increased risk for early-onset severe preeclampsia. Women with low PAPP-A (multiple of the median [MoM] ≤ the 10th percentile in nulliparous or ≤ the 5th percentile in multiparous) or high total hCG (MoM ≥ the 90th percentile in nulliparous or ≥ the 95th percentile in multiparous) were at more than a threefold increased risk for early-onset severe preeclampsia (RR, 4.2; 95% confidence interval [CI], 3.0–5.9 and RR, 3.3; 95% CI, 2.1–5.2, respectively).
Conclusion Routinely collected first trimester measurements of PAPP-A and total hCG provide unique risk information for early-onset severe preeclampsia.
-
References
- 1 Rudra CB, Williams MA. Monthly variation in preeclampsia prevalence: Washington State, 1987-2001. J Matern Fetal Neonatal Med 2005; 18 (5) 319-324
- 2 Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet 2006; 367 (9516) 1066-1074
- 3 Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol 2009; 33 (3) 130-137
- 4 American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists' Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122 (5) 1122-1131
- 5 Sibai BM. Publications Committee, Society for Maternal-Fetal Medicine. Evaluation and management of severe preeclampsia before 34 weeks' gestation. Am J Obstet Gynecol 2011; 205 (3) 191-198
- 6 ACOG Committee on Obstetric Practice; American College of Obstetricians and Gynecologists. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Int J Gynaecol Obstet 2002; 77 (1) 67-75
- 7 Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet 2010; 376 (9741) 631-644
- 8 von Dadelszen P, Magee LA, Roberts JM. Subclassification of preeclampsia. Hypertens Pregnancy 2003; 22 (2) 143-148
- 9 Kuc S, Koster MP, Franx A, Schielen PC, Visser GH. Maternal characteristics, mean arterial pressure and serum markers in early prediction of preeclampsia. PLoS ONE 2013; 8 (5) e63546
- 10 Park FJ, Leung CH, Poon LC, Williams PF, Rothwell SJ, Hyett JA. Clinical evaluation of a first trimester algorithm predicting the risk of hypertensive disease of pregnancy. Aust N Z J Obstet Gynaecol 2013; 53 (6) 532-539
- 11 Duley L, Henderson-Smart DJ, Meher S, King JF. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev 2007; (2) CD004659
- 12 Bujold E, Morency AM, Roberge S, Lacasse Y, Forest JC, Giguère Y. Acetylsalicylic acid for the prevention of preeclampsia and intra-uterine growth restriction in women with abnormal uterine artery Doppler: a systematic review and meta-analysis. J Obstet Gynaecol Can 2009; 31 (9) 818-826
- 13 Roberge S, Villa P, Nicolaides K , et al. Early administration of low-dose aspirin for the prevention of preterm and term preeclampsia: a systematic review and meta-analysis. Fetal Diagn Ther 2012; 31 (3) 141-146
- 14 Dugoff L, Hobbins JC, Malone FD , et al. 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). Am J Obstet Gynecol 2004; 191 (4) 1446-1451
- 15 Spencer K, Yu CK, Savvidou M, Papageorghiou AT, Nicolaides KH. Prediction of pre-eclampsia by uterine artery Doppler ultrasonography and maternal serum pregnancy-associated plasma protein-A, free beta-human chorionic gonadotropin, activin A and inhibin A at 22 + 0 to 24 + 6 weeks' gestation. Ultrasound Obstet Gynecol 2006; 27 (6) 658-663
- 16 Odibo AO, Zhong Y, Longtine M , et al. First-trimester serum analytes, biophysical tests and the association with pathological morphometry in the placenta of pregnancies with preeclampsia and fetal growth restriction. Placenta 2011; 32 (4) 333-338
- 17 Keikkala E, Vuorela P, Laivuori H, Romppanen J, Heinonen S, Stenman UH. First trimester hyperglycosylated human chorionic gonadotrophin in serum - a marker of early-onset preeclampsia. Placenta 2013; 34 (11) 1059-1065
- 18 Cole LA. Biological functions of hCG and hCG-related molecules. Reprod Biol Endocrinol 2010; 8: 102
- 19 Kirkegaard I, Uldbjerg N, Oxvig C. Biology of pregnancy-associated plasma protein-A in relation to prenatal diagnostics: an overview. Acta Obstet Gynecol Scand 2010; 89 (9) 1118-1125
- 20 Saito S, Nakashima A. A review of the mechanism for poor placentation in early-onset preeclampsia: the role of autophagy in trophoblast invasion and vascular remodeling. J Reprod Immunol 2014; 101-102: 80-88
- 21 Towner D, Gandhi S, El Kady D. Obstetric outcomes in women with elevated maternal serum human chorionic gonadotropin. Am J Obstet Gynecol 2006; 194 (6) 1676-1681 , discussion 1681–1682
- 22 Yu H, Shen YT, Li HL, Yan Y, Ren ML, Wang B. The relationship between maternal serum prenatal screening combined with epidemiological study and early onset preeclampsia. Arch Gynecol Obstet 2014; 289 (4) 749-753
- 23 Fitzgerald B, Levytska K, Kingdom J, Walker M, Baczyk D, Keating S. Villous trophoblast abnormalities in extremely preterm deliveries with elevated second trimester maternal serum hCG or inhibin-A. Placenta 2011; 32 (4) 339-345
- 24 Kazerouni NN, Currier B, Malm L , et al. Triple-marker prenatal screening program for chromosomal defects. Obstet Gynecol 2009; 114 (1) 50-58
- 25 Currier R, Wu N, Van Meter K, Goldman S, Lorey F, Flessel M. Integrated and first trimester prenatal screening in California: program implementation and patient choice for follow-up services. Prenat Diagn 2012; 32 (11) 1077-1083
- 26 Jelliffe-Pawlowski LL, Shaw GM, Currier RJ , et al. Association of early-preterm birth with abnormal levels of routinely collected first- and second-trimester biomarkers. Am J Obstet Gynecol 2013; 208 (6) 492.e1-492.e11
- 27 American Medical Association. International Classification of Diseases; Physician, Ninth Revision Clinical Modification. 9th ed. Chicago, IL: American Medical Association; 2008
- 28 Ong CY, Liao AW, Spencer K, Munim S, Nicolaides KH. First trimester maternal serum free beta human chorionic gonadotrophin and pregnancy associated plasma protein A as predictors of pregnancy complications. BJOG 2000; 107 (10) 1265-1270
- 29 Spencer K, Yu CK, Cowans NJ, Otigbah C, Nicolaides KH. Prediction of pregnancy complications by first-trimester maternal serum PAPP-A and free beta-hCG and with second-trimester uterine artery Doppler. Prenat Diagn 2005; 25 (10) 949-953
- 30 Spencer K, Cowans NJ, Chefetz I, Tal J, Meiri H. First-trimester maternal serum PP-13, PAPP-A and second-trimester uterine artery Doppler pulsatility index as markers of pre-eclampsia. Ultrasound Obstet Gynecol 2007; 29 (2) 128-134
- 31 Than NG, Romero R, Hillermann R, Cozzi V, Nie G, Huppertz B. Prediction of preeclampsia - a workshop report. Placenta 2008; 29 (Suppl A): S83-S85
- 32 Poon LC, Maiz N, Valencia C, Plasencia W, Nicolaides KH. First-trimester maternal serum pregnancy-associated plasma protein-A and pre-eclampsia. Ultrasound Obstet Gynecol 2009; 33 (1) 23-33
- 33 Myatt L, Clifton RG, Roberts JM , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. First-trimester prediction of preeclampsia in nulliparous women at low risk. Obstet Gynecol 2012; 119 (6) 1234-1242
- 34 Goetzinger KR, Singla A, Gerkowicz S, Dicke JM, Gray DL, Odibo AO. Predicting the risk of pre-eclampsia between 11 and 13 weeks' gestation by combining maternal characteristics and serum analytes, PAPP-A and free β-hCG. Prenat Diagn 2010; 30 (12-13) 1138-1142
- 35 Meekins JW, Pijnenborg R, Hanssens M, McFadyen IR, van Asshe A. A study of placental bed spiral arteries and trophoblast invasion in normal and severe pre-eclamptic pregnancies. Br J Obstet Gynaecol 1994; 101 (8) 669-674
- 36 Zhou Y, Damsky CH, Fisher SJ. Preeclampsia is associated with failure of human cytotrophoblasts to mimic a vascular adhesion phenotype. One cause of defective endovascular invasion in this syndrome?. J Clin Invest 1997; 99 (9) 2152-2164
- 37 Egbor M, Ansari T, Morris N, Green CJ, Sibbons PD. Morphometric placental villous and vascular abnormalities in early- and late-onset pre-eclampsia with and without fetal growth restriction. BJOG 2006; 113 (5) 580-589
- 38 Cole LA. New discoveries on the biology and detection of human chorionic gonadotropin. Reprod Biol Endocrinol 2009; 7: 8
- 39 Meloni P, D'Angeli I, Piazze J , et al. First trimester PAPP-A levels associated with early prediction of pregnancy induced hypertension. Hypertens Pregnancy 2009; 28 (4) 361-368
- 40 Brouillet S, Hoffmann P, Chauvet S , et al. Revisiting the role of hCG: new regulation of the angiogenic factor EG-VEGF and its receptors. Cell Mol Life Sci 2012; 69 (9) 1537-1550
- 41 Lee CL, Chiu PC, Hautala L , et al. Human chorionic gonadotropin and its free β-subunit stimulate trophoblast invasion independent of LH/hCG receptor. Mol Cell Endocrinol 2013; 375 (1-2) 43-52
- 42 Odibo AO, Patel KR, Spitalnik A, Odibo L, Huettner P. Placental pathology, first-trimester biomarkers and adverse pregnancy outcomes. J Perinatol 2014; 34 (3) 186-191
- 43 Costa SL, Proctor L, Dodd JM , et al. Screening for placental insufficiency in high-risk pregnancies: is earlier better?. Placenta 2008; 29 (12) 1034-1040
- 44 Askie LM, Duley L, Henderson-Smart DJ, Stewart LA. PARIS Collaborative Group. Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Lancet 2007; 369 (9575) 1791-1798
- 45 Levine RJ, Maynard SE, Qian C , et al. Circulating angiogenic factors and the risk of preeclampsia. N Engl J Med 2004; 350 (7) 672-683
- 46 Wortelboer EJ, Koster MP, Cuckle HS, Stoutenbeek PH, Schielen PC, Visser GH. First-trimester placental protein 13 and placental growth factor: markers for identification of women destined to develop early-onset pre-eclampsia. BJOG 2010; 117 (11) 1384-1389
- 47 Hawkins TL, Roberts JM, Mangos GJ, Davis GK, Roberts LM, Brown MA. Plasma uric acid remains a marker of poor outcome in hypertensive pregnancy: a retrospective cohort study. BJOG 2012; 119 (4) 484-492
- 48 Catov JM, Ness RB, Kip KE, Olsen J. Risk of early or severe pre-eclampsia related to pre-existing conditions. Int J Epidemiol 2007; 36 (2) 412-419
- 49 Hernández-Díaz S, Toh S, Cnattingius S. Risk of pre-eclampsia in first and subsequent pregnancies: prospective cohort study. BMJ 2009; 338: b2255
- 50 Audibert F, Boucoiran I, An N , et al. Screening for preeclampsia using first-trimester serum markers and uterine artery Doppler in nulliparous women. Am J Obstet Gynecol 2010; 203 (4) 383.e1-383.e8
- 51 Matsuda Y, Hayashi K, Shiozaki A, Kawamichi Y, Satoh S, Saito S. Comparison of risk factors for placental abruption and placenta previa: case-cohort study. J Obstet Gynaecol Res 2011; 37 (6) 538-546