Early-Onset Severe Preeclampsia by First Trimester Pregnancy-Associated Plasma Protein A and Total Human Chorionic Gonadotropin

Laura L. Jelliffe-Pawlowski; Rebecca J. Baer; Robert J. Currier; Deirdre J. Lyell; Yair J. Blumenfeld; Yasser Y. El-Sayed; Gary M. Shaw; Maurie L. Druzin

doi:10.1055/s-0034-1396697

American Journal of Perinatology, Table of Contents

Am J Perinatol 2015; 32(07): 703-712
DOI: 10.1055/s-0034-1396697

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Early-Onset Severe Preeclampsia by First Trimester Pregnancy-Associated Plasma Protein A and Total Human Chorionic Gonadotropin

Authors

Laura L. Jelliffe-Pawlowski

¹Genetic Disease Screening Program, California Department of Public Health, Richmond, California

²Division of Preventive Medicine and Public Health, Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco California
Rebecca J. Baer

¹Genetic Disease Screening Program, California Department of Public Health, Richmond, California
Robert J. Currier

¹Genetic Disease Screening Program, California Department of Public Health, Richmond, California
Deirdre J. Lyell

³Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
Yair J. Blumenfeld

³Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
Yasser Y. El-Sayed

³Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
Gary M. Shaw

⁴Department of Pediatrics, Stanford University School of Medicine, Stanford, California
Maurie L. Druzin

³Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California

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.

Keywords

early-onset severe preeclampsia - pregnancy-associated plasma protein A - total human chorionic gonadotropin - first trimester aneuploidy screening

Full Text

References

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