Association of extreme first-trimester free human chorionic gonadotropin-β, pregnancy-associated plasma protein A, and nuchal translucency with intrauterine growth restriction and other adverse pregnancy outcomes Conference

Krantz, D, Goetzl, L, Simpson, JL et al. (2004). Association of extreme first-trimester free human chorionic gonadotropin-β, pregnancy-associated plasma protein A, and nuchal translucency with intrauterine growth restriction and other adverse pregnancy outcomes . 191(4), 1452-1458. 10.1016/j.ajog.2004.05.068



cited authors

  • Krantz, D; Goetzl, L; Simpson, JL; Thom, E; Zachary, J; Hallahan, TW; Silver, R; Pergament, E; Platt, LD; Filkins, K; Johnson, A; Mahoney, M; Hogge, WA; Wilson, RD; Mohide, P; Hershey, D; Wapner, R

fiu authors

abstract

  • The purpose of this study was to determine the association between first-trimester trisomy 21 screening markers (free human chorionic gonadotropin-β [hCG], pregnancy-associated plasma protein A [PAPP-A], and nuchal translucency) and adverse pregnancy outcome. This was a cohort study of 8012 patients enrolled in a National Institute of Child Health and Human Development-sponsored study of first-trimester trisomy 21 and 18 screening. Trisomy 21 and 18 risk results and individual marker levels in unaffected pregnancies and pregnancies with adverse outcomes were evaluated. PAPP-A <1st percentile (OR 5.4, 95% CI 2.8-10.3) and PAPP-A <5th percentile (OR 2.7, 95% CI 1.9-3.9) and free β-hCG <1st percentile (OR 2.7, 95% CI 1.3-5.9) were associated with increased risk of intrauterine growth restriction (IUGR) with positive predictive values of 24.1%, 14.1%, and 14.3%, respectively. PAPP-A <5th percentile (OR 2.3 95% CI 1.1-4.7) and nuchal translucency >99th percentile (OR 3.5, 95% CI 1.1-11.3) were associated with increased risk of preterm delivery before 34 weeks. Increased risk at screening for trisomy 21 and 18 identified 16 of the 29 other chromosomal abnormalities (55%). Low free β-hCG, low PAPP-A, and increased nuchal translucency were all associated with an increased rate of fetal abnormality. Extreme values of first-trimester free β-hCG, PAPP-A, and nuchal translucency are all associated with adverse outcomes. The especially high predictive value for IUGR of PAPP-A levels below the 1st percentile suggests that patients within this group may benefit from increased surveillance for this condition. © 2004 Elsevier Inc. All rights reserved.

publication date

  • October 1, 2004

Digital Object Identifier (DOI)

start page

  • 1452

end page

  • 1458

volume

  • 191

issue

  • 4