A. JAYAMOL, DEY MADHUSUDAN, Ipsita SAHOO

A correlation of first trimester serum levels of PAPP-A and PlGF with preeclampsia in western Indian population

Preeclampsia till today is a leading cause of serious maternal morbidity as well as maternal mortality. Prevention of preeclampsia is the mainstay of controlling various maternal and fetal complications as cure for it is not available. Early identification of preeclamptic patients is helpful in prevention of serious morbidities. Various biochemical markers were studied for prediction of preeclampsia but the sensitivity and specificity were found to be low. We intend to study the serum levels of pregnancy associated plasma protein-a (PAPP-A) and placental growth factor (PlGF) at 10-14 weeks of period of gestation for early prediction of development of preeclampsia. In a prospective observational study carried out from Aug 2014 to Jul 2016 at a tertiary care hospital where 323 patients participated. Serum levels of PAPP-A and PlGF at 10-14 weeks were collected and followed up till the time of delivery for development of preeclampsia. Incidence of preeclampsia was 6.5%. Maternal characteristics and obstetric factors were comparable in cases and controls. Serum levels of PAPP-A in cases and controls were 14.34 ugm/ml & 18.96 ugm/ml and for PlGF it was 27.86 pg/ml & 38.56 pg/ml respectively. There was statistically significant difference between the cases and controls in serum levels of PAPP-A and PlGF. Low serum levels of PAPP-A and PlGF at 10-14 weeks were observed in patients who developed preeclampsia at later gestation.

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1. Berg CJ, Callaghan WM, Syverson C, et al. Pregnancy-related mortality in the United States, 1998–2005. Obstet Gynecol. 2010;116:1302.

2. Dey M, Arora D, Nagaraja N, Kumar R. Serum cholesterol and ceruloplasmin levels in second trimester can predict development of preeclampsia. North Am J Med Sci. 2013;5:41-6

3. Kumar P, Sharma JB. Hypertensive disorders of pregnancy. JIMSA. 2010;23:261-7.

4. Spencer K, Cowans NJ, Chefetz I, et al. First-trimester maternal serum PP13, PAPPA and second-trimester uterine artery Doppler pulsatility index as markers of preeclampsia. Ultrasound Obstet Gynecol. 2007;29:128-34.

5. Browne JL, Klipstein-Grobusch K, Koster MP, et al. Pregnancy associated plasma protein-a and placental growth factor in a sub-saharan african population: a nested cross-sectional study. PLoS One. 2016;11:e0159592. Published 2016 Aug 17.

6. Akolekar R, Zaragoza E, Poon LCY, et al. Maternal serum placental growth factor (PlGF) at 11 to 13 weeks of gestation in hypertensive disorders of pregnancy. Ultrasound Obstet Gynecol. 2008;32:732-9.

7. Huppertz B: The feto-maternal interface: setting the stage for potential immune interactions. Semin Immunopathol. 2007;29:83-94.

8. Myatt L, Clifton RG, Roberts JM, et al. First-trimester prediction of preeclampsia in nulliparous women at low risk. Obstet Gynecol. 119:2012a.

9. Scholten RR, Hopman MT, Sweep Fc et al. Co-occurrence of cardiovascular and prothrombotic risk factors in women with a history of preeclampsia. Obstet Gynecol 2013;121:97-105.

10. Kraus D, Fent L, Heine RP, et al. Smoking and preeclampsia protection: cigarette smoke increases placental adrenomedullin expression and improves trophoblast invasion via the adrenomedullin pathway. Abstract No. 43, Am J Obstet Gynecol. 2013;208:26.

11. Lai J, Pinas A, Poon l, et al. Maternal serum placental growth factor, pregnancyassociated plasma protein-a and free beta human chorionic gonadotrophin at 30– 33 weeks in the prediction of pre-eclampsia. Fetal Diagn Ther. 2013;33:164-72.

12. 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;33:23-33.

13. Le Ray C, Wavrant S, Rey E, et al. Induction or elective caesarean in severe earlyonset preeclampsia: a meta-analysis of observational studies. Abstract No 724. Presented at the 29th Annual Meeting of the Society for Maternal-Fetal Medicine, January 2009;26-31.

14. Langenveld J, Ravelli ACJ, van Kaam AH, et al. Neonatal outcome of pregnancies complicated by hypertensive disorders between 34 and 37 weeks of gestation: a 7 year retrospective analysis of national registry. Am J Obstet Gynecol. 2011;205:540-1.