• The association between first trimester maternal serum PAPP-A levels and some pregnancy outcomes
  • Samane Zeynodini,1,*
    1. Department of nursing and midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran


  • Introduction: Pregnancy associated plasma protein A (PAPP-A) is a protein mostly produced by placenta. It is one of the components of first trimester combined test which is an effective test for predicting fetal chromosomal anomalies. Some studies have shown an association between PAPP-A and some pregnancy outcomes. In due to measuring maternal serum PAPP-A levels in first trimester, it can be a predictive factor for complications which is associated with it. The aim of this review is to check out studies been published about PAPP-A relationship with some pregnancy outcomes.
  • Methods: A review literature search of eligible studies was conducted in the PubMed database from 2015 to 2021 for studies evaluating the association PAPP-A and some maternal outcomes using the following search strategy : ("Pregnancy associated plasma protein A " OR "PAPP-A") AND ("pregnancy outcome") as used keywords. 21 studies (meta-analysis) were found and 10 studies were included in this review.
  • Results: Two studies have reported the relationship between PAPP-A and Gestational diabetes Mellitus (GDM).On top of that one of them showed that the predictive value of PAPP-A for GDM has 55% sensitivity, 90% specificity with 95% confidence intervals. In another meta-analyze study PAPP-A <5th centile had a moderate association with pre-eclampsia OR 1.94 and preterm birth <37 weeks OR 2.09 was reported, however the predictive value was poor.
  • Conclusion: First trimester low maternal serum PAPP-A has an association with GDM, pre-eclampsia and preterm birth, however the predictive values of PAPP-A itself is poor so further works around combining this factor with others seem to be necessary.
  • Keywords: Pregnancy associated plasma protein A , PAPP-A, pregnancy outcome