This study analyzed 236 pregnancies with low PAPP-A levels on first trimester screening to determine outcomes. They found a preterm birth rate of 13.6% in this cohort, higher than the national average of 9.6%. Further analysis showed a statistically significant association between lower PAPP-A levels and higher rates of preterm birth. While no other adverse neonatal outcomes were found apart from preterm birth, the study concludes increased fetal surveillance is still needed for patients with low PAPP-A levels to optimize care and reduce unnecessary intervention. Future studies aim to further stratify risk based on additional factors.

1. Retrospective Analysis of Pregnancy and Neonatal Outcome
with Low and Very Low Papp-a on First Trimester Screen
V. Lozovyy, MD, D. Bradke, BS, J. King, BS, F. Schubert, MPH, K. Fitzpatrick, MD, S. Singh, MD
Department of Obstetrics and Gynecology, NYU Lutheran Medical Center, Brooklyn, NY
Introduction
v Low PAPP-A is a marker for Trisomy
21,13 and 18.
v Studies have shown some association
between low PAPP-A and higher rates
of adverse pregnancy outcomes such
as poor fetal growth, low birth weight,
pre-eclampsia and stillbirth.
v The goal of this study was to determine
whether differences in PAPP- A among
patients with low birth weight between
1st and 5th percentiles and very low birth
weight < 1st percentile are clinically
significant in predicting perinatal and
pregnancy adverse outcomes.
Methods
v A retrospective review of 2588 women
referred to the Maternal Fetal Medicine
Unit at NYU Lutheran Medical Center
between November 2011 and March
2015 for evaluation of first-trimester risk
assessment.
v Women who had low PAPP-A, less than
5th percentile, were included totaling
236 women enrolled in the study.
v Biochemical risk assessment was
performed from 9 0/7 -13 6/7 weeks.
v Pregnancy outcome was determined
from medical records and New York
Department of Health Birth Registry.
v Data were analyzed using one sample
t- test. P < 0.05 was significant.
Limitations and Strengths
v Small sample size
v Retrospective analysis
Conclusions
Within the cohort of patients with PAPP-A
under the 5th and 1st percentile, no adverse
perinatal outcome was found except for
preterm delivery rate of 13.6%. Further
analysis revealed that there is a statistically
significant association between lower PAPP-A
and incidence of preterm births. We can
conclude that increased fetal surveillance is
still required for patients with low PAPP-A.
In an effort to reduce the unnecessary
intervention in patients that are associated with
increased fetal surveillance, we will seek
through future studies to further stratify these
patients based on additional risk factors.
Utilizing the data in this study we believe that
we can optimize patient care while
simultaneously saving health care costs.
Maternal and
Neonatal
Characteristics
Outcome (n)
Weeks Gestational
age (GA)
38.1 2.2
(236)
Weeks GA at the Last
Biometry
30.9 6.6
(226)
EFW Percentile at
the Last Biometry
42.8 22.2
(222)
NSVD 70.3% (166)
Cesarean Delivery 29.7% (70)
Pre-eclampsia 17.8% (42)
Neonatal
Birth Weight
3096 553
(236)
IUGR incidence
(< 10th percentile)
9.3% (22)
Preterm Births 13.6% (32)
APGAR at 1 Minute 8.6 1.2 (236)
APGAR at 5 Minutes 8.8 0.8 (236)
NICU Admission 0.4% (1)
Table 1: Total study maternal & neonatal statistics
Table 2: Statistics within Low PAPP-A cohorts
>1st and ≤5th
Percentile
<1st
percentile
Preterm
Births
11.3% (20) 20.3% (12)
Cohort
Breakdown
75% (177) 25% (59)
Results
v 236 women were included. 9% incidence.
v The mean GA was 38.1 + 2.2.
v The mean birth weight was 3097 + 553.
v The mean gestational age at the time of the
last biometric measurement was 30.9
weeks + 7 days.
v Estimated fetal weight percentile at the last
growth scan was 42.8 (+22.2) percent.
v APGAR score at 5 minutes was 8.8 + 0.8 in
90% of neonates.
v One neonate (0.4%) required NICU
admission.
v Rate of preterm birth was observed in
13.6% of cohort vs. 9.6% nationally in 2015
(p=0.03) with 95% CI (9.50 to 18.64).
v Preterm birth rate was more common in the
very low PAPP-A group 20.3% compared
to low PAPP-A group 11.3% with no
statistical difference between groups
(p=0.079).
v There was no statistical association
between pre-eclampsia and PAPP-A levels.