Pregnancy Associated Plasma Protein-A (PAPP-A) as a Marker to Distinguish Normotensive with Early 2nd Trimester and Late 3rd Trimester Onset of Preeclampsia
DOI:
https://doi.org/10.36408/mhjcm.v11i1.979Keywords:
PAPP-A, Early Onset Preeclampsia, Normotensive Pregnancy, Second Trimester, Third TrimesterAbstract
Introduction: Preeclampsia is a hypertensive condition that occurs after 20 weeks of gestation accompanied by target organ damage. Complications of preeclampsia can cause intrauterine fetal growth retardation, and placental hypoperfusion, even in the most serious situations, namely termination of pregnancy and death of the fetus and/or mother. Pregnancy-associated plasma protein-A (PAPP-A) is a high molecular weight glycoprotein that is produced in the placenta and secreted into the maternal bloodstream. However, based on several studies that have been conducted, there is uncertainty in the results of assessing PAPP-A levels obtained in pregnant women in the second and third trimesters.
Aim: Proving differences in PAPP-A levels in the second and third trimesters in the incidence of early-onset preeclampsia and normotensive pregnancy.
Methods: An analytic observational study with a cross-sectional approach was carried out in the delivery room of RSUP Dr. Kariadi Semarang, Halmahera Health Center, Ngesrep Health Center, Bulu Health Center, and private midwife practice in Semarang City. The subjects of the study were six 2nd-trimester preeclampsia patients, fourteen 3rd-trimester preeclampsia patients, and twenty normotensive pregnancy patients who met the inclusion and exclusion criteria. Data were analyzed using Mann Whitney with a significance of p<0.05
Results: There was a significant difference in PAPP-A levels (p<0.001) between the preeclampsia and normotensive pregnancy groups, whereas PAPP-A levels were higher in the preeclampsia group. There were significant differences in PAPP-A levels (p<0.001) between the 2nd-trimester preeclampsia, 3rd-trimester preeclampsia, and normotensive pregnancies, where the highest PAPP-A levels were found in the 2nd-trimester preeclampsia group.
Conclusion: There was a significant difference in PAPP-A levels between the second and third trimesters of early-onset preeclampsia compared to normotensive pregnancies, where PAPP-A levels were higher in the second and third trimesters of early-onset preeclampsia. Elevated PAPP-A levels in the second and third trimesters are associated with an increased risk of early-onset preeclampsia.
Downloads
References
1. Peres GM, Mariana M, Cairrão E. Pre-eclampsia and eclampsia: An update on the pharmacological treatment applied in Portugal. J Cardiovasc Dev Dis. 2018;5(1).
2. Rana S, Lemoine E, Granger J, Karumanchi SA. Preeclampsia: Pathophysiology, Challenges, and Perspectives. Circ Res. 2019;124(7):1094–112.
3. Atis A, Aydin Y, Basol E, Kaleli S, Turgay F, Goker N. PAPP-A levels of late pregnancy in preeclampsia and HELLP syndrome. Arch Gynecol Obstet. 2012;285(1):45–9.
4. Moslemi Zadeh N, Naghshvar F, Peyvandi S, Gheshlaghi P, Ehetshami S. PP13 and PAPP-A in the First and Second Trimesters: Predictive Factors for Preeclampsia? ISRN Obstet Gynecol. 2012 Jun 18;2012:1–6.
5. Wright D, Silva M, Papadopoulos S, Wright A, Nicolaides KH. Serum pregnancy-associated plasma protein-A in the three trimesters of pregnancy: effects of maternal characteristics and medical history. Ultrasound in Obstetrics & Gynecology. 2015 Jul;46(1):42–50.
6. Wright A, Guerra L, Pellegrino M, Wright D, Nicolaides KH. Maternal serum PAPP-A and free β-hCG at 12, 22 and 32 weeks’ gestation in screening for pre-eclampsia. Ultrasound in Obstetrics & Gynecology. 2016 Jun;47(6):762–7.
7. Kalousová M, Muravská A, Zima T. Pregnancy-associated plasma protein a (papp-a) and preeclampsia. Vol. 63, Advances in Clinical Chemistry. 2014. 169–209 p.
8. Janani F, Changaee F. Seasonal variation in the prevalence of preeclampsia. J Family Med Prim Care. 2017;6(4):766.
9. Tabassum S, AlSada A, Bahzad N, Sulaibeekh N, Qureshi A, Dayoub N. Preeclampsia and Its Maternal and Perinatal Outcomes in Pregnant Women Managed in Bahrain’s Tertiary Care Hospital. Cureus. 2022 May 1;
10. Arwan B, Sriyanti R. Hubungan Status Gravida, Usia, BMI (Body Mass Index) dengan Kejadian Preeklampsia. JOURNAL OBGIN EMAS. 2020 Jan 10;4(1):13–21.
11. Quedarusman H, Wantania J, Kaeng JJ. Hubungan Indeks Massa Tubuh Ibu dan Peningkatan Berat Badan saat Kehamilan dengan Preeklampsia. eBiomedik. 2013;1(1):305–11.
12. Motedayen M, Rafiei M, Rezaei Tavirani M, Sayehmiri K, Dousti M. The relationship between body mass index and preeclampsia: A systematic review and meta-analysis. Int J Reprod Biomed. 2019 Jul 25;
13. Bastani P, Hamdi K, Najafi H. Risk Factors for Preeclampsia in Multigravida Women. Research Journal of Biological Sciences. 2008;3(1):148–53.
14. Antsaklis P, Fasoulakis Z, Theodora M, Diakosavvas M, Kontomanolis EN. Association of Low Maternal Pregnancy-associated Plasma Protein A with Adverse Perinatal Outcome. Cureus. 2019;11(6).
15. Muravská A, Germanová A, Jáchymová M, Hájek Z, Švarcová J, Zima T, et al. Association of pregnancy-associated plasma protein A polymorphism with preeclampsia — A pilot study. Clin Biochem. 2011 Dec;44(17–18):1380–4.
16. Lai J, Pinas A, Poon LCY, Agathokleous M, Nicolaides KH. Maternal Serum Placental Growth Factor, Pregnancy-Associated Plasma Protein-A and Free β-Human Chorionic Gonadotrophin at 30-33 Weeks in the Prediction of Pre-Eclampsia. Fetal Diagn Ther. 2013;33(3):164–72.
17. Uriel M, Romero Infante XC, Rincón Franco S, Ibáñez Pinilla EA, Rojas NA. Higher PAPP-A Values in Pregnant Women Complicated with Preeclampsia Than with Gestational Hypertension. Reproductive Sciences. 2023 Mar 14;
18. Mbah A, Kornosky J, Kristensen S, August E, Alio A, Marty P, et al. Super-obesity and risk for early and late pre-eclampsia. BJOG. 2010 Jul;117(8):997–1004.
19. Shao Y, Qiu J, Huang H, Mao B, Dai W, He X, et al. Pre-pregnancy BMI, gestational weight gain and risk of preeclampsia: a birth cohort study in Lanzhou, China. BMC Pregnancy Childbirth. 2017 Dec 1;17(1):400.
Additional Files
Published
How to Cite
Issue
Section
Citation Check
License
Copyright (c) 2024 Ragam Pesona Simangunsong, Herman Kristanto, Mirza Iskandar, Syarief Thaufik, Besari Adi Pramono, Arufiadi Anityo Mochtar (Author)
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Copyrights Notice
Copyrights:
Researchers publishing manuscrips at Medica Hospitalis: Journal of Clinical Medicine agree with regulations as follow:
Copyrights of each article belong to researchers, and it is likewise the patent rights
Researchers admit that Medica Hospitalia: Journal of Clinical Medicine has the right of first publication
Researchers may submit manuscripts separately, manage non exclusive distribution of published manuscripts into other versions (such as: being sent to researchers’ institutional repository, publication in the books, etc), admitting that manuscripts have been firstly published at Medica Hospitalia: Journal of Clinical Medicine
License:
Medica Hospitalia: Journal of Clinical Medicine is disseminated based on provisions of Creative Common Attribution-Share Alike 4.0 Internasional It allows individuals to duplicate and disseminate manuscripts in any formats, to alter, compose and make derivatives of manuscripts for any purpose. You are not allowed to use manuscripts for commercial purposes. You should properly acknowledge, reference links, and state that alterations have been made. You can do so in proper ways, but it does not hint that the licensors support you or your usage.
