Background & Aim : Intrauterine growth retardation (IUGR) and preterm birth are major determinants of prenatal morbidity and mortality. Standard diagnostic methods like ultrasound are accurate, but they cannot be employed as the screening tools. Lately, it is proposed that there might be an association between IUGR and placental dysfunction so its hormones such as human chorionic gonadotropin-beta subunit (β-HCG) and pregnancy-associated plasma protein-A (PAPP-A) may be good early indicators of unwanted outcomes.

  Methods & Materials : In this cohort study, 1440 normal singleton pregnancies were evaluated in Tabriz Alzahra Teaching Hospital during a 17-month period. free serum β-HCG and PAPP-A levels were measured in 10-14 weeks of pregnancy by ELISA. All the women were followed up by the time of delivery and categorized as with or without IUGR and preterm infant, separately. Serum free β-HCG and PAPP-A levels were compared between the groups.

  Results : The results show that the rates of IUGR and preterm deliveries were 4.4% and 7.2%, respectively. The mean serum levels of free β-HCG and PAPP-A were 2.6±2.7 (range: 0.1-10.8, median: 0.9) MoM 2.4±2.6 (range: 0.1-8.9, median: 0.9) MoM, respectively. The median serum β-HCG was 1 and 0.9 MoM in cases with normal and IUGR pregnancies, respectively (p=0.587). The median serum PAPP-A was significantly lower in patients with IUGR (0.7 vs. 0.9 MoM p=0.044). The optimal cut-off point was 0.79 MoM≥ with sensitivity and specificity 51% and 54%, respectively. The median serum β-HCG was 0.9 MoM in both cases with normal and preterm pregnancies (p=0.236). The median serum PAPP-A was significantly lower in patients with preterm delivery (0.7 vs. 2.4 MoM p=0.44). The optimal cut-off point was 1.85 MoM≥ with sensitivity and specificity 58% and 57%, respectively.

  Conclusion : This study showed that low level of serum PAPP-A, but not β-HCG, during the first trimester is associated with IUGR and preterm delivery.

  SOURCE: URMIA MED J 2013: 23(6): 699 ISSN: 1027-3727