First trimester maternal serum free beta human chorionic gonadotrophin andpregnancy associated plasma protein A as predictors of pregnancy complications

Objective To examine the value of first trimester maternal serum free beta human chorionic gonadotrophin (beta hCG) and pregnancy associated plasma pr otein A (PAPP-A) as predictors of pregnancy complications. Design Screening study. Setting Antenatal clinics. Population Singleton pregnancies at 10-14 weeks of gestation. Methods Maternal serum free beta hCG and PAPP-A were measured at 10-14 week s of gestation in 5584 singleton pregnancies. In the 5297 (94.9%) pregnanci es with complete follow up free beta hCG and PAPP-A were compared between t hose with normal outcome and those resulting in miscarriage, spontaneous pr eterm delivery, pregnancy induced hypertension or fetal growth restriction and in those with pre-existing or gestational diabetes. Results Maternal serum PAPP-A increased and beta hCG decreased with gestati on. The multiple of median maternal serum PAPP-A was significantly lower in those pregnancies resulting in miscarriage, pregnancy induced hypertension , growth restriction and in those with pre-existing or gestational diabetes mellitus, but not in those complicated by spontaneous preterm delivery. Th e level was < 10th centile of the reference range in about 20% of the pregn ancies that subsequently resulted in miscarriage or developed pregnancy ind uced hypertension or growth restriction, and in 27% of those that developed gestational diabetes. Maternal serum free beta hCG was < 10th centile of t he reference range in about 15% of the pregnancies that subsequently result ed in miscarriage or developed pregnancy induced hypertension or growth res triction, and in 20% of those that developed gestational diabetes. Conclusion Low maternal serum PAPP-A or beta hCG at 10-14 weeks of gestatio n are associated with subsequent development of pregnancy complications.