Volume 18, Issue 6 (June 2020)                   IJRM 2020, 18(6): 395-406 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Hadizadeh-Talasaz Z, Taghipour A, Mosavi-Vahed S H, Latifnejad Roudsari R. Predictive value of pregnancy-associated plasma protein-A in relation to fetal loss: A systematic review and meta-analysis. IJRM 2020; 18 (6) :395-406
URL: http://ijrm.ir/article-1-1461-en.html
Predictive value of pregnancy-associated plasma protein-A in relation to fetal loss: A systematic review and meta-analysis
Zahra Hadizadeh-Talasaz1 , Ali Taghipour * 2, Seyede Hoora Mosavi-Vahed3 , Robab Latifnejad Roudsari4
1- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.
2- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Department of Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran. , Taghipoura@mums.ac.ir
3- Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
4- Nursing and Midwifery Care Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran. Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
Abstract:   (2268 Views)

Background: For a woman with bleeding and threatened abortion, ultrasound scan is done to confirm the viability of the fetus; however, 10-15% of the embryos are eventually aborted. Distinguishing between women with good and poor prognosis can be a helpful approach.
Objective: This study aimed to review the predictive value of Pregnancy-associated Plasma Protein A (PAPP-A) in relation to the diagnosis of fetal loss.
Materials and Methods: The articles published in multiple databases including Web of Science, PubMed, MEDLINE, Scopus, and Persian databases such as ISC, Magiran, and IranMedx were searched for articles published until May 2019. MeSH terms was used for searching the databases including fetal loss OR pregnancy loss OR abortion OR miscarriage with the following word using AND; Pregnancy-Associated Plasma Protein-A OR PAPP-A. Two reviewers extracted data and recorded them in a pre-defined form and assessed the quality of articles using the Newcastle-Ottawa tool. Meta-analysis was done using the Comprehensive Meta-Analysis/2.0 software and MetaDisc.
Results: A total number of 16 studies were eligible for the qualitative data synthesis, out of which 8 studies were included in the meta-analysis. All studies had high and medium quality. The forest plot analysis showed a sensitivity of 57% (95% CI: 53-63%), a specificity of 83% (95% CI: 80-85%), a positive likelihood ratio of 3.52 (95% CI: 2.44-5.07), a negative likelihood ratio of 0.54 (95% CI: 0.37-0.79), and a diagnostic odds ratio of 6.95 (95% CI: 3.58-13.50).
Conclusion: PAPP-A cannot be recommended on a routine basis for predicting fetal loss and still further research with a combination of other biomarkers is required.

Keywords: Pregnancy-associated plasma protein-A, Fetal loss, Pregnancy, Systematic review.
Full-Text [PDF 835 kb]   (1302 Downloads) |   |   Full-Text (HTML)  (443 Views)  
Type of Study: Review Article | Subject: Reproductive Biology
References
1. Valbuena H, Ramis J, Sagala J, Sanchez MA, Aulesa C. First-trimester screening biochemical markers (free beta-subunit human chorionic gonadotropin, pregnancy-associated plasma protein-A) and risk of early fetal loss. J Obstet Gynaecol Res 2015; 41: 69-76.
2. Ruge S, Pedersen JF, Sorensen S, Lange AP. Can pregnancy-associated plasma protein A (PAPP-A) predict the outcome of pregnancy in women with threatened abortion and confirmed fetal viability? Acta Obstet Gynecol Scand 1990; 69: 589-595.
3. Lin TM, Galbert SP, Kiefer D, Spellacy WN, Gall S. Characterization of four human pregnancy-associated plasma proteins. Am J Obstet Gynecol 1974; 118: 223-236.
4. Zhong Y, Zhu F, Ding Y. Serum screening in first trimester to predict pre-eclampsia, small for gestational age and preterm delivery: systematic review and meta-analysis. BMC Pregnancy Childbirth 2015; 15: 191-201.
5. Smith GC, Stenhouse EJ, Crossley JA, Aitken DA, Cameron AD, Connor JM. Early pregnancy levels of pregnancy-associated plasma protein a and the risk of intrauterine growth restriction, premature birth, preeclampsia, and stillbirth. J Clin Endocrinol Metab 2002; 87: 1762-1767.
6. Gupta S, Goyal M, Verma D, Sharma A, Bharadwaj N, Kabra M, et al. Adverse pregnancy outcome in patients with low pregnancy-associated plasma protein-A: The Indian Experience. J Obstet Gynaecol Res 2015; 41: 1003-1008.
7. Talasaz ZH, Sadeghi R, Askari F, Dadgar S, Vatanchi A. First trimesters pregnancy-associated plasma protein-a levels value to predict gestational diabetes mellitus: A systematic review and meta-analysis of the literature. Taiwan J Obstet Gynecol 2018; 57: 181-189.
8. Hanita O, Roslina O, Azlin MI. Maternal level of pregnancy-associated plasma protein A as a predictor of pregnancy failure in threatened abortion. Malays J Pathol 2012; 34: 145-151
9. Goetzl L, Krantz D, Simpson JL, Silver RK, Zachary JM, Pergament E, et al. Pregnancy-associated plasma protein A, free beta-hCG, nuchal translucency, and risk of pregnancy loss. Obstet Gynecol 2004; 104: 30-36.
10. Kagan KO, Maier V, Sonek J, Abele H, Lüthgens K, Schmid M, et al. False-positive rate in first-trimester screening based on ultrasound and cell-free DNA versus first-trimester combined screening with additional ultrasound markers. Fetal Diagn Ther 2019; 45: 317-324.
11. Dugoff L, Hobbins JC, Malone FD, Porter TF, Luthy D, Comstock CH, et al. First-trimester maternal serum PAPP-A and free-beta subunit human chorionic gonadotropin concentrations and nuchal translucency are associated with obstetric complications: a population-based screening study (the FASTER Trial). Am J Obstet Gynecol 2004; 191: 1446-1451.
12. Dugoff L, Cuckle HS, Hobbins JC, Malone FD, Belfort MA, Nyberg DA, et al. Prediction of patient-specific risk for fetal loss using maternal characteristics and first- and second-trimester maternal serum Down syndrome markers. Am J Obstet Gynecol 2008; 199: 290. e1-6.
13. Suzuki K, Sata F, Yamada H, Saijo Y, Tsuruga N, Minakami H, et al. Pregnancy-associated plasma protein-A polymorphism and the risk of recurrent pregnancy loss. J Reprod Immunol 2006; 70: 99-108.
14. Wells GA, Shea B, O’connell D, Peterson J, Welch V, Losos M, et al. The newcastle-ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa, Hospital Research Institute; 2011.
15. Peterson J, Welch V, Losos M, Tugwell P. The newcastle-ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Liverpool, UK. 2011.
16. Bischof P, Mignot TM, Cédard L. Are pregnancy-associated plasma protein-A (PAPP-A) and CA 125 measurements after IVF-ET possible predictors of early pregnancy wastage? Hum Reprod 1989; 4: 843-847.
17. Dumps P, Meisser A, Pons D, Morales MA, Anguenot JL, Campana A, et al. Accuracy of single measurements of pregnancy-associated plasma protein-A, human chorionic gonadotropin and progesterone in the diagnosis of early pregnancy failure. Eur J Obstet Gynecol Reprod Biol 2002; 100: 174-180.
18. Van Ravenswaaij R, Tesselaar‐Van der Goot M, de Wolf S, van Leeuwen‐Spruijt M, Visser GH, Schielen PC. First‐trimester serum PAPP‐A and fβ‐hCG concentrations and other maternal characteristics to establish logistic regression‐based predictive rules for adverse pregnancy outcome. Prenat Diagn 2011; 31: 50-57.
19. Karim JN, Sau A. Low pregnancy associated plasma protein-A in the 1st trimester: is it a predictor of poor perinatal outcome? J Obstet Gynaecol 2013; 33: 351-354.
20. Bersinger NA, Keller PJ, Naiem A, Fischer M, Schneider H. Pregnancy-specific and pregnancy-associated proteins in threatened abortion. Gynecol Endocrinol 1987; 1: 379-384.
21. Spencer K, Cowans NJ, Avgidou K, Nicolaides KH. First‐trimester ultrasound and biochemical markers of aneuploidy and the prediction of impending fetal death. Ultrasound Obstet Gynecol 2006; 28: 637-643.
22. Spencer CA, Allen VM, Flowerdew G, Dooley K, Dodds L. Low levels of maternal serum PAPP-A in early pregnancy and the risk of adverse outcomes. Prenat Diagn 2008; 28: 1029-1036.
23. Masson GM, Anthony F, Wilson MS. Value of Schwangerschaftsprotein 1 (SP1) and pregnancy‐associated plasma protein‐A (PAPP‐A) in the clinical management of threatened abortion. Br J Obstet Gynecol 1983; 90: 146-149.
24. Ong CY, Liao AW, Spencer K, Munim S, Nicolaides KH. First trimester maternal serum free beta human chorionic gonadotrophin and pregnancy associated plasma protein A as predictors of pregnancy complications. BJOG 2000; 107: 1265-1270.
25. Kaijomaa M, Rahkonen L, Ulander VM, Hämäläinen E, Alfthan H, Markkanen H, et al. Low maternal pregnancy-associated plasma protein A during the first trimester of pregnancy and pregnancy outcomes. Int J Gynecol Obstet 2017; 136: 76-82.
26. Westergaard JG, Teisner B, Sinosich MJ, Madsen LT, Grudzinskas JG. Does ultrasound examination render biochemical tests obsolete in the prediction of early pregnancy failure? Br J Obstet Gynaecol 1985; 92: 77-83.
27. Barrett SL, Bower C, Hadlow NC. Use of the combined first‐trimester screen result and low PAPP‐A to predict risk of adverse fetal outcomes. Prenat Diagn 2008; 28: 28-35.
28. Ugurlu EN, Ozaksit G, Karaer A, Zulfikaroglu E, Atalay A, Ugur M. The value of vascular endothelial growth factor, pregnancy-associated plasma protein-A, and progesterone for early differentiation of ectopic pregnancies, normal intrauterine pregnancies, and spontaneous miscarriages. Fertil Steril 2009; 91: 1657-1661.
29. Yaron Y, Heifetz S, Ochshorn Y, Lehavi O, Orr-Urtreger A. Decreased first trimester PAPP-A is a predictor of adverse pregnancy outcome. Prenat Diagn 2002; 22: 778-782.
30. Tong S, Marjono B, Mulvey S, Wallace EM. Low levels of pregnancy-associated plasma protein-A in asymptomatic women destined for miscarriage. Fertil Steril 2004; 82: 1468-1470.
31. Campbell J, Klugar M, Ding S, Carmody D, Hakonsen S, Jadotte Y. The systematic review of studies of diagnostic test accuracy. Joanna Briggs Institute Reviewers’ Manual 2015: 1-46.
32. Zhang Y, Zhao Q, Xie Y, Su K, Yang J, Yang L. A correlation analysis between the expression of pregnancy-associated plasma protein A in basal decidual cells and recurrent spontaneous abortion. Exp Ther Med 2013; 6: 485-488.
33. Santolaya-Forgas J, De Leon JA, Cullen Hopkins R, Castracane VD, Kauffman RP, Sifuentes GA. Low pregnancy-associated plasma protein-a at 10(+1) to 14(+6) weeks of gestation and a possible mechanism leading to miscarriage. Fetal Diagn Ther 2004; 19: 456-461.
34. Ghazanfarpour M, Sadeghi R, Latifnejad Roudsari R. The application of soy isoflavones for subjective symptoms and objective signs of vaginal atrophy in menopause: A systematic review of randomized controlled trials, J Obstet Gynaecol 2016; 36: 160-171.
Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Designed & Developed by : Yektaweb