Low PAPP-A: the impact of ultrasound to evaluate fetal growth

• Published in: Prenatal diagnosis Vol. 36; no. 2; pp. 112 - 116
• Main Authors: Razavi, Armin S., Chasen, Stephen T.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.02.2016; Wiley Subscription Services, Inc
• Subjects: Adult; Age; Babies; Birth weight; Case-Control Studies; Cohort Studies; Female; Fetal Growth Retardation - blood; Fetal Growth Retardation - diagnostic imaging; Gestational Age; Health risk assessment; Humans; Infant, Newborn; Infant, Small for Gestational Age; Obstetrics; Perinatology; Pregnancy; Pregnancy Outcome - epidemiology; Pregnancy-Associated Plasma Protein-A - metabolism; Premature Birth - epidemiology; Prenatal development; Retrospective Studies; Ultrasonography, Prenatal - utilization
• ISSN: 0197-3851; 1097-0223
• DOI: 10.1002/pd.4723

Objective Our objective was to describe utilization and impact of sonographic growth assessment in pregnancies with low pregnancy‐associated plasma protein‐A (PAPP‐A). Methods Singleton pregnancies with PAPP‐A ≤5th percentile and no other risk factors for fetal growth restriction from January 2011–June 2013 were included. Antepartum and delivery data were obtained by reviewing medical records. Outcomes of pregnancies referred for sonographic growth assessment were compared with those not referred for ultrasound. Fisher's exact test, chi‐square analysis, and Mann–Whitney U were used for statistical comparison. Results Two hundred ninety‐five patients were included. Of 285 pregnancies reaching the third trimester, 77.5% were referred for ultrasound, with the initial scan at a median gestational age of 28 weeks [26–29]. Referral for growth scans was associated with earlier gestational age at delivery and higher rates of delivery for fetal indications. Those who did not undergo growth scans were more likely to deliver a small for gestational age infant at term, 20.7% versus 35.0% (p = 0.04). There was one third‐trimester fetal demise, occurring in a patient who had been undergoing growth scans. Conclusion Growth scans in those with low PAPP‐A were associated with delivery at earlier gestational age, with higher rates of delivery for fetal indications and lower rates of small for gestational age newborns at term. No significant differences in neonatal outcomes were observed. © 2015 John Wiley & Sons, Ltd. What's already known about this topic? The association between low PAPP‐A and intrauterine growth restriction is well described. What does this study add? This study evaluated outcomes in pregnancies with low PAPP‐A by comparing groups referred for growth scans due to low PAPP‐A with those not referred. It reinforces the fact that any benefit to fetal assessment in this population remains unproven.