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PAPP-A, free β-hCG, and early fetal growth identify two pathways leading to preterm delivery

Authors

  • Ida Kirkegaard,

    Corresponding author
    1. Perinatal Epidemiology Research Unit, Aarhus University Hospital, Skejby, Aarhus, Denmark
    2. Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Aarhus, Denmark
    • Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, DK-8200 Aarhus N, Denmark.
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  • Niels Uldbjerg,

    1. Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Aarhus, Denmark
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  • Olav Bjørn Petersen,

    1. Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Aarhus, Denmark
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  • Niels Tørring,

    1. Department of Clinical Biochemistry, Aarhus University Hospital, Skejby, Aarhus, Denmark
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  • Tine Brink Henriksen

    1. Perinatal Epidemiology Research Unit, Aarhus University Hospital, Skejby, Aarhus, Denmark
    2. Department of Pediatrics, Aarhus University Hospital, Skejby, Aarhus, Denmark
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Abstract

Objective

To evaluate early fetal growth and the biomarkers, pregnancy-associated plasma protein A (PAPP-A) and free β-human chorionic gonadotrophin (β-hCG), in relation to preterm delivery.

Methods

A cohort study of 9450 singleton pregnant women who attended the prenatal screening program at Aarhus University Hospital between January 2005 and December 2007, was conducted. PAPP-A and free β-hCG were measured in the first trimester. Early fetal growth was estimated by (GA20− GA12)/Dayscalendar, where GA12 reflects the gestational age in days calculated from the crown-rump length at a 12-week scan, GA20 reflects the gestational age in days calculated from the biparietal diameter at a 20-week scan, and Dayscalendar is the number of calendar days between the two scans.

Results

Low PAPP-A and low free β-hCG were significantly associated with preterm delivery (<37 weeks). The association was even stronger when low PAPP-A and slow early fetal growth were combined, resulting in an adjusted odds ratio of 3.8 (95% CI, 1.6–8.7). Fast early fetal growth, but neither high PAPP-A nor high free β-hCG, was significantly associated with preterm delivery.

Conclusion

Two different biological pathways leading to spontaneous preterm delivery are suggested: fast early fetal growth and the combination of low PAPP-A and slow early fetal growth. Copyright © 2010 John Wiley & Sons, Ltd.

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