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)

Objective The purpose of this study was to determine whether maternal serum levels of pregnancy-associated plasma protein A, free-beta subunit human chorionic gonadotropin, or nuchal translucency size are associated with obstetric complications. Study design Data were obtained from the First and Second Trimester Evaluation of Risk trial. Pregnancy-associated plasma protein A and free-beta subunit human chorionic gonadotropin levels were analyzed, and nuchal translucency was measured between 10 weeks 3 days and 13 weeks 6 days of gestation in 34,271 pregnancies. Results Women with pregnancy-associated plasma protein A of ≤5th percentile were significantly more likely to experience spontaneous fetal loss at ≤24 weeks of gestation, low birth weight, preeclampsia, gestational hypertension, preterm birth (P< .001) and stillbirth, preterm premature rupture of membranes, and placental abruption (P< .02). Nuchal translucency at ≥99th percentile and free-beta subunit human chorionic gonadotropin at ≤1st percentile were associated with an increased risk of spontaneous loss at ≤24 weeks of gestation (adjusted odds ratios, 3.90, 3.62, respectively; P< .001). Conclusion Low pregnancy-associated plasma protein A levels in the first trimester were associated strongly with a number of adverse pregnancy outcomes. Low free-beta subunit human chorionic gonadotropin levels and large nuchal translucency were both associated with early fetal loss.