NEW SCREENING TESTS IN EARLY PREGANCY: DIAGNOSIS AND PREVENTION

Distinction between fetal growth restriction and small for gestational age newborn weight enhances the prognostic value of low PAPP-A in the first trimester. Conserva V, Signaroldi M, Mastroianni C, Stampalija T, Ghisoni L, Ferrazzi E. Prenat Diagn. 2010 Oct;30(10):1007-9 Objective Low levels of PAPP-A in maternal blood may become an early marker of obstetrical complications. The aim of this article was to sort out those outcomes consistently related to an abnormal placental vascular function and to evaluate their association with low levels of maternal serum PAPP-A in early pregnancy Methods We analyzed retrospectively a database of the first trimester combined screening of an Italian biotech company and investigated the correlation between PAPP-A value < 5th percentile, 0.40 multiples of the median (MoM), and infants with birthweight below the 10th percentile for gestational age (small for gestational age SGA), preterm delivery, GH and PE not associated with intra-uterine growth restriction (IUGR), IUGR isolated with an abnormal umbilical PI or associated with maternal GH-PE, placental abruption and intra-uterine fetal demise (IUFD) after 22 weeks of gestation. Results 1687 patients were analyzed. Overall pregnancy complications were observed in 31.4% of women with low PAPP-A and in 21.1% women with a PAPP-A value >0.4 MoM (P < 0.0001). Severe and early fetal growth restriction (<34 weeks) with abnormal umbilical PI or maternal PE, was significantly associated with low levels of PAPP-A (OR= 10, 95% CI 1.0–97, P = 0.02). No relationship was observed between SGA newborns and low PAPP-A. Weak association was observed in with GH and PE not associated with fetal growth restriction (OR = 1.9, 95% CI 1.1–3, P = 0.01). We also observed a correlation between low PAPP-A and preterm delivery (OR = 1.8, 95% CI 1.1–2,9, P = 0.01). Because of the small number of cases, the OR for placental abruption and IUFD were not calculated Conclusions. Low values of PAPP-A are associated with abnormal obstetrical outcome. Evaluating separately growth-restricted fetuses and small for gestational age fetuses we observe that only growth-restricted fetuses are significantly associated with low values of PAPP-A, whereas SGA newborns, simply defined by their percentile rank, are not predicted by this test in the first trimester of pregnancy.   Recurrence and severity of abnormal pregnancy outcome in patients treated by low-molecular-weight-heparin: a prospective pilot study. Conserva V, Muggiasca M, Arrigoni L, Mantegazza V, Edoardo Rossi E, Ferrazzi E J Matern Fetal Neonatal Med. 2011 Nov 29 Objective This prospective pilot study assesses the recurrence rate and severity of abnormal pregnancy outcome (APO), excluding early pregnancy complications, in pregnant patients, without acquired thrombophilia, treated by prophylactic doses of LMWH, independently from their congenital thrombophilic condition. Methods We recruited a cohort of 128 pregnant patients with previous APO; 100 of whom with APO and intrauterine growth restriction (IUGR), and 28 with maternal APO only. LMWH treatment was started at recruitment. Composite cross over recurrence rate IUGR, gestational hypertension, preeclampsia, HELLP, abruptio was analyzed. The main outcome measure was severe APOs with iatrogenic delivery ≤ 32 weeks of gestation. Results Median gestational age at LMWH treatment was 20 weeks. Severe APO decreased in treated pregnancies from 45% to 4% (R.R.=0.3, CI .95=0.2-0.8). This value was not significantly different in thrombophilic and non thrombophilic patients. When severe and minor complications were analyzed altogether the recurrence rate was 28%. In patients with APO and FGR in the index pregnancy, newborn weights were significantly better in the treated pregnancy: 1090g (1035-1145) vs. 850g (535-1200), P<0,01) Conclusions. Prophylactic regimen of LMWH significantly reduced the recurrence rate of severe composite APO in pregnancies affected in the index pregnancy by APO and fetal growth restriction or SGA newborns. This result was independent from the patients’ inherited thrombophilic conditions.