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Prediction of pre-eclampsia with PAPP-A and mean uterine artery pulsatility index (UTAPI) in first trimester

Objective To assess the association between pre-eclampsia (PE) and levels of PAPP-A and UtaPI in first trimester. Methods Retrospective study of singleton pregnancies attending for first trimester screening for trisomy 21. PAPP-A was expressed as multiples of the median (MOM). We defined low PAPP-A as levels below 5th percentile and high PI as levels above the 95th percentile. PE was defined according the ISSHP criteria. PE requiring delivery before 34 weeks was designated as early, and after 34 weeks as late. UtaPI was preformed at 11-14 weeks. Results PAPP-A levels were available for 12729 women and values for mean UtaPI for 8020. In the population, 302 (2.43%) women developed PE, including 35 (0.5%) early PE and 267 (2.1%) late PE. The median maternal serum PAPP-A MOM was significantly lower in women with PE, and early PE (1.10 and 0.72 MOM, respectively) than normotensive women (1.14 MOM, p < 0.01). There was a significant association between low PAPPA and development of PE (OR: 1.9, 95% CI: 1.3 to 2.8) and with early PE (OR: 6.6, 95% CI:3.1 to 14.3), but not with late PE. Mean UtaPI was higher in women who developed PE, early PE and late PE. Conclusion There is a significant association between low PAPP-A, all preeclampsia and early pre-eclampsia. High UtaPI in the first trimester is associated with all, early and late pre-eclampsia.