Diagnostic Value of Pregnancy-Associated Plasma Protein A in Women with Intrauterine Fetal Growth Restriction

Document Type : Original Article

Authors

1 Assistant Professor, Department of Obstetrics and Gynecology, Clinical Research Center of Imam Reza Hospital, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.

2 Associate Professor, Department of Community Medicine, Social Development and Health Promotion Research Center, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.

3 General Physician, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.

10.22038/ijogi.2025.87532.6417

Abstract

Introduction: Intrauterine growth restriction (IUGR) is associated with increased perinatal morbidity and mortality as well as long-term growth and health problems. This study was conducted with aim to investigate the diagnostic value of pregnancy-associated plasma protein A (PAPP-A) in assessing the risk of IUGR.
Methods: This retrospective case-control study was conducted from 2020 to 2023 on 80 singleton pregnancies with IUGR as the case group and 80 uncomplicated pregnancies as the control group. Serum PAPP-A and β-hCG levels were measured in the first trimester of gestation (weeks 11–13) and expressed as multiples of the median (MoM). Uterine artery Doppler was assessed by mean pulsatility index (PI). Logistic regression and receiver operating characteristic (ROC) curves were used to determine odds ratio (OR), sensitivity, and specificity. Data analysis was performed using SPSS statistical software (version 27) and Chi-square, Fisher's exact and independent t-tests. P<0.05 was considered significant.
Results: The mean PAPA-A level in women with IUGR infants (0.83±0.37) was significantly lower than that in the control group (1.17±0.95) (P < 0.002) and the mean uterine artery PI was higher (1.85 vs. 1.42, P < 0.001). High PI (>95th percentile) predicted IUGR with an odds ratio of 5.5 (95% CI: 3.1-9.8) and PAPA-A was 0.52 (95% CI: 0.34-0.84).
Conclusion: In first trimester screening, in addition to assessing the risk of Down syndrome, serum PAPA-A levels and uterine artery Doppler can be used to assess the risk of IUGR.

Keywords

Main Subjects

References

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The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 28, Issue 8
October 2025
Pages 10-19

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