ASSESSING THE PREDICTIVE VALUE OF PLACENTAL PAPP-A LEVELS IN HIGH-RISK PREGNANCIES: A PROSPECTIVE COHORT STUDY ON PLACENTA PREVIA AND PREVIOUS CESAREAN SECTIONS

Objective: We tried to study the predictive value of first-trimester serum Pregnancy-Associated Plasma Protein-A (PAPP-A) levels in detecting high-risk pregnancies for Placenta Previa and Previous Cesarean Sections. Methods: This was a prospective one center cohort study conducted on 225 pregnant women recruited from the one hospitals in Iraq for which all had PAS risk factors, including smokers or had taken previous c/s. According to their PAPP-A multiples of the median (MoM) levels, participants were divided into 3 groups: Low; Normal; and High PAPP-A. Primary end-point was the occurrence of PAS confirmed by histopathologic examination and/or clinical diagnosis. The relationship between PAPP-A levels, together with smoking and previous cesarean sections, as well as the risk of PAS were evaluated using univariate, multivariate logistic regression analyses. Results: A significant link was detected between elevated PAPP-A levels and an increased risk of PAS. Among them, patients in the High PAPP-A group experienced a significantly higher prevalence of PAS compared to those with Low and Normal PAPPA (Adjusted OR: ٣٫٥١; ٩٥٪ CI: ١٫٧٧–٦٫٩٤; p =٠٠٠٠٣). The smoking (Adjusted OR: ١٠٫١٧; ٩٥٪CI:١٫٩٩–٥٤٫١٢, p=) and a history of previous cesareans with PAS were significantly associated among others. Now the study and found association between maternal BMI with PAS in Iraq. Conclusion: The results of the study propose that high first‐trimester PAPP− A may be an important predictor for PAS in some high-risk pregnancies. This study illustrates a strategy for introducing PAPP-A screening to routine early prenatal care as an additional way of better discerning risk and management amongst pregnancies at high-risk for PAS. These results reinforce the need for more investigation on pathways from PAPP-A levels to abnormal placentation, and studies to improve practice-based risk assessment models.