Low PAPP-A in the first trimester is associated with reduced fetal growth rate prior to gestational week 20

Objective To evaluate the association between maternal pregnancy‐associated plasma protein‐A (PAPP‐A) and fetal growth from the first to the second trimester. Methods A prospective cohort study including 8347 pregnant women attending prenatal care at Aarhus University Hospital were conducted. PAPP‐A was measured during 8 to 14 gestational weeks. Fetal growth between the two scans in the first and second trimesters was estimated by (GA20− GA12)/Dayscalendar, where GA12 reflects gestational age in days calculated from crown‐rump length at a 12‐week scan, GA20 reflects gestational age in days calculated from biparietal diameter at a 20‐week scan, and Dayscalendar reflects the number of calendar days between the two scans. Results Fetal growth rate from the first to the second trimester was correlated with PAPP‐A, with a regression coefficient of 0.009 (95% CI, 0.007–0.012, P < 0.001). PAPP‐A below 0.30 MoM was associated with a fetal growth rate below the tenth centile, with an adjusted OR of 2.05 (95% CI, 1.24–3.38). Conclusion Low levels of PAPP‐A are associated not only with low birth weight at term but also with slower fetal growth prior to 20 weeks of gestation. Copyright © 2010 John Wiley & Sons, Ltd.