孕早期母体PAPP-A水平与早产关系分析

Relationship between maternal PAPP-A level in the first trimester and premature delivery

目的:探讨孕早期孕妇血清中妊娠相关蛋白A(PAPP-A)与早产的关系。方法:收集2019年1—12月在张家港市第一人民医院分娩的204例早产妇,分为早期早产组(28~33周)和晚期早产组(34~36周),随机抽取574例足月产为足月对照组,回顾性调查孕早期(11~13^(+6)周)血清中PAPP-A中位数倍数(MoM)值及孕前BMI、年龄、文化程度等一般临床资料,采用Logistic回归分析PAPP-A与早产的关系。结果:(1)早期早产组PAPP-A MoM值明显低于晚期早产组和足月对照组,差异有统计学意义(P<0.05),晚期早产组PAPP-A MoM值与足月对照组差异无统计学意义(P>0.05);(2)Logistic回归分析显示PAPP-A MoM值低,发生早期早产风险升高,孕妇文化程度低、多次流产、胎膜早破、妊娠期糖尿病、妊娠期高血压疾病和胎位异常是早期早产的危险因素。结论:PAPP-A MoM值是早期早产独立的危险因素,在孕期保健中,可以结合孕妇孕期情况尽早干预,改善母婴预后。

Objective:To explore the relationship between serum pregnancy-associated plasma protein-A(PAPPA)in the first trimester and premature delivery.Methods:204 cases of premature delivery who gave birth in Zhangjiagang First People’s Hospital from January to December 2019 were recruited and were divided into early premature delivery group(gestational weeks 28-33)and late premature delivery group(gestational weeks 34-36);574 subjects of full-term birth were enrolled as control group.The serum PAPP-A MoM value in the first trimester(gestational weeks 11-13^(+6)),as well as the general clinical data of pregnant women including pre-pregnancy BMI,age,and education level,were collected.The relationship between serum PAPP-A and premature delivery was analyzed using Logistic regression.Results:(1)PAPP-A MoM value was significantly lower in the early premature delivery group than that in the late premature delivery group and the full-term birth group(P<0.05),and showed no statistically significant difference between the late premature delivery group and the full-term birth group(P>0.05).(2)Logistic regression showed that low PAPP-A MoM value was associated with higher risk of early premature delivery;low education level of pregnant woman,multiple abortions,premature rupture of membranes,gestational diabetes mellitus,gestational hypertension,and abnormal fetal position were all risk factors for early premature delivery.Conclusion:The serum PAPP-A Mo M value presents an independent risk factor for early premature delivery;in pregnancy care,early intervention based on the condition of the pregnant woman could improve outcome for both mothers and babies.