Altered PAPP-A and Placental Thickness in Pre-Eclampsia and Intrauterine Growth Restriction: A Pilot Study.

Pre-eclampsia (PE) is a multisystem disorder that affects 5-6% of all pregnancies.

Background

PE and intrauterine growth restriction (IUGR) are two major causes of maternal mortality and morbidity. We hypothesize that first-trimester pregnancy-associated plasma protein-A (PAPP-A) levels are useful as a prognostic marker. The aim of our study is to identify the role of PAPP-A and placental thickness in pre-eclampsia screening, as well as its value in IUGR prognosis.

Methods

This prospective study was conducted at the Al. Simionescu County Hospital Hunedoara, Romania, Department of Obstetrics and Gynecology, from 12 May to 31 October 2025. A total of 102 patients were included in our study; of these, 28 patients (28.56%) developed pre-eclampsia, and 13 (13.26%) developed IUGR associated with PE.

Results

The demographic data showed no differences between groups, except for BMI, smoking habits, and diabetes mellitus. Of the 28 cases of pre-eclampsia, 14.28% had PE detected by 28 weeks, 46.4% had PE associated with IUGR by 33/34 weeks, and 39.32% had PE detected at term/delivery. The highest detection rate was at 33/34 weeks, when the association with IUGR was obvious. For PE with IUGR at 34 weeks, the area under the curve (AUC) was 0.909, with a p-value < 0.001. The PAPP-A cut-off was 0.65 MoM, indicating high sensitivity and specificity for predicting PE. Placental thickness was also assessed, resulting in statistically significant differences between groups. The PAPP-A level shows strong predictive value for PE, especially when associated with placental thickness.

Conclusions

This study demonstrates a clear correlation between low PAPP-A in the first trimester of pregnancy, placental thickness in the second trimester, and the subsequent development of pre-eclampsia and its association with IUGR.