Can we improve the outcome of pregnancies with low serum PAPP-A in the first trimester?

Abstract

Low birth weight is associated with various complications, and recent findings rely on the fact that micronized progesterone supplementation leads to improved birth weight, which is crucial for addressing concerns related to fetal growth.

Objective

This study aimed to assess the impact of micronized progesterone (VMP4) supplementation on pregnancies with low serum pregnancy-associated plasma protein-A (PAPP-A) multiples of the median (MoM) values during first-trimester screening.

Methods

Out of 8933 patients evaluated, 116 pregnant women with low PAPP-A concentrations in their blood and no fetal chromosomal anomalies (CAs) were included. Three groups were formed: group 1 received VMP4 from 11 to 16 weeks (29 women, 25%), group 2 received VMP4 from 11 to 36 weeks (25 women, 21.5%), and group 3 (62 women, 53.5%) served as controls without receiving progesterone.

Results

Results indicated that group 3 had higher rates of complications, including miscarriages (16.37%), preterm delivery (17.8%), and fetal developmental abnormalities (19.4%). Birthweight variations were elevated in pregnancies without progesterone, contrasting with lower variations in VMP4 groups. Group 2, receiving VMP4 until 36 weeks, reported the lowest incidence of abortion and preterm birth (PB), along with the highest mean birth weight.

Conclusions

The conclusion suggests that 200 mg per day of VMP4 up to 36 weeks of supplementation led to fewer placental-related complications in women with very low PAPP-A at first-trimester screening (0.399 MoM). By reporting lower rates of miscarriages, PBs, and fetal developmental abnormalities in the micronized progesterone-treated groups, the study suggests a potential reduction in complications.

Graphical Abstract

Keywords:

• Pregnancy
• micronized vaginal progesterone
• PAPP-A
• first-trimester screening
• preterm birth

Ethical approval

The Ethical Committee approved the study protocol of Leningrad Region Hospital, Saint Petersburg, Russian Federation (No. 114; 14 November 2019). All participants provided written informed consent to participate in the study.

Author contributions

GCDR and VT conceptualized the article. AF, IG, and VT wrote the original draft. AF, IG, VT, and AM performed the literature search and selected bibliographic sources, AF, IG, and VT performed all clinical results. GCDR, VT, BAS, and AM performed review and editing. All authors read and agreed to the final version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data available upon request.

Additional information

Funding

This research received no external funding.