Efficacy of combined screening tests used in the first trimester in predicting adverse pregnancy outcomes

Abstract

Aim: This study aims to evaluate the predictive efficacy of first-trimester screening test parameters, including free β-human chorionic gonadotropin (β-hCG), pregnancy-associated plasma protein-A (PAPP-A), and nuchal translucency (NT), in identifying adverse pregnancy outcomes such as gestational diabetes mellitus (GDM), fetal growth restriction (FGR), preeclampsia, preterm birth, and placenta accreta spectrum (PAS) or placenta previa (PP).

Materials and Methods: A retrospective cohort analysis involved 776 pregnant women who underwent first-trimester screening tests between January 2023 and August 2024. Patients were categorized into two groups based on the presence or absence of pregnancy complications. 

Results: Pregnancy complications were identified in 36.6% of participants, with GDM, FGR, and preterm birth being the most common. PAPP-A levels were significantly reduced in pregnancies complicated by GDM (p=0.033), FGR (p=0.048), and preeclampsia (p=0.001). NT values were notably elevated in GDM cases (p=0.016). Free β-hCG levels were significantly higher in preterm birth (p=0.040) and PAS/PP cases (p=0.016). ROC analysis revealed notable predictive thresholds: PAPP-A <0.64 for preeclampsia (AUC=0.760, p=0.001) and β-hCG >1.01 for PAS/PP (AUC=0.814, p=0.016).

Conclusion: First-trimester screening test parameters, particularly PAPP-A, NT, and β-hCG, exhibit potential in predicting adverse pregnancy outcomes. Reduced PAPP-A levels correlate with GDM, FGR, and preeclampsia, while elevated NT and β-hCG levels are associated with GDM and PAS/PP, respectively. Although these markers demonstrate promise, larger-scale prospective studies are needed to confirm their clinical utility and reliability in predicting pregnancy complications.