Document Detail

Pregnancies conceived using assisted reproductive technologies (ART) have low levels of pregnancy-associated plasma protein-A (PAPP-A) leading to a high rate of false-positive results in first trimester screening for Down syndrome.
MedLine Citation:
PMID:  19246467     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: First trimester screening (FTS) for Down syndrome combines measurement of nuchal translucency, free beta-human chorionic gonadotrophin and pregnancy-associated plasma protein-A (PAPP-A). The aim of this study was to undertake a detailed analysis of FTS results in singleton pregnancies conceived using assisted reproductive technologies (ART) and non-ART pregnancies. METHODS: A record linkage study compared outcomes in 1739 ART-conceived and 50 253 naturally conceived pregnancies. RESULTS: Overall, significantly lower PAPP-A levels were detected in ART pregnancies (0.83 multiples of median, MoM) than in controls (1.00 MoM) (t-test P < 0.001). This difference remained after excluding complicated pregnancies. Analysis of factors affecting PAPP-A levels suggested fresh compared with frozen embryo transfers and use of artificial cycles compared with natural cycles for frozen transfers were associated with lower values. The adjusted odds ratio (AdjOR) for receiving a false-positive result was 1.71 (95% CI 1.44-2.04; P < 0.001) for ART pregnancies compared with non-ART pregnancies, and this leads to a higher AdjOR (1.24, 95% CI 1.03-1.49; P = 0.02) for having a chorionic villous sampling (CVS) or amniocentesis. CONCLUSIONS: ART pregnancies have reduced FTS PAPP-A levels leading to an increased likelihood of receiving a false-positive result and having a CVS/amniocentesis. Lower PAPP-A may reflect impairment of early implantation with some forms of ART.
D J Amor; J X Xu; J L Halliday; I Francis; D L Healy; S Breheny; H W G Baker; A M Jaques
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-02-26
Journal Detail:
Title:  Human reproduction (Oxford, England)     Volume:  24     ISSN:  1460-2350     ISO Abbreviation:  Hum. Reprod.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-05-19     Completed Date:  2009-08-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701199     Medline TA:  Hum Reprod     Country:  England    
Other Details:
Languages:  eng     Pagination:  1330-8     Citation Subset:  IM    
Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.
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MeSH Terms
Biological Markers / blood*
Chorionic Gonadotropin, beta Subunit, Human / metabolism
Chorionic Villi Sampling
Down Syndrome / diagnosis*,  epidemiology
False Positive Reactions
Heart / embryology
Middle Aged
Nuchal Translucency Measurement
Pregnancy Trimester, First / blood
Pregnancy-Associated Plasma Protein-A / metabolism*
Prenatal Diagnosis / standards*
Reproductive Techniques, Assisted*
Risk Factors
Young Adult
Reg. No./Substance:
0/Biological Markers; 0/Chorionic Gonadotropin, beta Subunit, Human; EC 3.4.24.-/Pregnancy-Associated Plasma Protein-A

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