Predictive value of pregnancy-associated plasma protein-A in relation to fetal loss: A systematic review and meta-analysis

Background: For a woman with bleeding and threatened abortion, ultrasound scan is done to confirm the viability of the fetus; however, 10-15% of the embryos are eventually aborted. Distinguishing between women with good and poor prognosis can be a helpful approach. Objective: This study aimed to review the predictive value of Pregnancy-associated Plasma Protein A (PAPP-A) in relation to the diagnosis of fetal loss. Materials and Methods: The articles published in multiple databases including Web of Science, PubMed, MEDLINE, Scopus, and Persian databases such as ISC, Magiran, and IranMedx were searched for articles published until May 2019. MeSH terms was used for searching the databases including fetal loss OR pregnancy loss OR abortion OR miscarriage with the following word using AND; Pregnancy-Associated Plasma ProteinA OR PAPP-A. Two reviewers extracted data and recorded them in a pre-defined form and assessed the quality of articles using the Newcastle-Ottawa tool. Meta-analysis was done using the Comprehensive Meta-Analysis/2.0 software and MetaDisc. Results: A total number of 16 studies were eligible for the qualitative data synthesis, out of which 8 studies were included in the meta-analysis. All studies had high and medium quality. The forest plot analysis showed a sensitivity of 57% (95% CI: 53-63%), a specificity of 83% (95% CI: 80-85%), a positive likelihood ratio of 3.52 (95% CI: 2.44-5.07), a negative likelihood ratio of 0.54 (95% CI: 0.37-0.79), and a diagnostic odds ratio of 6.95 (95% CI: 3.58-13.50). Conclusion: PAPP-A cannot be recommended on a routine basis for predicting fetal loss and still further research with a combination of other biomarkers is required.