The little room has a half finished
look, the tails of the stencilled rabbits not yet painted
in. The would-be nursery is a testament to 31-year-old
Maureen Clare's abortive hopes, dashed when her child
was stillborn. Maureen doesn't know why the stillbirth
happened. However, research in the November 10 issue of
the Journal of the American Medical Association
sheds new light on this shadowy issue with the discovery
that a blood test performed in the first trimester may
flag women at higher risk of stillbirth.
The researchers examined medical
records and databases of births and stillbirths of nearly
8,000 Scottish women from 1998 to 2000. All had blood
samples taken within the first 10 weeks of conception.
The women were divided into five groups based on their
levels of pregnancy-associated plasma protein A (PAPP-A).
In the group of 400 women with
the lowest PAPP-A level, eight had stillbirths (0.02%).
Of all the remaining 7,534 women, only 17 (0.002%) had
stillbirths. The incidence rate of stillbirth was a
shocking 13.4 per 10,000 women for the group with the
lowest PAPP-A while this rate for the rest of the women
was 1.4 per 10,000.
Analysis of the data to determine
the cause of the stillbirths revealed that a depressed
PAPP-A level was strongly associated with abnormal growth
of the placenta or a rupture of placental blood vessels.
Indeed, women with the lowest PAPP-A level were 40 times
more at risk of stillbirth due to placental dysfunction.
PAPP-A levels stood alone as a
risk factor. The levels of the placental protein were
not associated with a mother's age, ethnicity, weight,
height, marital status or other factors. The researchers
concluded that placental dysfunction occurring early
in pregnancy, evident as lower levels of PAPP-A, may
be a prelude to disaster later on.
"People have tended to look late
in pregnancy for the determinants of stillbirth," commented
lead researcher Dr Gordon CS Smith of UK's Cambridge
University. "But to see that a test in the first few
weeks of pregnancy can predict stillbirth really suggests
that whatever is going wrong is occurring at a very
early stage."
Scrutiny of the protein level during
the first trimester may help identify pregnant women
who need close monitoring through their pregnancy. "In
some cases, it could lead to an earlier induction of
labour," said Dr Smith.
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