Objective To assess the association between pre-eclampsia (PE) and levels of PAPP-A and UtaPI in first trimester.

Methods Retrospective study of singleton pregnancies attending for first trimester screening for trisomy 21. PAPP-A was expressed as multiples of the median (MOM). We defined low PAPP-A as levels below 5^th percentile and high PI as levels above the 95^th percentile. PE was defined according the ISSHP criteria. PE requiring delivery before 34 weeks was designated as early, and after 34 weeks as late. UtaPI was preformed at 11-14 weeks.

Results PAPP-A levels were available for 12729 women and values for mean UtaPI for 8020. In the population, 302 (2.43%) women developed PE, including 35 (0.5%) early PE and 267 (2.1%) late PE. The median maternal serum PAPP-A MOM was significantly lower in women with PE, and early PE (1.10 and 0.72 MOM, respectively) than normotensive women (1.14 MOM, p < 0.01). There was a significant association between low PAPPA and development of PE (OR: 1.9, 95% CI: 1.3 to 2.8) and with early PE (OR: 6.6, 95% CI:3.1 to 14.3), but not with late PE. Mean UtaPI was higher in women who developed PE, early PE and late PE.

Conclusion There is a significant association between low PAPP-A, all preeclampsia and early pre-eclampsia. High UtaPI in the first trimester is associated with all, early and late pre-eclampsia.