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Study characteristics, quality and results extracted. Meta\u2010analysis of odds ratios (ORs), and likelihood ratios (LRs) and 95% confidence intervals (CI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010two studies including 175\u2009240 pregnancies. PAPP\u2010A &lt;5th centile had a moderate association with: birth weight &lt;10th centile OR 2.08 (95% CI 1.89\u20132.29), &lt;5th centile OR 2.83 (95% CI 2.52\u20133.18); pre\u2010eclampsia OR 1.94 (95% CI 1.63\u20132.30), preterm birth &lt;37\u2009weeks OR 2.09 (95% CI 1.87\u20132.33), and composite adverse outcome OR 3.31 (95% CI 1.80\u20135.11). The predictive ability was poor: Birth weight &lt;10th centile LR\u2009+\u2009ve 1.96 (95% CI 1.58\u20132.43), LR\u2010ve 0.93 (95% CI 0.89\u20130.98); birth weight &lt;5th centile LR\u2009+\u2009ve 2.65 (95% CI 2.35\u20132.99), LR\u2010ve 0.85 (95% CI 0.74\u20130.98); PTB &lt;37\u2009weeks LR\u2009+\u2009ve 1.84 (95% CI 1.41\u20132.39), LR\u2010ve 0.92 (95% CI 0.87\u20130.98).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>First trimester low maternal serum PAPP\u2010A is associated with adverse pregnancy outcome, but predictive values are poor. Further work should address PAPP\u2010A as a continuous variable in combination with other prognostic markers as a prediction model. \u00a9 2016 John Wiley &amp; Sons, Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pd.5001","type":"journal-article","created":{"date-parts":[[2016,12,25]],"date-time":"2016-12-25T05:04:17Z","timestamp":1482642257000},"page":"253-265","source":"Crossref","is-referenced-by-count":114,"title":["Association of serum <scp>PAPP\u2010A<\/scp> levels in first trimester with small for gestational age and adverse pregnancy outcomes: systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1247-429X","authenticated-orcid":false,"given":"R. 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