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The main purpose of our study was to evaluate the association of low PAPP-A levels in twin pregnancies with the subsequent development of perinatal complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>454 twin pregnancies were recruited over a period of 11\u00a0years, and their data were analyzed retrospectively. First trimester assessment at 11\u2009+\u20090\u201313\u2009+\u20096\u00a0weeks included examination of fetal anatomy and markers of aneuploidy and measurement of the maternal serum concentration of PAPP-A and free b-hCG. The outcomes under investigation were preterm rupture of the membranes, preterm delivery earlier than 32, 34, and 36\u00a0weeks, gestational diabetes, hypertensive disease of the pregnancy (including pregnancy induced hypertension and pre-eclampsia), intrauterine demise, birth weight difference of more than 25% among the fetuses and composite adverse pregnancy outcome (which included preterm rupture of the membranes, preterm delivery earlier than\u2009&lt;\u200936\u00a0weeks, hypertensive disease of the pregnancy, and gestational diabetes).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Low first-trimester PAPP-A levels were related with preterm birth, whereas high levels were associated with hypertensive disorders of pregnancy. When using specific cut-off points such as low PAPP-A MoM\u2009&lt;\u20095th and\u2009&lt;\u200910th centile or high PAPP-A MoM\u2009&gt;\u200990th and 95th centile, these associations were not significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Low first-trimester PAPP-A levels were related with preterm birth, whereas high levels were associated with hypertensive disorders of pregnancy. When specific cut-off points were investigated, these associations were not statistically significant.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00404-025-08299-7","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T14:19:15Z","timestamp":1768832355000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Low PAPP-A levels and their association with adverse perinatal outcomes in twin pregnancies"],"prefix":"10.1007","volume":"313","author":[{"given":"Sapantzoglou","family":"Ioakeim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afroditi Maria","family":"Kontopoulou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karasmani","family":"Christina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fasoulakis","family":"Zacharias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Ioanna","family":"Chatziioannou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pegkou","family":"Afroditi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simou","family":"Maria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pafilis","family":"Ioannis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Souka","family":"Athina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodora","family":"Marianna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antsaklis","family":"Panagiotis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daskalakis","family":"Georgios","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"8299_CR1","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1007\/s00404-024-07547-6","volume":"310","author":"A Queir\u00f3s","year":"2024","unstructured":"Queir\u00f3s A, Gomes L, Pereira I, Charepe N, Plancha M, Rodrigues S, Cohen \u00c1, Alves M, Papoila AL, Sim.es T (2024) First-trimester serum biomarkers in twin pregnancies and adverse obstetric outcomes-a single center cohort study. 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