Maternal serum zinc shows significant positive correlation with PAPP-A in FGR group, suggests study
The dual test is the most used aneuploidy screening method in first-trimester pregnancy. The dual test considers the lack of fetal nasal bone (a sonography data on the fetus having trisomy 21), Crown rump length, age of gestation along with Nuchal Translucency (NT), age of mother, Fetal aneuploidy can be assessed with 95% accuracy by maternal free beta human chorionic gonadotropin (β hCG) and Pregnancy associated plasma protein A (PAPP-A). Abnormally high or low values of PAPP-A and β hCG are linked with adverse pregnancy outcomes. High free β -hCG have role in several complications including late fetal loss, gestational hypertension, pre-eclampsia, IUGR (Intrauterine growth restriction), preterm delivery and dead fetus in utero.
In pregnancy, deficiency in micronutrient have profound effects on fetal growth, development and pregnancy outcomes. Plasma trace minerals including copper, zinc, magnesium and iron are important in supporting reproduction and maintaining normal fetal development. PAPP-A produced by the syncytiotrophoblasts of the placenta is a zinc binding metalloproteinase. Maternal serum micronutrients such as zinc, copper, magnesium and iron have known to negatively correlate with the indices used in calculation of dual test scores such as fetal NT and PAPPA.
This study aimed to associate serum copper, zinc, magnesium, iron, PAPP-A and aneuploidy risk score calculated by dual test in pregnant women (20-40 yrs) upto week of pregnancy 13th (i.e first trimester) with different adverse pregnancy outcomes.
This cohort study was conducted in Department of Biochemistry, Kasturba Medical College, Manipal, Karnataka, India, from March2019 to March2022.Ethical approval was obtained from the Institutional Ethical Committee. The pregnancy was followed up for any adverse pregnancy outcomes.
Authors found n=102 mothers had normal delivery, n=46 had FGR, n=57 had gestational diabetes mellitus and n=68 had preterm delivery. In FGR group, serum zinc showed positive relation with PAPPA (r=0.7, p<0.001) and Multiple of Median (MoM) of PAPPA (r=0.77, p<0.001).
Study was conducted to identify possible confounding effect of micronutrients on fetal indices and hormones used in calculation of aneuploidy risk. This study has shown that in pregnancies with different adverse pregnancy outcomes, there was no statistically significant association of maternal serum trace elements measured in 4-13th week of gestation and dual test scores. But serum zinc showed strong positive correlation with first trimester dual test aneuploidy risk score with respect to fetal growth restriction group and gestational diabetes mellitus, so it has potential to be part in the existing biochemical parameters used in aneuploidy risk calculation algorithms. Down syndrome and micronutrient deficiency have rare occurrences due to increased education/knowledge on health and high accurate screening methods involved. PAPP-A, established parameter included in aneuploidy screening is a zinc containing protein. So, to further improve the sensitivity of the test zinc can be included in the risk calculation algorithm.
This study concludes that maternal serum magnesium and zinc have the potential to predict aneuploidy risk by including it in risk calculation algorithms. Maternal zinc and magnesium are crucial in early stages of pregnancy for maintaining healthy pregnancy. Further research has to be conducted to know the role of serum micronutrient and zinc deficiency in relation to Down syndrome.
Source: Sairoz et al. / Indian Journal of Obstetrics and Gynecology Research 2026;13(1):83–88
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