PAPPA and obesity due to melanocortin 4 receptor deficiency: Measurement of maternal serum levels of PlGF and Pregnancy-associated Plasma Protein-A (PAPP-A), combined with maternal risk factors (e.g., obesity, hypertension, maternal age, etc.)and uterine artery measures by Doppler ultrasound, is proposed to have sensitivity of about 95% for detection of early-onset PE (diagnosed < 34 weeks) (272).