PAPPA and spontaneous abortion: Low PAPP-A levels have been associated with PA, and these data have also argued that the origins of PA can be traced back to the early stages of pregnancy.(22)In addition, Sirikunalai et al.(23) reported that lower (< 0.5 MoM) and high (> 2.0 MoM) β-hCG groups which were detected in the second trimester (n = 5470) and showed that it significantly increased poor obstetric outcomes such as spontaneous abortion, IUGR, and PB.