PAPPA and gestational diabetes: The main objective of this study was to assess the possible correlation of low PAPP-A levels with the subsequent development of preterm premature rupture of membranes (PPROM), preterm birth (PTB) at < 32, < 34, and < 36 weeks of gestation, gestational diabetes (GDM), hypertensive disorders of pregnancy (HDP) such as early and late-onset pre-eclampsia or gestational hypertension, intrauterine death (IUD) of at least one twin (s-IUD), birthweight discordance (BWD) of more than 25% among the fetuses and composite adverse pregnancy outcome (which included PPROM, PTB < 36 weeks, HDP, and GDM).