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Assay of PSG has, however, been applied to the monitoring of therapeutic response in patients treated for choriocarcinoma and other malignancies.251 Additionally, first trimester maternal serum levels of PSG were lower in Down syndrome pregnancies than in unaffected pregnancies, but the difference was not large enough for PSG to be a useful marker in screening.252 Pregnancy-Associated Plasma Protein A Pregnancy-associated plasma protein A (PAPP-A) is a 750-kd glycoprotein that is structurally related to 2 macroglobulin, which binds and inactivates serine proteases.253, 254, 255 It is isolated as a dimer of homologous subunits

consider monitoring and supplementing if needed

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