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Potential role of biochemical placentation markers — pregnancy associated plasma protein-A and human chorionic gonadotropin for early gestational diabetes screening — a pilot study
, 2, 13, 45
Affiliations- Department of Endocrinology, Specialized Hospital for Active Treatment of Obstetrics and Gynaecology “Dr Shterev”, Sofia, Bulgaria, Bulgaria
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Medical University of Plovdiv, Bulgaria, Bulgaria
- Department of Molecular Immunology, Institute of Biology and Immunology of Reproduction, Bulgarian Academy of Sciences, Sofia, Bulgaria
- Department of Internal Medicine, Medical University Sofia, Bulgaria, Sofia, Bulgaria
- Clinic of Endocrinology, University Hospital, Sofia, Bulgaria
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Abstract
Objectives: Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications. The universal screening for GDM is usually performed between 24-28 weeks’ gestation. This often delays the diagnosis and could increase the risk of adverse pregnancy outcomes. Some of the biochemical placental markers — pregnancy associated plasma protein A (PAPP-A) and free-β human chorionic gonadotropin (hCG), probably could provide a diagnostic value for GDM. The aim of our study was to assess if PAPP-A and hCG values were different among pregnant women with and without GDM and respectively, to tested their place in the early GDM screening. Material and methods: We conducted a retrospective, case-control study by reviewing the clinical database records of 662 pregnant women. The analysis includes the data for a two-year period. The patients included in the observation were divided into two groups — GDM group (n = 412) and Euglycemic group (n = 250). Early screening for GDМ between 9–12 weeks’ gestation was performed in 173 of the women in the interventional group due to: registered fasting plasma glucose (FPG) above 5.1 mmol/L, obesity, macrosomia in previous pregnancies or family history for diabetes mellitus. The remaining 239 women underwent universal screening at 24–28 weeks’ gestation. Mean serum levels of PAPP-A, hCG, FPG, and body mass index (BMI) were measured between 10–13 gestational weeks. Serum levels of PAPP-A and hCG are presented as multiples of the normal median (MoM), adjusted by maternal baseline characteristics and demographics. Results: In patients who developed GDM during pregnancy, compared with the control group, we have found significantly lower MoM values of PAPP-A (p < 0.0001), higher levels of FPG (р < 0.0001) and higher BMI (р < 0.0001). Median hCG MoM was similar in both group of pregnant women. Conclusion: Our findings suggest that low-normal to low reference range values of PAPP-A might be associated with higher risk for GDM. PAAP-A levels can be used as an additional factor to recommend early screening for GDM.
Abstract
Objectives: Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications. The universal screening for GDM is usually performed between 24-28 weeks’ gestation. This often delays the diagnosis and could increase the risk of adverse pregnancy outcomes. Some of the biochemical placental markers — pregnancy associated plasma protein A (PAPP-A) and free-β human chorionic gonadotropin (hCG), probably could provide a diagnostic value for GDM. The aim of our study was to assess if PAPP-A and hCG values were different among pregnant women with and without GDM and respectively, to tested their place in the early GDM screening. Material and methods: We conducted a retrospective, case-control study by reviewing the clinical database records of 662 pregnant women. The analysis includes the data for a two-year period. The patients included in the observation were divided into two groups — GDM group (n = 412) and Euglycemic group (n = 250). Early screening for GDМ between 9–12 weeks’ gestation was performed in 173 of the women in the interventional group due to: registered fasting plasma glucose (FPG) above 5.1 mmol/L, obesity, macrosomia in previous pregnancies or family history for diabetes mellitus. The remaining 239 women underwent universal screening at 24–28 weeks’ gestation. Mean serum levels of PAPP-A, hCG, FPG, and body mass index (BMI) were measured between 10–13 gestational weeks. Serum levels of PAPP-A and hCG are presented as multiples of the normal median (MoM), adjusted by maternal baseline characteristics and demographics. Results: In patients who developed GDM during pregnancy, compared with the control group, we have found significantly lower MoM values of PAPP-A (p < 0.0001), higher levels of FPG (р < 0.0001) and higher BMI (р < 0.0001). Median hCG MoM was similar in both group of pregnant women. Conclusion: Our findings suggest that low-normal to low reference range values of PAPP-A might be associated with higher risk for GDM. PAAP-A levels can be used as an additional factor to recommend early screening for GDM.
Keywords
gestational diabetes mellitus; PAPP-A; early screening
About this articleTitle
Potential role of biochemical placentation markers — pregnancy associated plasma protein-A and human chorionic gonadotropin for early gestational diabetes screening — a pilot study
Journal
Issue
Article type
Research paper
Pages
405-409
Published online
2021-08-13
Page views
5474
Article views/downloads
959
DOI
Pubmed
Bibliographic record
Ginekol Pol 2022;93(5):405-409.
Keywords
gestational diabetes mellitus
PAPP-A
early screening
Authors
Vesselina Evtimova Yanachkova
Radiana Staynova
Ivan Bochev
Zdravko Kamenov
References (21)- 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2020. Diabetes Care. 2019; 43(Supplement 1): S14–S31.
- Bulgarian Society of Endocrinology. Recommendations for good clinical practice for Diabetes Mellitus. Bulgarian Society of Endocrinology, Sofia 2019.
- Todorova K. Diabetes and pregnancy. 1st. Artik, Sofia 2010.
- International Diabetes Federation. IDF Diabetes Atlas, 9th ed. International Diabetes Federation, Brussels 2019.
- Feig DS, Berger H, Donovan L, et al. Diabetes Canada Clinical Practice Guidelines Expert Committee. Diabetes and Pregnancy. Can J Diabetes. 2018; 42 Suppl 1: S255–S282.
- Hod M, Kapur A, Sacks DA, et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. Int J Gynaecol Obstet. 2015; 131 Suppl 3: S173–S211.
- Bodmer-Roy S, Morin L, Cousineau J, et al. Pregnancy outcomes in women with and without gestational diabetes mellitus according to the International Association of the Diabetes and Pregnancy Study Groups criteria. Obstet Gynecol. 2012; 120(4): 746–752.
- Zhang X, Xu H, Hu R, et al. Gestational diabetes mellitus: prevalence, risk factors, maternal and infant outcomes. Int J Gynaecol Obstet. 2001; 75(3): 221–228.
- Davey RX, Hamblin PS. Selective versus universal screening for gestational diabetes mellitus: an evaluation of predictive risk factors. Med J Aust. 2001; 174(3): 118–121.
- Lee KW, Ching SM, Ramachandran V, et al. Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2018; 18(1): 494.
- Svare JA, Hansen BB, Mølsted-Pedersen L. Perinatal complications in women with gestational diabetes mellitus. Acta Obstet Gynecol Scand. 2001; 80(10): 899–904.
- Lalooha F, Elmizadeh K, Javadi A, et al. Association between abnormal glucose challenge test and pregnancy outcome. J Zanjan Univ Med Sci. 2012; 20(83): 53–61.
- Clemmons DR. Metabolic actions of insulin-like growth factor-I in normal physiology and diabetes. Endocrinol Metab Clin North Am. 2012; 41(2): 425–43, vii.
- Bayes-Genis A, Conover CA, Overgaard MT, et al. Pregnancy-associated plasma protein A as a marker of acute coronary syndromes. N Engl J Med. 2001; 345(14): 1022–1029.
- Rojas-Rodriguez R, Lifshitz LM, Bellve KD, et al. Human adipose tissue expansion in pregnancy is impaired in gestational diabetes mellitus. Diabetologia. 2015; 58(9): 2106–2114.
- Saruhan Z, Ozekinci M, Simsek M, et al. Association of first trimester low PAPP-A levels with adverse pregnancy outcomes. Clin Exp Obstet Gynecol. 2012; 39(2): 225–228.
- Lovati E, Beneventi F, Simonetta M, et al. Gestational diabetes mellitus: including serum pregnancy-associated plasma protein-A testing in the clinical management of primiparous women? A case-control study. Diabetes Res Clin Pract. 2013; 100(3): 340–347.
- Syngelaki A, Kotecha R, Pastides A, et al. First-trimester biochemical markers of placentation in screening for gestational diabetes mellitus. Metabolism. 2015; 64(11): 1485–1489.
- Nanda S, Savvidou M, Syngelaki A, et al. Prediction of gestational diabetes mellitus by maternal factors and biomarkers at 11 to 13 weeks. Prenat Diagn. 2011; 31(2): 135–141.
- Talasaz ZH, Sadeghi R, Askari F, et al. First trimesters Pregnancy-Associated Plasma Protein-A levels value to Predict Gestational diabetes Mellitus: A systematic review and meta-analysis of the literature. Taiwan J Obstet Gynecol. 2018; 57(2): 181–189.
- Donovan BM, Nidey NL, Jasper EA, et al. First trimester prenatal screening biomarkers and gestational diabetes mellitus: A systematic review and meta-analysis. PLoS One. 2018; 13(7): e0201319.
