First trimesters Pregnancy-Associated Plasma Protein-A levels value to Predict Gestational diabetes Mellitus: A systematic review and meta-analysis of the literature

Abstract

Detecting pregnant women at risk of diabetes in first months can help them by early intervention for delaying or preventing onset of GDM. In this study, we aimed to assess the Predictive value of first trimester Pregnancy related plasma protein-A (PAPP-A) levels for detecting Gestational diabetes Mellitus (GDM). This systematic review and meta-analysis was conducted through probing in databases. PubMed, Scopus, Medline and Google scholar citations were searched to find the published papers from 1974 to 2017. Studies were considered eligible if they were cohorts, case-control studies, reported GDM result, not other types, conducted on singleton pregnancy, measured Serum pregnancy associated plasma protein A in the first trimester and evaluated the relation of first trimester pregnancy associated plasma protein-A and GDM. Two reviewers independently assessed the quality with Newcastle-Ottawa and extracted data in the Pre-defined checklist. Analysis of the data was carried out by "Comprehensive Meta-analysis Version 2 (CAM)" and Metadisc software. 17 articles have our inclusion criteria and were considered in our systematic review, 5 studies included in Meta-analysis. Meta-analysis of these articles showed that the predictive value of PAPP-A for GDM has 55% sensitivity (53-58), 90% (89-90) specificity, LR + 2.48 (0.83-7.36) and LR - 0.70 (0.45-1.09) with 95% confidence intervals. In our study PAPP-A has low predictive accuracy overall, but it may be useful when combined with other tests, and this is an active part for future research. One limitation of our study is significant heterogeneity because of different adjusted variables and varied diagnostic criteria.

First Trimester Combined Test (FTCT) as a Predictor of Gestational Diabetes Mellitus

“…In addition, our data are consistent with those reported in a large Thailandian population, indicating a specific protective effect against GDM of a β-hCG value >2 MoM [18]. Besides, our results for PAPP-A are in agreement with a recent systematic review and meta-analysis indicating that PAPP-A has a low predictive accuracy overall [31]. Other studies, involving different populations, confirmed that first trimester PAPP-A levels are decreased in women who subsequently developed GDM, even though they did not report significant changes in β-hCG values [17,32,33].…”

Potential role of biochemical placentation markers — pregnancy associated plasma protein-A and human chorionic gonadotropin for early gestational diabetes screening — a pilot study

“…The current study indicates that women with GDM have low or low normal PAAP-A levels. Our findings confirmed the results from previous studies [16][17][18][19][20][21]. There are conflicting data regarding the relationship between PAPP-A levels and the manifestation of gestational diabetes.…”

“…However, studies could not determine definitively if low PAPP-A levels lead to carbohydrate metabolism disorders. [20,21].…”

First trimester secreted Frizzled-Related Protein 4 and other adipokine serum concentrations in women developing gestational diabetes mellitus

“…However, the addition of biochemical markers might improve the performance of these prediction models [24,25]. A reason for this might be that biochemical markers are more related to the direct pathophysiology and several potential prognostic and diagnostic markers for the first and second trimester have already been described [5,[26][27][28][29][30][31][32][33][34]. Although, none of these markers has been developed into a clinical test so far.…”