Gestational diabetes mellitus: Including serum pregnancy-associated plasma protein-A testing in the clinical management of primiparous women? A case–control study

Lovati, Elisabetta; Beneventi, Fausta; Simonetta, Margherita; Laneri, Marco; Quarleri, L.; Scudeller, Luigia; Albonico, Giulia; Locatelli, Elena; Cavagnoli, Chiara; Tinelli, Carmine; Spinillo, Arsenio; Corazza, Gino Roberto

doi:10.1016/j.diabres.2013.04.002

Cited by 58 publications

(61 citation statements)

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“…There were, however, only two (1.2%) women with GDM in our study who required insulin, a much lower frequency compared with other study populations (12%-100%). 8,9,11,18,23,[26][27][28][29] Although both women had a lower PAPP-A MoM than women with non-insulin-treated GDM or non-GDM group, such a small proportion is insufficient to determine whether PAPP-A MoM differs significantly between women with insulin-treated GDM and non-insulintreated women with GDM. The low frequency of insulin treatment in our study population may imply that the majority of affected Chinese women had mild GDM and may also explain why our study population did not exhibit changes in PAPP-A MoM during the first trimester.…”

Section: Discussionmentioning

confidence: 95%

“…Women with GDM who require insulin may have a more severe type of GDM or undiagnosed pre-existing DM. Lovati et al 8 showed that women with GDM had a significantly lower PAPP-A MoM if they received insulin therapy than women with GDM who were managed by diet (0.56 vs 0.76 MoM; P<0.001). Beneventi et al 29 showed a similar result that PAPP-A MoM was significantly lower in GDM managed with insulin treatment than GDM without (0.87 vs 1.11 MoM; P=0.031).…”

Section: Discussionmentioning

confidence: 99%

“…This is consistent with the results of three other studies 18,26,27 but contradicts others. 8,9,11,23,28,29 These published series are summarised in Table 5. 8,9,11,18,23,[26][27][28][29] There are several possible explanations for the different results of these studies, including ours.…”

Section: Discussionmentioning

confidence: 99%

“…8,27 Second, the studies differed in terms of the OGTT method (75-g 2 hours, 100-g 3 hours, 100-g 2 hours) and diagnostic criteria. Tran et al 30 showed that GDM varied substantially in the same population by different diagnostic criteria: 5.9% ADA, 20.4% IADPSG, and 24.3% WHO 1999.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 In Hong Kong, all women undergo firsttrimester screening for Down syndrome using a combination of maternal age, maternal free β-human chorionic gonadotrophin (β-HCG), pregnancy-associated plasma protein-A (PAPP-A), and fetal nuchal translucency (NT) thickness at 11-13+6 weeks of gestation. Studies have shown that low free β-HCG and PAPP-A levels in the first trimester are associated with pregnancy complications.…”

Section: Introductionmentioning

confidence: 99%

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Association between pregnancy-associated plasma protein-A levels in the first trimester and gestational diabetes mellitus in Chinese women

Wong

et al. 2015

Hong Kong Med J

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Introduction:Several studies have shown that women with pre-existing diabetes mellitus have significantly lower pregnancy-associated plasma protein-A levels than those without. This study aimed to evaluate whether first-trimester pregnancyassociated plasma protein-A multiple of median is associated with gestational diabetes mellitus in Chinese pregnant women. Methods:This prospectively collected case series was conducted in a regional hospital in Hong Kong. All consecutive Chinese women with a singleton pregnancy who attended the hospital for their first antenatal visit (before 14 weeks' gestation) from April to July 2014 were included. Pregnancyassociated plasma protein-A multiple of median was compared between the gestational diabetic (especially for early-onset gestational diabetes) and non-diabetic groups. The correlation between pregnancy-associated plasma protein-A level and glycosylated haemoglobin level in women with gestational diabetes was also examined. Results:Of the 520 women recruited, gestational diabetes was diagnosed in 169 (32.5%). Among them, 43 (25.4%) had an early diagnosis, and 167 (98.8%) with the disease were managed by diet alone. The gestational diabetic group did not differ significantly to the non-diabetic group in pregnancyassociated plasma protein-A (0.97 vs 0.99, P=0.40) or free β-human chorionic gonadotrophin multiple of median (1.05 vs 1.02, P=0.29). Compared with the non-gestational diabetic group, women with early diagnosis of gestational diabetes had a non- Association between pregnancy-associated plasma protein-A levels in the first trimester and gestational diabetes mellitus in Chinese womenNew knowledge added by this study • This is the first study to assess the association of first-trimester pregnancy-associated plasma protein-A multiple of median (PAPP-A MoM) with gestational diabetes mellitus (GDM) in a Chinese population. PAPP-A MoM was not predictive of development of non-insulin-dependent GDM in Chinese women.• There was no correlation between PAPP-A MoM and glycosylated haemoglobin level in Chinese women with GDM. PAPP-A levels were not useful to predict and identify poor glycaemic control in women with GDM.• There was a high prevalence of GDM (32.5%) in the Chinese population. Implications for clinical practice or policy • PAPP-A and β-human chorionic gonadotrophin do not seem to be predictive of non-insulin-dependent GDM.Other predictive model that comprises the maternal and clinical risk factors in Chinese women is warranted to identify women at risk of GDM.• Further studies that employ the new diagnostic criteria for GDM are warranted to examine the potential of first-trimester biochemical markers to predict GDM as well as their influence on the prevalence of GDM in the Chinese population.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association between pregnancy-associated plasma protein-A levels in the first trimester and gestational diabetes mellitus in Chinese women

Wong

et al. 2015

Hong Kong Med J

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First trimester screening can predict adverse pregnancy outcomes

Sharp

Alfirević

2014

Prenatal Diagnosis

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Methods: We retrospectively reviewed and performed 4D-HDFI in 204 normal and 33 fetuses with confirmed diagnosis of cardiac anomalies of the great arteries. Cardiac volumes were available for post-analysis to obtain 4D rendered images of the great arteries. For the normal fetuses, two other traditional modalities including colour Doppler and HDFI were used to detect aortic arch and its branches and comparisons were made between each of these traditional methods and 4D-HDFI. Results: Two cases of interrupted aortic arch (IAA) type A, 3 cases of IAA type B, 5 cases of tetralogy of Fallot, 3 cases of double outlet right ventricle, 2 cases of truncus arteriosus, 2 cases of transposition of the great arteries, 2 cases of double aortic arch, 11 cases of right aortic arch with aberrant left subclavian arteries, 1 case of right aortic arch with mirror-image branching, and 2 cases of aberrant right subclavian artery were included in the current study. The 4D rendered images vividly depicted the origination, course, and the spatial relationship of the great arteries. For the normal fetuses, HDFI modality was superior to colour Doppler in detecting more brachiocephalic arteries throughout the gestational period. 4D-HDFI was the best method during the second trimester of pregnancy in identifying the greatest number of brachiocephalic arteries. Conclusions: HDFI and the advanced 4D-HDFI technique could facilitate identification of the anatomical features of the great arteries in both normal and abnormal fetuses, 4D-HDFI therefore provides additional and more precise information than conventional sonography techniques. Objectives: Prediction of pre-eclampsia (PE) before 34 and 37 weeks' at 11-14 weeks' in nulliparous women. Methods: All nulliparous women attending routine first-trimester ultrasound examination who delivered in our department between 2009 and 2016 were offered the 2016' FMF prediction model for PE before 34 and 37 weeks'. Risk assessment for PE included maternal factors, pregnancy-associated plasma protein-A (PAPP-A), mean maternal arterial blood pressure (MAP) and uterine artery Doppler (UtAPI). Risk was calculated for all nulliparous women optimally with all variables: PAPP-A + MAP + Ut IP, or pragmatically using only available parameters. Models performance was evaluated using receiver-operating characteristics (ROC) curve analysis in both groups. Results: 6,260 nulliparous women were included, 108 (1.7%) developed PE, including13 (0.2 %) and 41 (0.6%) before 34 and 37 weeks' respectively. Prediction models for PE before 34 and 37 weeks were optimal and suboptimal for 2080 (33.2%) and 4180 (66.8%) respectively. Prevalences were similar in both groups, 0.19% & 0.67% and 0.21% & 0.64%, respectively. The optimal model showed better AUC (95% CI) at predicting PE<34 and 37 weeks': 0.84 (0.66-1) V. 0.76 (0.50-1) and 0.91 (0.84-0.98) V. 0.81 (0.70-0.92), respectively. For a 10% false positive rate, the detection rate (95% CI) when using the optimal model was 20% higher than when using a suboptimal model <37 weeks'...

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