Predicting complications of pregnancy with first‐trimester maternal serum free‐βhCG, PAPP‐A and inhibin‐A

Tul, Nataša; Pušenjak, Stanko; Osredkar, Joško; Spencer, Kevin; Novak-Antolič, Živa

doi:10.1002/pd.735

Cited by 130 publications

(109 citation statements)

References 41 publications

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“…Nevertheless, first-trimester PAPP-A MoM was not a useful predictor for development of GDM or earlyonset GDM. 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.…”

Section: Discussionsupporting

confidence: 83%

“…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: 41%

“…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: 96%

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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: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 41%

Section: Discussionmentioning

confidence: 96%

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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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“…Increased risk of low birth weight, intrauterine growth retardation and premature birth in women with low PAPP-A has been noted by others (Dugoff et al, 2004;Kabili et al, 2004;Krantz et al, 2004). In contrast, other studies have found an association between low PAPP-A and increased risk of low birth weight or intrauterine growth retardation, but not with preterm birth (Ong et al, 2000;Yaron et al, 2002a;Kwik and Morris, 2003;Tul et al, 2003). Furthermore, Morssink et al (1998) concluded that PAPP-A is not associated with either fetal growth restriction or preterm delivery.…”

Section: Low Papp-a and Adverse Outcomesmentioning

confidence: 72%

Use of the combined first‐trimester screen result and low PAPP‐A to predict risk of adverse fetal outcomes

Barrett¹,

Bower

Hadlow³

2008

Prenatal Diagnosis

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ObjectivesTo investigate associations between combined first‐trimester screen result, pregnancy associated plasma protein‐A (PAPP‐A) level and adverse fetal outcomes in women.MethodsPregnancy outcomes for 10 273 women participating in a community based first‐trimester screening (FTS) programme in Western Australia were ascertained by record linkage to birth and birth defect databases. A first‐trimester risk cut‐off of ≥ 1 in 300 defined screen positive women.ResultsScreen positive pregnancies were more likely to have Down syndrome and birth defects (chromosomal or nonchromosomal) than screen negative pregnancies. When birth defects were excluded, screen positive pregnancies were at increased risk of pregnancy loss, low birth weight and preterm birth. Pregnancies with low PAPP‐A (⩽0.3 multiples of the median (MoM)) had higher risk of chromosomal abnormality, birth defect, preterm birth, low birth weight, or pregnancy loss, compared to those with PAPP‐A > 0.3 MoM. In pregnancies without birth defects, low PAPP‐A was a stronger predictor of preterm birth, low birth weight or pregnancy loss than a screen positive result.ConclusionsWomen with positive screen or low PAPP‐A were at increased risk for some adverse fetal outcomes. The sensitivity of these parameters was insufficient to support primary screening, but increased surveillance during pregnancy may be appropriate. Copyright © 2008 John Wiley & Sons, Ltd.

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“…Several recent studies have shown an association between low first-trimester maternal serum pregnancy associated plasma protein-A (PAPP-A) levels and the subsequent development of pregnancy complications, including pre-eclampsia Smith et al, 2002;Yaron et al, 2002;Tul et al, 2003;Dugoff et al, 2004;Krantz et al, 2004;Spencer et al, 2005aSpencer et al, , 2006aSpencer et al, ,b, 2007aCowans and Spencer, 2007).…”

Section: Introductionmentioning

confidence: 99%

Low levels of maternal serum PAPP‐A in the first trimester and the risk of pre‐eclampsia

Spencer

Cowans²,

Nicolaides³

2007

Prenatal Diagnosis

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113

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Background Low levels of pregnancy associated plasma protein-A (PAPP-A) have been previously shown to be associated with pregnancies that subsequently develop pre-eclampsia. The objective of this study was to establish the relative risk for pre-eclampsia at various PAPP-A levels as an aid to counselling and follow up of pregnancies.Methods Maternal serum PAPP-A and free ß-human chorionic gonadotropin (ß-hCG) levels at 11 to 13 weeks of gestation from 224 singleton pregnancies that subsequently developed pre-eclampsia were compared to those from 47 770 normal singleton pregnancies resulting in live births after 37 weeks with birth weight greater than or equal to the 10th centile of normal for gestation. In all cases, the measured PAPP-A and free ß-hCG levels were expressed as multiple of the median (MoM). The association between metabolite levels and the incidence of pre-eclampsia was assessed by comparing the relative incidence at a number of MoM cut-offs and at various centiles. At various marker levels, the likelihood ratio for pre-eclampsia was also calculated. ResultsIn the pre-eclampsia group the median PAPP-A MoM was significantly reduced (0.772 MoM, p < 0.0001) whilst the median free β-hCG MoM was not different from controls (0.981 MoM, p = 0.26). With decreasing levels of PAPP-A, the likelihood ratio for pre-eclampsia increased. At the 5th centile of normal (PAPP-A MoM 0.415) the odds ratio was increased 4-fold and at this cut-off 15% of cases of pre-eclampsia would be identified. ConclusionsThe graphical presentation of a likelihood ratio curve for pre-eclampsia at any PAPP-A MoM level is likely to be useful in counselling women with low levels of PAPP-A and a normal karyotype. Use of low levels of PAPP-A for selecting women for further follow-up with uterine artery Doppler may further improve the clinical discrimination.

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Predicting complications of pregnancy with first‐trimester maternal serum free‐βhCG, PAPP‐A and inhibin‐A

Cited by 130 publications

References 41 publications

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

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

Use of the combined first‐trimester screen result and low PAPP‐A to predict risk of adverse fetal outcomes

Low levels of maternal serum PAPP‐A in the first trimester and the risk of pre‐eclampsia

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