Kastamonu Medical Journal regularly publishes internationally qualified issues in the field of Medicine in the light of up-to-date information.

EndNote Style
Original Article
The predictive value of first trimester maternal serum pregnancy-associated plasma protein-a (papp-a) level in predicting gestational diabetes mellitus
Aims: The aim of this study is to evaluate the predictive value of first trimester biochemical markers in the subsequent development of gestational diabetes mellitus.
Methods: Data were retrospectively collected from the file records of 361 pregnant patients, who were admitted to the 1st Obstetrics and Gynecology Clinic at Sisli Etfal Education and Training Hospital for first trimester prenatal screening test between 11-14 weeks of their gestation and who later had undergone 50 gram glucose challenge test at 24-28 weeks of their gestation, between November 2007 and February 2011. Age, patient weight, Crown rump length (CRL), gestational week, Pregnancy-Associated Plasma Protein-A (PAPP-A) concentration, PAPP-A multiple of median (MoM) value, Beta-human koryonik gonadotropin (B-HCG) concentration, B-HCG MoM value, 50 and 100 g oral glucose challange test result were recorded from the files. Gestational diabetes was diagnosed according to National Diabates Data Grup cutt-off values and criteria. The association between first trimester biochemical markers and subsequent development of gestational diabetes was evaluated.
Results: In this study low PAPP-A and/or HCG MoM values and increased Nuchal translucency (NT) MoM values were found to be statistically significant for subsequent development of gestational diabetes.
Conclusion: GDM is an important health problem that carries many risks of complications for both mother and fetus. Pregnant women with GDM may have high blood sugar levels before diagnosis at 24 weeks of gestation, so fetal growth may be negatively affected by maternal hyperglycemia. Use of first trimester screening maternal serum biomarkers may lead to early diagnosis of GDM and interventions to improve maternal and fetal outcomes.

1. Davies MJ, Aroda VR, Collins BS, et al. Management of hyperglycemiain type 2 diabetes, 2022. A consensus report by the American DiabetesAssociation (ADA) and the European Association for the Study ofDiabetes (EASD). Diab Care. 2022;45(11):2753-2786. doi: 10.2337/dci22-0034
2. Modzelewski R, Stefanowicz-Rutkowska MM, Matuszewski W, Bandurska-Stankiewicz EM. Gestational diabetes mellitus—recent literature review. JClin Med. 2022;11(19):5736.
3. Ogurtsova K, Guariguata L, Barengo NC, et al. IDF diabetes atlas: globalestimates of undiagnosed diabetes in adults for 2021. Diab Res Clin Pract.2022;183:109118.
4. Çiçek N. Kadın hastalıkları ve doğum bilgisi. Güneş Kitabevi: 2006.
5. Kjos SL, Buchanan TA. Gestational diabetes mellitus. New Engl J Med.1999;341(23):1749-1756.
6. Riskin-Mashiah S, Younes G, Damti A, Auslender R. First-trimesterfasting hyperglycemia and adverse pregnancy outcomes. Diab Care.2009;32(9):1639-1643.
7. Spencer K, Yu CK, Cowans NJ, Otigbah C, Nicolaides KH. Prediction ofpregnancy complications by first-trimester maternal serum PAPP-A andfree β-hCG and with second-trimester uterine artery Doppler. PrenatalDiagnosis. 2005;25(10):949-953.
8. Huang T, Hoffman B, Meschino W, Kingdom J, Okun N. Predictionof adverse pregnancy outcomes by combinations of first and secondtrimester biochemistry markers used in the routine prenatal screening ofDown syndrome. Prenatal Diagnosis. 2010;30(5):471-477.
9. Smith GC, Stenhouse EJ, Crossley JA, Aitken DA, Cameron AD, ConnorJM. Early pregnancy levels of pregnancy-associated plasma protein a andthe risk of intrauterine growth restriction, premature birth, preeclampsia,and stillbirth. J Clin Endocrinol Metab. 2002;87(4):1762-1767.
10. Dugoff L, Hobbins JC, Malone FD, et al. First-trimester maternalserum PAPP-A and free-beta subunit human chorionic gonadotropinconcentrations and nuchal translucency are associated with obstetriccomplications: a population-based screening study (the FASTER Trial).Am J Obstetr Gynecol. 2004;191(4):1446-1451.
11. Montanari L, Alfei A, Albonico G, et al. The impact of first-trimesterserum free β-human chorionic gonadotropin and pregnancy-associatedplasma protein A on the diagnosis of fetal growth restriction and small forgestational age infant. Fetal Diagn Therapy. 2009;25(1):130-135.
12. Mook-Kanamori DO, Steegers EA, Eilers PH, Raat H, Hofman A, JaddoeVW. Risk factors and outcomes associated with first-trimester fetal growthrestriction. JAMA. 2010;303(6):527-534.
13. Beneventi F, Simonetta M, Lovati E, et al. First trimester pregnancy-associated plasma protein-A in pregnancies complicated by subsequentgestational diabetes. Prenatal Diagn. 2011;31(6):523-528.
14. Ong CY, Liao AW, Spencer K, Munim S, Nicolaides KH. First trimestermaternal serum free β human chorionic gonadotrophin and pregnancyassociated plasma protein A as predictors of pregnancy complications.BJOG: Int J Obstetr Gynaecol. 2000;107(10):1265-1270.
15. Nese Kavak Z, Basgul A, Elter K, Uygur M, Gokaslan H. The efficacyof first-trimester PAPP-A and free βhCG levels for predicting adversepregnancy outcome. J Perinatal Med. 2006;34(2):145-148.
16. National Diabetes Data Group. Classification and diagnosis ofdiabetes mellitus and other categories of glucose intolerance. Diabetes.1979;28(12):1039-1057.
17. Krantz D, Goetzl L, Simpson JL, et al. Association of extreme first-trimester free human chorionic gonadotropin-β, pregnancy-associatedplasma protein A, and nuchal translucency with intrauterine growthrestriction and other adverse pregnancy outcomes. Am J Obstetr Gynecol.2004;191(4):1452-1458.
18. Ben-Haroush A, Yogev Y, Hod M. Epidemiology of gestational diabetesmellitus and its association with Type 2 diabetes. Diabetic Med.2004;21(2):103-113.
19. Xiao D, Chenhong W, Yanbin X, Lu Z. Gestational diabetes mellitus andfirst trimester pregnancy-associated plasma protein A: a case-controlstudy in a Chinese population. J Diab Invest. 2018;9(1):204-210.
20. Cui J, Li P, Chen X, et al. Study on the Relationship and predictive value offirst-trimester pregnancy-associated plasma protein-a, maternal factors,and biochemical parameters in gestational diabetes mellitus: a large case-control study in Southern China mothers. Diab Metab Syndr Obesity.2023;16:947-957.
21. Ren Z, Zhe D, Li Z, Sun XP, Yang K, Lin L. Study on the correlationand predictive value of serum pregnancy-associated plasma protein A,triglyceride and serum 25-hydroxyvitamin D levels with gestationaldiabetes mellitus. World J Clin Cases. 2020;8(5):864.
22. Ramezani S, Doulabi MA, Saqhafi H, Alipoor M. Prediction of gestationaldiabetes by measuring the levels of pregnancy associated plasmaprotein-A (PAPP-A) during gestation weeks 11-14. J Reproduc Infertil.2020;21(2):130.
23. Yanachkova VE, Staynova R, Bochev I, Kamenov Z. Potential roleof biochemical placentation markers—pregnancy associated plasmaprotein-A and human chorionic gonadotropin for early gestationaldiabetes screening—a pilot study. Ginekol Polska. 2022;93(5):405-409.
24. Visconti F, Quaresima P, Chiefari E, et al. First trimester combined test(FTCT) as a predictor of gestational diabetes mellitus. Int J Environ ResPublic Health. 2019;16(19):3654.
Volume 4, Issue 1, 2024
Page : 10-14