Association of Pregnancy-Associated Plasma Protein A (PAPP-A) and Gestational Diabetes

Authors

1 M.Sc. student of Midwifery, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 PHD, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 PHD of Laboratory Sciences, Faculty of Paramedical, Qazvin University of Medical Sciences, Iran.

4 Assistant professor, Department of Biostatistics, Faculty of Medicine, Qazvin University of Medical Sciences, Iran.

Abstract

Introduction: Gestational diabetes mellitus is the most common medical complication during pregnancy that negatively affects the health of mother and fetus and neonate. Gestational diabetes mellitus occurs in 3-5% of pregnancies. Early detection of gestational diabetes can prevent of these complications. This study was performed with aim to determine the association between pregnancy-associated plasma protein A (PAPP-A) and gestational diabetes to detect a risk factor for predicting gestational diabetes.
Methods: This prospective analytical study was performed on 250 pregnant women referring to six healthcare centers of Qazvin from February to October 2016. PAPP-A was measured at 11-14 gestational weeks, then 75 gr glucose tolerance test was performed on the samples at 24-27 gestational weeks. The association between gestational diabetes and PAPP-A was studied. Data were analyzed by SPSS software (version 21) and Chi-square, t-test, Mann-Whitney, relative risk, and logistic regression. PResults: Twenty-four subjects (30.8%) of patients with decreased PAPPA and 15 (8.7%) of patients with normal PAPP-A were diagnosed with gestational diabetes. Chi-square test showed significant difference between two groups based in terms of gestational diabetes (P<0.001). The risk of gestational diabetes in the patients with decreased PAPP-A was 3.90 times more than control group (CI=1.87-8.14, P<0.001)
Conclusion: Low level of PAPP-A at gestation weeks of 11-14 can be a possible risk factor for the incidence of gestational diabetes. Therefore, it can be used as an early detection test for preventing the fetal and maternal adverse effects.

Keywords

References

  1. American Diabetes Association. 2. Classification and diagnosis of diabetes. Diabetes Care 2015; 38(Suppl 1):S11-24.
  2. Cunningham F, Leveno K, Bloom S, Spong CY, Dashe J. Williams obstetrics. 24th ed. New York: McGraw-Hill; 2014.
  3. del Rosario-Capellan ML, Carlos-Raboca J, Litonjua AD. Total sialic acid and other inflammatory markers as predictors of gestational diabetes. Philos J Intern Med 2009; 47:11-7.
  4. Baptiste-Roberts K, Barone BB, Gary TL, Golden SH, Wilson LM, Bass EB, et al. Risk factors for type 2 diabetes among women with gestational diabetes: a systematic review. Am J Med 2009; 122(3):207-14.
  5. Kariman N, Ahi Z, Zahedi S, Majd AH. Relationship between maternal serum C-reactive protein concentration and gestational diabetes mellitus. J Diabetes 2013; 5:17.
  6. Reece EA. The fetal and maternal consequences of gestational diabetes mellitus. J Matern Fetal Neonatal Med 2010; 23(3):199-203.
  7. Coustan DR, Lowe LP, Metzger BE, Dyer AR. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: paving the way for new diagnostic criteria for gestational diabetes mellitus. Am J Obstet Gynecol 2010; 202(6):654.e1-6.
  8. Protocol of screening and diagnosis of gestational diabetes. Ministry of Health and Medical Education. Available at: URL: health.behdasht.gov.ir; 2013.
  9. Beneventi F, Simonetta M, Lovati E, Albonico G, Tinelli C, Locatelli E, et al. First trimester pregnancy‐associated plasma protein‐A in pregnancies complicated by subsequent gestational diabetes. Prenatal Diagn 2011; 31(6):523-8.
  10. Beneventi F, Simonetta M, Locatelli E, Cavagnoli C, Badulli C, Lovati E, et al. Temporal variation in soluble human leukocyte antigen‐G (sHLA‐G) and pregnancy‐associated plasma protein A (PAPP‐A) in pregnancies complicated by gestational diabetes mellitus and in controls. Am J Reprod Immunol 2014; 72(4):413-21.
  11. Huynh L, Kingdom J, Akhtar S. Low pregnancy-associated plasma protein A level in the first trimester. Can Fam Physician 2014; 60(10):899-903.
  12. Lovati E, Beneventi F, Simonetta M, Laneri M, Quarleri L, Scudeller L, 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):340-7.
  13. Giudice I, Benintende G, Di Nicolò AM, Mangiameli D, Carrara G, Randazzo C, et al. Correlation of neonatal weight with maternal serum levels of pregnancy-associated plasma protein-A during the first trimester of pregnancy: a retrospective study. J Perinat Med 2015; 43(2):227-32.
  14. Ledesma AM, Yuste MG, Bújez AR, Valentín RL, Soto BG, Arévalo YP, et al. Low maternal serum PAPP-A levels in the first trimester of gestation and the risk of gestational diabetes. 18th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI), Vienna, Austria; 2014. P. 183.
  15. Schaas C, Titianu M, Visinari R, Berescu A, Carp A, Onofriescu M. P06. 12: PAPP‐A—a marker for gestational diabetes? Ultrasound Obstet Gynecol 2012; 40(S1):192.
  16. Husslein H, Lausegger F, Leipold H, Worda C. Association between pregnancy-associated plasma protein-A and gestational diabetes requiring insulin treatment at 11–14 weeks of gestation. J Matern Fetal Neonatal Med 2012; 25(11):2230-3.
  17. SpencerK, Cicero S, Atzei A, Otigbah C, Nicolaides KH. The influence of maternal insulin‐dependent diabetes on fetal nuchal translucency thickness and first‐trimester maternal serum biochemical markers of aneuploidy. Prenat Diagn 2005; 25(10):927-9.
  18. Mohammadi K, Mallekafzali V. Statistical method and health index. Tehran, Iran: Dariche; 2015. (Persian).
  19. Jelliffe-Pawlowski LL, Baer RJ, Currier RJ, Lyell DJ, Blumenfeld YJ, El-Sayed YY, et al. Early-onset severe preeclampsia by first trimester pregnancy-associated plasma protein A and total human chorionic gonadotropin. Am J Perinatol 2015; 32(7):703-12.
  20. Spencer K, Cowans NJ, Avgidou K, Molina F, Nicolaides KH. First‐trimester biochemical markers of aneuploidy and the prediction of small‐for‐gestational age fetuses. Ultrasound Obstet Gynecol 2008; 31(1):15-9.
  21. Spencer K, Cowans NJ, Molina F, Kagan KO, Nicolaides KH. First‐trimester ultrasound and biochemical markers of aneuploidy and the prediction of preterm or early preterm delivery. Ultrasound Obstet Gynecol 2008; 31(2):147-52.
  22. Ong CY, Liao AW, Spencer K, Munim S, Nicolaides KH. First trimester maternal serum free β human chorionic gonadotrophin and pregnancy associated plasma protein A as predictors of pregnancy complications. BJOG 2000; 107(10):1265-70.
  23. Iversen KK, Dalsgaard M, Teisner AS, Schoos M, Teisner B, Nielsen H, et al. Pregnancy-associated plasma protein-A, a marker for outcome in patients suspected for acute coronary syndrome. Clin Biochem 2010; 43(10-11):851-7.
  24. Pellitero S, Reverter JL, Pizarro E, Pastor MC, Granada ML, Tàssies D, et al. Pregnancy-associated plasma protein-a levels are related to glycemic control but not to lipid profile or hemostatic parameters in type 2 diabetes. Diabetes Care 2007; 30(12):3083-5.
  25. Savvidou MD, Syngelaki A, Muhaisen M, Emelyanenko E, Nicolaides KH. First trimester maternal serum free β‐human chorionic gonadotropin and pregnancy‐associated plasma protein A in pregnancies complicated by diabetes mellitus. BJOG 2012; 119(4):410-6.
  26. Nanda S, Savvidou M, Syngelaki A, Akolekar R, Nicolaides KH. Prediction of gestational diabetes mellitus by maternal factors and biomarkers at 11 to 13 weeks. Prenat Diagn 2011; 31(2):135-41.
  27. Teede HJ, Harrison CL, Teh WT, Paul E, Allan CA. Gestational diabetes: development of an early risk prediction tool to facilitate opportunities for prevention. Aust N Z J Obstet Gynaecol 2011; 51(6):499-504.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 20, Issue 1
April 2017
Pages 61-69

Files

Share

How to cite

Statistics