Birinci Trimester Taramasında Bakılan Serum Belirteçlerinden β-hCG ve PAPP-A’nın Kötü Obstetrik Sonuçları Öngörmede Etkisi: 889 Tekil Gebelik ile yapılan Prospektif Bir Çalışma

Abstract

Amaç: Bu çalışmada birinci trimester tarama testinde değerlendirilen serum belirteçlerinden PAPP-A ve serbest β-hCG nin preterm eylem, preterm doğum, gestasyonel diyabetes mellitus (GDM), gebelik hipertansiyonu, preeklampsi, düşük doğum ağırlığı (DDA), gebelik yaşına göre küçük (SGA), gebelik yaşına göre büyük (LGA), intrauterin gelişme geriliği (IUGR), makrozomi, intrauterin eksitus (IUEX) gibi gebelik komplikasyonları ile ilişkisini değerlendirmeyi amaçladık. Gereçler ve Yöntem: Bu prospektif çalışma 1 Mayıs 2011 ile 1 Mayıs 2012 arasında Gazi Üniversitesi Tıp Fakültesi Hastanesi’nde yürütülmüştür. Tekil gebelik nedeni ile takip edilen ve 11-14. haftalarda birinci trimester tarama testi yapılmış 889 kadın çalışmaya dahil edilmiştir. Bulgular: Çalışmaya kriterlere uygun olan 889 kadın dahil edildi. Yaş ortanca değeri 29 (26-33) olup serbest β-hCG MoM ve PAPP-A MoM ortanca değerleri sırasıyla 1.0 (0.7- 1.48) ve 1.04 (0.73- 1.46) idi. En sık gözlenen gebelik komplikasyonları preterm eylem 164 (18.4%), düşük tehdidi 95 (10.7%), ve GDM 75 (8.4%) idi. PAPP-A MoM ile SGA, DDA ve preterm doğum arasında doğrusal bir ilişki izlendi (sırasıyla, p=<0.0000001, 0.033, ve 0.03). PAPP-A MoM değerleri ≤0.42 (5. persentil),>2.5 (95. persentil), ve 0.73-1.47 (25.-75. persentil) olmak üzere üç kategoriye ayrıldığında bu üç grup arasında SGA (<0.0000001), DDA (0.01), IUEX (0.00005), preterm eylem (0.002), ve IUGR (0.006) için anlamlı farklılık izlendi. Sadece preterm eylem ile serbest β-hCG MoM değerleri arasında doğrusal bir ilişki izlendi (p =0.007). Ancak bu ilişki β-hCG MoM değerleri ≤0.40 (5. persentil), >2.9 (95. persentil), ve 0.75-1.49 (25.-75. persentil) olmak üzere üç grupta kategorize edildiğinde kayboldu (p=0.47). Doğum ağırlığı ve PAPP-A MoM değerleri arasında göz ardı edilebilir düzeyde düşük bir korelasyon izlendi (r=0.133, p=0.0001). Sonuç: Bu çalışma birinci trimesterde bakılan serum biyokimyasal belirteçlerinden serbest β-hCG ve PAPP-A değerlerinin bazı olumsuz gebelik komplikasyonlarını öngörmede faydalı olabileceğini göstermektedir.

Keywords

• birinci trimester
• biyobelirteçler
• β-hCG
• PAPP-A
• gebelik komplikasyonları

Prediction of Adverse Obstetric Outcomes by First Trimester Screening with Free β-hCG and PAPP-A: A Prospective Study of 889 Singleton Pregnancies

Abstract

Aim: We aimed to analyze the association of first-trimester screening biomarkers (PAPP-A and free β-hCG) that correspond specific percentile with adverse pregnancy outcomes, including preterm labor, preterm delivery, gestational diabetes mellitus (GDM), gestational hypertension, preeclampsia, low birth weight (LBW), small for gestational age (SGA), large for gestational age (LGA), intrauterine growth restriction (IUGR), macrosomia, and intrauterine exitus (IUEX). Materials and Method: This prospective study conducted between 1st May 2011 and 1st May 2012 at Gazi University Faculty of Medicine, Turkey. We recruited only singleton pregnancies. The first-trimester screening test was performed between 11-14 weeks of gestation. Results: Eight hundred eighty-nine of them met the inclusion criteria for our study. The median age was 29 (26-33) years. Median free β-hCG MoM and PAPP-A MoM were 1.0 (0.7 - 1.48) and 1.04 (0.73 - 1.46), respectively. The most common adverse obstetric outcomes were preterm labor 164 (18.4%), threatened abortion 95 (10.7%), and GDM 75 (8.4%). There was a linear trend with PAPP-A MoM and SGA, LBW, preterm delivery (p=<0.0000001, 0.033, and 0.03, respectively). When PAPP-A MoM results were categorized under three groups as ≤0.42 (5th percentile), >2.5 (95th percentile), and 0.73-1.47 (25th -75th), a significant difference between there groups were detected for SGA (<0.0000001), LBW (0.01), IUEX (0.00005), preterm labor (0.002), IUGR (0.006). Only preterm labor showed a significant linear trend for β-hCG MoM values (p =0.007). However, this significance was not detected when β-hCG MoM values were categorized as ≤0.40 (5th percentile), >2.9 (95th percentile), and 0.75-1.49 (25th -75th) (p=0.47). The correlation coefficient of birth weight and PAPP-A MoM was 0.133, which is negligible (p=0.0001). Conclusion: Our study suggested the possibility of predicting the women with the risk of adverse obstetric outcomes by using first-trimester screening biomarkers, namely maternal free β-hCG, and PAPP-A levels.

Keywords

• first trimester
• biomarkers
• β-hCG
• PAPP-A
• pregnancy complications

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