Klinik Araştırma
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Can First Trimester Plasma Protein A Level Predict Gestational Diabetes Mellitus

Yıl 2025, , 240 - 244, 15.01.2025
https://doi.org/10.37990/medr.1598384

Öz

Aim: Gestational diabetes mellitus (GDM), a condition with multifactorial etiology and adverse perinatal consequences, affects approximately 15% of pregnancies globally, with higher prevalence in certain populations, such as Türkiye. The role of pregnancy-associated plasma protein-A (PAPP-A) on GDM risk remains unclear. This prospective study aimed to assess whether first-trimester maternal PAPP-A levels are predictive of GDM.
Material and Method: This study involved 573 singleton pregnancies in women aged 18 to 45 years, conducted at a tertiary maternity hospital. PAPP-A and free β-hCG were assessed, and GDM screening was carried out using a 75 g oral glucose tolerance test. Comprehensive statistical analyses were applied to evaluate the findings.
Results: Of the participants, 28.09% were diagnosed with GDM. GDM group exhibited significantly lower PAPP-A MoM levels compared to controls (p=0.042). ROC analysis revealed limited predictive utility, with a PAPP-A threshold of 0.99 demonstrating 52.3% sensitivity and 51.7% specificity. Logistic regression identified low PAPP-A levels, advanced maternal age, and higher body mass index (BMI) as independent GDM risk factors.
Conclusion: While the findings underscore a potential association between PAPP-A levels and GDM, the predictive capacity of PAPP-A alone is modest. Future research should explore integrated predictive models incorporating PAPP-A and other biomarkers for improved early GDM screening.

Etik Beyan

The research protocol received approval from the Local Ethics Committee (approval number E2-21-513).

Destekleyen Kurum

No

Teşekkür

No

Kaynakça

  • Yanachkova V, Staynova R, Stankova T, Kamenov Z. Placental growth factor and pregnancy-associated plasma protein-A as potential early predictors of gestational diabetes mellitus. Medicina (Kaunas). 2023;59:398.
  • American Diabetes Association Professional Practice Committee. 2. classification and diagnosis of diabetes: standards of medical care in diabetes-2022. Diabetes Care. 2022;45:S17-38.
  • Modzelewski R, Stefanowicz-Rutkowska MM, Matuszewski W, Bandurska-Stankiewicz EM. Gestational diabetes mellitus-recent literature review. J Clin Med. 2022;11:5736.
  • Aktün HL, Uyan D, Yorgunlar B, et al. Gestational diabetes mellitus screening and outcomes. J Turk Ger Gynecol Assoc. 2015;16:25-9.
  • Balık G, Şahin Baydur S, Tekin Bayoğlu Y, et al. The prevalence of gestational diabetes mellitus in pregnants who applied to the maternity outpatient clinic of a university hospital. EJM. 2016;55:55-8.
  • Karaçam Z, Çelİk D. The prevalence and risk factors of gestational diabetes mellitus in Turkey: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2021;34:1331-41.
  • Sezer H, Yazici D, Canbaz HB, et al. The frequency of acceptance of oral glucose tolerance test in Turkish pregnant women: a single tertiary center results. North Clin Istanb. 2022;9:140-8.
  • Patil M, Panchanadikar TM, Wagh G. Variation of papp-a level in the first trimester of pregnancy and its clinical outcome. J Obstet Gynaecol India. 2014;64:116-9.
  • Wu YT, Zhang CJ, Mol BW, et al. Early prediction of gestational diabetes mellitus in the Chinese population via advanced machine learning. J Clin Endocrinol Metab. 2021;106:e1191-205.
  • Saruhan Z, Ozekinci M, Simsek M, et al. Association of first trimester low PAPP-A levels with adverse pregnancy outcomes. Clin Exp Obstet Gynecol. 2012;39:225-8.
  • Petry CJ, Hughes IA, Ong KK. Increased basal insulin sensitivity in late pregnancy in women carrying a male fetus: a cohort study. Biol Sex Differ. 2022;13:20.
  • Rojas-Rodriguez R, Ziegler R, DeSouza T, et al. PAPPA-mediated adipose tissue remodeling mitigates insulin resistance and protects against gestational diabetes in mice and humans. Sci Transl Med. 2020;12:eaay4145.
  • Savvidou MD, Syngelaki A, Muhaisen M, et al. First trimester maternal serum free β-human chorionic gonadotropin and pregnancy-associated plasma protein A in pregnancies complicated by diabetes mellitus. Bjog. 2012;119:410-6.
  • Cheuk QK, Lo TK, Wong SF, et al. Association between pregnancy-associated plasma protein- A levels in the first trimester and gestational diabetes mellitus in Chinese women. Hong Kong Med J. 2016;22:30-8.
  • Visconti F, Quaresima P, Chiefari E, et al. First trimester combined test (FTCT) as a predictor of gestational diabetes mellitus. Int J Environ Res Public Health. 2019;16:3654.
  • Sweeting AN, Wong J, Appelblom H, et al. A novel early pregnancy risk prediction model for gestational diabetes mellitus. Fetal Diagn Ther. 2019;45:76-84.
  • Borna S, Ashrafzadeh M, Ghaemi M, et al. Correlation between PAPP-A serum levels in the first trimester of pregnancy with the occurrence of gestational diabetes, a multicenter cohort study. BMC Pregnancy Childbirth. 2023;23:847.
  • Gastaldelli A, Gaggini M, DeFronzo RA. Role of adipose tissue insulin resistance in the natural history of type 2 diabetes: results from the San Antonio metabolism study. Diabetes. 2017;66:815-22.
  • Caliskan R, Atis A, Aydin Y, et al. PAPP-A concentrations change in patients with gestational diabetes. Journal of Obstetrics and Gynaecology. 2020;40:190-4.
  • Takele WW, Vesco KK, Josefson J, et al. Effective interventions in preventing gestational diabetes mellitus: a systematic review and meta-analysis. Commun Med (Lond). 2024;4:75.
  • Xiao D, Chenhong W, Yanbin X, et al. Gestational diabetes mellitus and first trimester pregnancy-associated plasma protein A: a case-control study in a Chinese population. J Diabetes Investig. 2018;9:204-10.
  • Ramezani S, Doulabi MA, Saqhafi H, et al. Prediction of gestational diabetes by measuring the levels of pregnancy associated plasma protein-A (PAPP-A) during gestation weeks 11-14. J Reprod Infertil. 2020;21:130-7.
  • Ren Z, Zhe D, Li Z, et al. Study on the correlation and predictive value of serum pregnancy- associated plasma protein A, triglyceride and serum 25-hydroxyvitamin D levels with gestational diabetes mellitus. World J Clin Cases. 2020;8:864-73.
  • Talasaz ZH, Sadeghi R, Askari F, et al. First trimesters pregnancy-associated plasma protein-A levels value to predict gestational diabetes mellitus: a systematic review and meta-analysis of the literature. Taiwan J Obstet Gynecol. 2018;57:181-9.
  • Yanachkova VE, Staynova R, Bochev I, et al. Potential role of biochemical placentation markers - pregnancy associated plasma protein-A and human chorionic gonadotropin for early gestational diabetes screening - a pilot study. Ginekol Pol. 2021 Sep 20. doi: 10.5603/GP.a2021.0129. [Epub ahead of print].
  • Husslein H, Lausegger F, Leipold H, et al. 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;25:2230-3.
  • Kantomaa T, Vääräsmäki M, Gissler M, et al. First trimester maternal serum PAPP-A and free β-hCG levels and risk of SGA or LGA in women with and without GDM. BMC Pregnancy Childbirth. 2024;24:580.
  • Leung TY, Spencer K, Leung TN, et al. Higher median levels of free β-hCG and PAPP-A in the first trimester of pregnancy in a chinese ethnic group: implication for first trimester combined screening for down’s syndrome in the Chinese population. Fetal Diagn Ther. 2005;21:140-3.
Yıl 2025, , 240 - 244, 15.01.2025
https://doi.org/10.37990/medr.1598384

Öz

Kaynakça

  • Yanachkova V, Staynova R, Stankova T, Kamenov Z. Placental growth factor and pregnancy-associated plasma protein-A as potential early predictors of gestational diabetes mellitus. Medicina (Kaunas). 2023;59:398.
  • American Diabetes Association Professional Practice Committee. 2. classification and diagnosis of diabetes: standards of medical care in diabetes-2022. Diabetes Care. 2022;45:S17-38.
  • Modzelewski R, Stefanowicz-Rutkowska MM, Matuszewski W, Bandurska-Stankiewicz EM. Gestational diabetes mellitus-recent literature review. J Clin Med. 2022;11:5736.
  • Aktün HL, Uyan D, Yorgunlar B, et al. Gestational diabetes mellitus screening and outcomes. J Turk Ger Gynecol Assoc. 2015;16:25-9.
  • Balık G, Şahin Baydur S, Tekin Bayoğlu Y, et al. The prevalence of gestational diabetes mellitus in pregnants who applied to the maternity outpatient clinic of a university hospital. EJM. 2016;55:55-8.
  • Karaçam Z, Çelİk D. The prevalence and risk factors of gestational diabetes mellitus in Turkey: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2021;34:1331-41.
  • Sezer H, Yazici D, Canbaz HB, et al. The frequency of acceptance of oral glucose tolerance test in Turkish pregnant women: a single tertiary center results. North Clin Istanb. 2022;9:140-8.
  • Patil M, Panchanadikar TM, Wagh G. Variation of papp-a level in the first trimester of pregnancy and its clinical outcome. J Obstet Gynaecol India. 2014;64:116-9.
  • Wu YT, Zhang CJ, Mol BW, et al. Early prediction of gestational diabetes mellitus in the Chinese population via advanced machine learning. J Clin Endocrinol Metab. 2021;106:e1191-205.
  • Saruhan Z, Ozekinci M, Simsek M, et al. Association of first trimester low PAPP-A levels with adverse pregnancy outcomes. Clin Exp Obstet Gynecol. 2012;39:225-8.
  • Petry CJ, Hughes IA, Ong KK. Increased basal insulin sensitivity in late pregnancy in women carrying a male fetus: a cohort study. Biol Sex Differ. 2022;13:20.
  • Rojas-Rodriguez R, Ziegler R, DeSouza T, et al. PAPPA-mediated adipose tissue remodeling mitigates insulin resistance and protects against gestational diabetes in mice and humans. Sci Transl Med. 2020;12:eaay4145.
  • Savvidou MD, Syngelaki A, Muhaisen M, et al. First trimester maternal serum free β-human chorionic gonadotropin and pregnancy-associated plasma protein A in pregnancies complicated by diabetes mellitus. Bjog. 2012;119:410-6.
  • Cheuk QK, Lo TK, Wong SF, et al. Association between pregnancy-associated plasma protein- A levels in the first trimester and gestational diabetes mellitus in Chinese women. Hong Kong Med J. 2016;22:30-8.
  • Visconti F, Quaresima P, Chiefari E, et al. First trimester combined test (FTCT) as a predictor of gestational diabetes mellitus. Int J Environ Res Public Health. 2019;16:3654.
  • Sweeting AN, Wong J, Appelblom H, et al. A novel early pregnancy risk prediction model for gestational diabetes mellitus. Fetal Diagn Ther. 2019;45:76-84.
  • Borna S, Ashrafzadeh M, Ghaemi M, et al. Correlation between PAPP-A serum levels in the first trimester of pregnancy with the occurrence of gestational diabetes, a multicenter cohort study. BMC Pregnancy Childbirth. 2023;23:847.
  • Gastaldelli A, Gaggini M, DeFronzo RA. Role of adipose tissue insulin resistance in the natural history of type 2 diabetes: results from the San Antonio metabolism study. Diabetes. 2017;66:815-22.
  • Caliskan R, Atis A, Aydin Y, et al. PAPP-A concentrations change in patients with gestational diabetes. Journal of Obstetrics and Gynaecology. 2020;40:190-4.
  • Takele WW, Vesco KK, Josefson J, et al. Effective interventions in preventing gestational diabetes mellitus: a systematic review and meta-analysis. Commun Med (Lond). 2024;4:75.
  • Xiao D, Chenhong W, Yanbin X, et al. Gestational diabetes mellitus and first trimester pregnancy-associated plasma protein A: a case-control study in a Chinese population. J Diabetes Investig. 2018;9:204-10.
  • Ramezani S, Doulabi MA, Saqhafi H, et al. Prediction of gestational diabetes by measuring the levels of pregnancy associated plasma protein-A (PAPP-A) during gestation weeks 11-14. J Reprod Infertil. 2020;21:130-7.
  • Ren Z, Zhe D, Li Z, et al. Study on the correlation and predictive value of serum pregnancy- associated plasma protein A, triglyceride and serum 25-hydroxyvitamin D levels with gestational diabetes mellitus. World J Clin Cases. 2020;8:864-73.
  • Talasaz ZH, Sadeghi R, Askari F, et al. First trimesters pregnancy-associated plasma protein-A levels value to predict gestational diabetes mellitus: a systematic review and meta-analysis of the literature. Taiwan J Obstet Gynecol. 2018;57:181-9.
  • Yanachkova VE, Staynova R, Bochev I, et al. Potential role of biochemical placentation markers - pregnancy associated plasma protein-A and human chorionic gonadotropin for early gestational diabetes screening - a pilot study. Ginekol Pol. 2021 Sep 20. doi: 10.5603/GP.a2021.0129. [Epub ahead of print].
  • Husslein H, Lausegger F, Leipold H, et al. 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;25:2230-3.
  • Kantomaa T, Vääräsmäki M, Gissler M, et al. First trimester maternal serum PAPP-A and free β-hCG levels and risk of SGA or LGA in women with and without GDM. BMC Pregnancy Childbirth. 2024;24:580.
  • Leung TY, Spencer K, Leung TN, et al. Higher median levels of free β-hCG and PAPP-A in the first trimester of pregnancy in a chinese ethnic group: implication for first trimester combined screening for down’s syndrome in the Chinese population. Fetal Diagn Ther. 2005;21:140-3.
Toplam 28 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Kadın Hastalıkları ve Doğum
Bölüm Özgün Makaleler
Yazarlar

Sema Baki Yıldırım 0000-0001-5321-0739

Neslihan Bezirganoglu Altuntas 0000-0002-6352-4085

Ali Muhtaroğlu 0000-0001-5412-2175

Mehmet Albayrak 0000-0002-2371-6437

Yayımlanma Tarihi 15 Ocak 2025
Gönderilme Tarihi 8 Aralık 2024
Kabul Tarihi 2 Ocak 2025
Yayımlandığı Sayı Yıl 2025

Kaynak Göster

AMA Baki Yıldırım S, Bezirganoglu Altuntas N, Muhtaroğlu A, Albayrak M. Can First Trimester Plasma Protein A Level Predict Gestational Diabetes Mellitus. Med Records. Ocak 2025;7(1):240-244. doi:10.37990/medr.1598384

 Chief Editors

Assoc. Prof. Zülal Öner
Address: İzmir Bakırçay University, Department of Anatomy, İzmir, Turkey

Assoc. Prof. Deniz Şenol
Address: Düzce University, Department of Anatomy, Düzce, Turkey

Editors
Assoc. Prof. Serkan Öner
İzmir Bakırçay University, Department of Radiology, İzmir, Türkiye

E-mail: medrecsjournal@gmail.com

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