Relationship Between First Trimester Screening Test Biomarkers and Gestational Diabetes Mellitus

Yıl 2020, Cilt: 4 Sayı: 1, 41 - 45, 23.04.2020

Gokcen Orgul , Tan Ayık Dilek Şahin , Aykan Yücel

https://doi.org/10.25048/tudod.611537

Öz

Aim: Pregnancy-related plasma protein A (PAPP-A) and human chorionic gonadotropin free beta subunit (β-hCG) are used as
biochemical markers in first trimester Down Syndrome screening. The relationship between gestational diabetes mellitus (GDM) and
combined test results was investigated in this study.

Material and Methods: The study group consisted of 95 patients who were diagnosed as GDM and gave birth at our hospital between
1 August 2018 and 31 October 2018. The control group consisted of 100 patients who were delivered at term in our hospital, had no
additional disease or pregnancy complications with combined test results. First trimester serum β-hCG and PAPP-A levels of the
patients were compared.

Results: PAPP-A level and MoM value and β-hCG level and MoM value were lower in GDM group. (p value 0.013; 0.081; 0.001 and
0.007). The optimum cut-off value was 1.715 ng/mL (sensitivity 61%, specificity 22%) for PAPP-A and 0.905 (sensitivity 51.6%, specificity
39%) for PAPP-A MoM. The ideal cut-off value was 25.75 mIU/mL (sensitivity 56.8%, specificity 30%) for β-hCG and 0.745 (sensitivity
57.9%, specificity 28%) for β-hCG MoM.

Conclusion: PAPP-A and β-hCG levels were lower in GDM than healthy pregnant women. However, false positive rates for both PAPP-A
and β-hCG are quite high.

Anahtar Kelimeler

beta Subunit, gestational diabetes mellitus, pregnancy-associated plasma protein A, chorionic gonadotropin beta subunit, human

İlk Trimester Tarama Test Biyobelirteçlerinin Gestasyonel Diyabetes Mellitus İle İlişkisi

Öz

Amaç: İlk trimester Down Sendromu tarama testi olarak biyokimyasal belirteçler olan gebelik ile ilişkili plazma protein A (PAPP-A) ve
human koriyonik gonadotropin serbest beta alt birimi (β-hCG) kullanılmaktadır. Bu çalışmada gebeliğin ilk üç ayında yapılan kombine
test sonuçlarının gestasyonel diabetes mellitus (GDM) ile ilişkisi araştırılmıştır.

Gereç ve Yöntemler: Çalışma grubunu GDM tanısı alan ve doğumu 1 Ağustos 2018 ile 31 Ekim 2018 arasında hastanemizde gerçekleşen
95 hasta oluşturmaktaydı. Kontrol grubu için hastanemizde termde doğum yapan, ek hastalığı olmayan, gebelik komplikasyonu
saptanmayan ve kombine test sonuçlarına ulaşılabilen 100 hasta rastgele seçilmiştir. Gruplardaki hastaların ilk trimester serum β-hCG
ve PAPP-A düzeyleri karşılaştırılmıştır.

Bulgular: PAPP-A düzeyi ve MoM değeri ile β-hCG düzeyi ve MoM değeri GDM grubunda daha düşük saptanmıştır (sırasıyla, p=0,013,
p=0,081, p=0,001 ve p=0,007). En ideal kesme değeri PAPP-A için 1,715 ng/mL (duyarlılık %61 ve özgüllük %22) ve PAPP-A MoM
için 0,905 (duyarlılık %51,6 ve özgüllük %39) olarak bulundu. En ideal kesme değeri Β-hCG için 25,75 mIU/mL (duyarlılık %56,8 ve
özgüllük %30) ve β-hCG MoM için 0,745 (duyarlılık %57,9 ve özgüllük %28) olarak bulundu.

Sonuç: PAPP-A ve β-hCG düzeyleri GDM gelişenlerde sağlıklı gebelere kıyasla daha düşüktür. Ancak hem PAPP-A hem de β-hCG için
bulunan ideal kesme değerlerde yalancı pozitiflik oranları oldukça yüksektir.

Anahtar Kelimeler

Diyabet, gebelik, gebelik ilişkili plazma proteini A, Koryonik gonadotropin, Beta altünitesi, İnsan

Kaynakça

• 1. Wald NJ, Hackshaw AK. Combining ultrasound and biochemistry in first‐trimester screening for Down's syndrome. Prenat Diagn 1997;17(9):821-9.
• 2. Ökem ZG, ve ark. Economic analysis of prenatal screening strategies for Down syndrome in singleton pregnancies in Turkey. Eur J Obstet Gynecol Reprod Biol 2017;219:40-4.
• 3. Donovan BM, ve ark. First trimester prenatal screening biomarkers and gestational diabetes mellitus: A systematic review and meta-analysis. PloS one. 2018;13(7):e0201319.
• 4. Savvidou M, ve ark. 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.
• 5. Yaron Y, ve ark. First trimester maternal serum free human chorionic gonadotropin as a predictor of adverse pregnancy outcome. Fetal Diagn Ther 2002;17(6):352-6.
• 6. Ferrara A. Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes care 2007;30(Supplement 2):141-6.
• 7. Ayhan S, ve ark. Prognosis of Pregnancies with Different Degrees of Glucose Intolerance. Gynecology Obstetrics & Reproductive Medicine. 2016;19(2).
• 8. Dugoff L, ve ark. First-trimester maternal serum PAPP-A and free-beta subunit human chorionic gonadotropin concentrations and nuchal translucency are associated with obstetric complications: a population-based screening study (the FASTER Trial). Am J Obstet Gynecol 2004;191(4):1446-51.
• 9. Husslein H, ve ark. 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.
• 10. Tul N, ve ark. Predicting complications of pregnancy with first‐trimester maternal serum free‐βhCG, PAPP‐A and inhibin‐A. Prenat Diagn 2003;23(12):990-6.
• 11. Shiefa S, ve ark. First trimester maternal serum screening using biochemical markers PAPP-A and free β-hCG for down syndrome, patau syndrome and edward syndrome. Indian J Clin Biochem 2013;28(1):3-12.
• 12. Theofanakis C, ve ark. Human chorionic gonadotropin: the pregnancy hormone and more. Int J Mol Sci 2017;18(5):1059.
• 13. TC Sağlık Bakanlığı, Turkish Public Health Instutition, Department of Women's Reproductive Health). Doğum Öncesi Bakım Yönetim Rehberi (Antenatal Care Management Guideline). Ankara: 2014.
• 14. Irwin J, ve ark. Role of the IGF system in trophoblast invasion and pre-eclampsia. Hum reprod 1999;14(suppl_2):90-8.
• 15. Spencer K, Cowans NJ. The association between gestational diabetes mellitus and first trimester aneuploidy screening markers. Ann Clin Biochem. 2013;50(6):603-10.
• 16. Ong CY, ve ark. 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.