THE ROLE OF BIOCHEMICAL MARKERS OF FIRST TRIMESTER TRISOMY SCREENING TEST IN THE PREDICTION OF GESTATIONAL DIABETES MELLITUS

Yıl 2018, Cilt: 49 Sayı: 1, 6 - 8, 05.03.2018

Çiğdem Yayla Abide

https://doi.org/10.16948/zktipb.378683

Öz

Objective: To
investigate the potential advantage of routinely examined biochemical markers;
PAPP-A (pregnancy related plasma protein A) and 
ßHCG values, in the first trimester screening test for the screening and
early diagnosis of gestational diabetes mellitus (GDM) disease that occured in
the following weeks of pregnancy without bringing any additional cost.

Material
and Method: This study was designed as a retrospective cohort study. In
this study singleton pregnancies were included whose first trimester trisomy
screening tests were examined in our hospital and also deliviries of them took
place in our hospital with the routine pregnancy follow up between January 2014
– December 2016. The pregnancies were divided into two groups as GDM and
control group. The functional role of biochemical markers ( PAPP-A (MoM), ßhcg (MoM)) in
the first trimester screening test were investigated for early diagnosis of GDM
which appeared in the later gestational weeks of pregnancy.

Results: In
the GDM group; maternal age, the number of pregnancies, parity, abort and
living children were found significantly high, according to the control group (p<0.05). Statistically significant
difference was not observed between PAPP-A (MoM), ßhcg (MoM), NT (mm) ve NT
(MoM),  gestational week of delivery,
birth infant weight, APGAR 1.minute and APGAR 5.minute in the GDM group.

Conclusion: No statistically
significant relationship was established between biochemical markers of first
trimester screening test and GDM in this study. However, more patients and
carefully planned prospective studies are needed in this subject.

Anahtar Kelimeler

First trimester screening, gestational diabetes mellitus, pregnancy associated protein A

BİRİNCİ TRİMESTER TRİZOMİ TARAMA TESTİ BİYOKİMYASAL BELİRTEÇLERİNİN GESTASYONEL DİYABETES MELLİTUS ÖNGÖRÜSÜNDEKİ YERİ

Öz

Amaç: Gebelere rutinde
bakılan birinci trimester tarama testi biyokimyasal belirteçleri olan PAPP-A
(Gebelik ilişkili plazma protein A) ve ßhcg değerlerinin, ilerleyen gebelik
haftalarında gelişen gestasyonel diyabetes mellitus (GDM) hastalığının taranmasında
ve erken tanısında ek maliyet yaratmadan faydalanabilme potansiyelini
araştırmaktır.

Materyal ve Metod: Bu
çalışma retrospektif kohort bir çalışma olarak planlandı. Çalışmaya Ocak 2014 –
Aralık 2016 yılları arasında birinci trimester trizomi taraması hastanemizde
yapılan ve rutin gebelik takibine alınıp doğumunu yine hastanemizde gerçekleştirmiş
olan tekil gebeler dahil edilmiştir. Gebeler GDM ve kontrol grubu olarak iki gruba ayrılmıştır. Birinci
trimester tarama testi biyokimyasal belirteçlerinin ( PAPP-A (MoM), ßhcg (MoM))
ilerleyen gebelik haftalarında ortaya çıkan GDM’nin tanısının daha erken
konulmasında rolünün etkisi araştırılmıştır.

Bulgular: GDM grubunda,  kontrol grubuna göre, anne yaşı, gebelik
sayısı, parite, abortus ve yaşayan çocuk sayısı anlamlı olarak yüksek
bulunmuştur (p<0.05). GDM grubunda PAPP-A (MoM), ßhcg (MoM), NT (mm) ve NT
(MoM), doğumun gerçekleştiği gestasyonel hafta, bebek doğum ağırlığı, APGAR
1.dk ve APGAR 5.dk değerleri arasında istatistiksel olarak anlamlı bir fark
gözlenmemiştir.

Sonuç: Çalışmada birinci trimester tarama testi biyokimyasal
belirteçleri ile GDM arasında istatistiksel olarak anlamlı bir ilişki
saptanmamıştır. Ancak bu konuda daha çok hasta sayısı ve özenle planlanmış
prospektif çalışmalara ihtiyaç duyulmaktadır.

Anahtar Kelimeler

Birinci trimester tarama, gestasyonel diyabetes mellitus, gebelik ilişkili protein A

Kaynakça

• [1] Sweeting AN, Wong J, Appelblom H, Ross GP, Kouru H, Williams PF, et al. A first trimester prediction model for gestational diabetes utilizing aneuploidy and pre-eclampsia screening markers. J Matern Fetal Neonatal Med 2017:1–9. doi:10.1080/14767058.2017.1336759.
• [2] Sovio U, Murphy HR, Smith GCS. Accelerated Fetal Growth Prior to Diagnosis of Gestational Diabetes Mellitus: A Prospective Cohort Study of Nulliparous Women. Diabetes Care 2016;39:982–7. doi:10.2337/dc16-0160.
• [3] Logan KM, Emsley RJ, Jeffries S, Andrzejewska I, Hyde MJ, Gale C, et al. Development of Early Adiposity in Infants of Mothers With Gestational Diabetes Mellitus. Diabetes Care 2016;39:1045–51. doi:10.2337/dc16-0030.
• [4] Nanda S, Singhal SR, Papneja A. Induction of labour with intravaginal misoprostol and prostaglandin E2 gel: a comparative study. Trop Doct 2007;37:21–4. doi:10.1258/004947507779952032.
• [5] Smith GCS. First trimester origins of fetal growth impairment. Semin Perinatol 2004;28:41–50.
• [6] Ong CY, Liao AW, Spencer K, Munim S, Nicolaides KH. First trimester maternal serum free beta human chorionic gonadotrophin and pregnancy associated plasma protein A as predictors of pregnancy complications. BJOG 2000;107:1265–70.
• [7] 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;25:2230–3. doi:10.3109/14767058.2012.684170.
• [8] 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;100:340–7. doi:10.1016/j.diabres.2013.04.002.
• [9] Chelius D, Conover CA, Baldwin MA, Spencer EM. Characterization of the enzymatic specificity of the IGF-dependent insulin-like growth factor binding protein-4 (IGFBP-4) protease. Growth Horm IGF Res 2000;10:360–6. doi:10.1054/GHIR.2000.0177.
• [10] Lawrence JB, Oxvig C, Overgaard MT, Sottrup-Jensen L, Gleich GJ, Hays LG, et al. The insulin-like growth factor (IGF)-dependent IGF binding protein-4 protease secreted by human fibroblasts is pregnancy-associated plasma protein-A. Proc Natl Acad Sci U S A 1999;96:3149–53. doi:10.1073/PNAS.96.6.3149.
• [11] Gomes MS, Carlos-Alves M, Trocado V, Arteiro D, Pinheiro P. Prediction of adverse pregnancy outcomes by extreme values of first trimester screening markers. Obstet Med 2017;10:132–7. doi:10.1177/1753495X17704799.
• [12] Dugoff L, Hobbins JC, Malone FD, Porter TF, Luthy D, Comstock CH, et al. 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;191:1446–51. doi:10.1016/j.ajog.2004.06.052.
• [13] Krantz D, Goetzl L, Simpson JL, Thom E, Zachary J, Hallahan TW, et al. Association of extreme first-trimester free human chorionic gonadotropin-beta, pregnancy-associated plasma protein A, and nuchal translucency with intrauterine growth restriction and other adverse pregnancy outcomes. Am J Obstet Gynecol 2004;191:1452–8. doi:10.1016/j.ajog.2004.05.068.
• [14] Smith GCS, Stenhouse EJ, Crossley JA, Aitken DA, Cameron AD, Connor JM. Early pregnancy levels of pregnancy-associated plasma protein a and the risk of intrauterine growth restriction, premature birth, preeclampsia, and stillbirth. J Clin Endocrinol Metab 2002;87:1762–7. doi:10.1210/jcem.87.4.8430.
• [15] Spencer K, Yu CKH, Cowans NJ, Otigbah C, Nicolaides KH. Prediction of pregnancy complications by first-trimester maternal serum PAPP-A and free β-hCG and with second-trimester uterine artery Doppler. Prenat Diagn 2005;25:949–53. doi:10.1002/pd.1251.
• [16] Sirikunalai P, Wanapirak C, Sirichotiyakul S, Tongprasert F, Srisupundit K, Luewan S, et al. Associations between maternal serum free beta human chorionic gonadotropin ( β -hCG ) levels and adverse pregnancy outcomes Associations between maternal serum free beta human chorionic gonadotropin ( b -hCG ) levels and adverse pregnancy outcomes 2015;3615. doi:10.3109/01443615.2015.1036400.
• [17] Luchi C, Schifano M, Nanini C, Di Cianni G, Lencioni C, Genazzani AR. Does nuchal translucency thickness in the first trimester predict GDM onset during pregnancy? Gynecol Endocrinol 2011;27:782–4. doi:10.3109/09513590.2010.538101.