Is it possible that biochemical markers in first-trimester screening test predict gestational diabetes mellitus?

Year 2024, Volume: 17 Issue: 1, 119 - 129, 30.04.2024

Yusuf Dal , Sebnem Karagun , Fatih Akkuş , Hakan Aytan , Ayhan Coskun

Abstract

Aim: Early diagnosis and treatment are critical to minimize the complications of gestational diabetes mellitus (GDM). Therefore, the present study aimed to determine whether first-trimester screening test biochemical markers could be an early predictive model for GDM. Method: This retrospective study was performed by accessing the electronic media data of 116 pregnant women who underwent first-trimester screening tests at the 11th-14th weeks of gestation and were diagnosed with GDM at the 24th-28th weeks and 65 pregnant women who did not receive this diagnosis. Demographic characteristics of GDM and control groups, first-trimester screening test biochemical markers, oral glucose tolerance test (OGTT), and hemoglobin A1c values were recorded, and intergroup comparison was made. Results: There was no statistically significant difference between the groups regarding first-trimester biochemical markers (p>0.05). A negative correlation was determined between pregnancy-associated plasma protein A (PAPP-A) and free beta- human chorionic gonadotropin (β-HCG) multiple of median (MoM) values and OGTT fasting value (p<0.05). Conclusion: In this study, we concluded that first-trimester biochemical markers could not predict the development of GDM.

Keywords

Gestational diabetes mellitus, first-trimester screening test, pregnancy-associated plasma protein A, human chorionic gonadotropin, oral glucose tolerance test

Birinci trimester tarama testindeki biyokimyasal belirteçlerin gestasyonel diabetes mellitusu öngörmesi mümkün mü?

Abstract

Amaç: Gestasyonel diabetes mellitus (GDM) komplikasyonlarını en aza indirmek için erken tanı ve tedavi önemlidir. Bu nedenle bu çalışmada birinci trimester tarama testi biyokimyasal belirteçlerinin GDM için erken öngörü modeli olup olamayacağını belirlemeyi hedefledik. Yöntem: Bu retrospektif çalışma 11-14. gebelik haftasında birinci trimester tarama testi yapılan ve 24-28. gebelik haftasında GDM tanısı konulan 116 gebe ile bu tanıyı almayan 65 gebenin elektronik ortamda verilerine ulaşılarak yapıldı. GDM ve kontrol grubunun demografik özellikleri ile birlikte birinci trimester tarama testi biyokimyasal belirteçleri, oral glukoz tolerans testi (OGTT) ve hemoglobin A1c değerleri kaydedildi ve gruplar arası karşılaştırması yapıldı. Bulgular: Gruplar arasında birinci trimester biyokimyasal belirteçleri arasında istatistiksel olarak anlamlı bir fark yoktu (p>0.05). Gebelikle ilişkili plazma protein A (PAPP-A) ve serbest beta- insan koryonik gonadotropin (β-hCG) medyan kat sayısı (MoM) değerleri ile OGTT açlık değeri arasında negatif yönde bir korelasyon saptandı (p<0.05). Sonuç: Çalışmamızda birinci trimester biyokimyasal belirteçlerinin, gelişecek GDM’ yi öngöremeyeceği sonucuna vardık.

Keywords

Gestasyonel diabetes mellitus, birinci trimester tarama testi, gebelikle ilişkili plazma protein A, insan koryonik gonadotropin, oral glukoz tolerans testi

References

• Chiefari E, Arcidiacono B, Foti D, Brunetti A. Gestational diabetes mellitus: an updated overview. Journal of endocrinological investigation. 2017;40(9):899-909.
• Bellamy L, Casas J-P, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. The Lancet. 2009;373(9677):1773-9.
• Sacks DA, Hadden DR, Maresh M, Deerochanawong C, Dyer AR, Metzger BE, et al. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel–recommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Diabetes care. 2012;35(3):526-8.
• Group HSCR. Hyperglycemia and adverse pregnancy outcomes: the HAPO study cooperative research group. Obstetrical & Gynecological Survey. 2008;63(10):615-6.
• Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676-82.
• Wright D, Spencer K, Kagan K K, Tørring N, Petersen OB, Christou A, et al. First‐trimester combined screening for trisomy 21 at 7–14 weeks' gestation. Ultrasound in Obstetrics and Gynecology. 2010;36(4):404-11.
• Nicolaides K, Spencer K, Avgidou K, Faiola S, Falcon O. Multicenter study of first‐trimester screening for trisomy 21 in 75 821 pregnancies: results and estimation of the potential impact of individual risk‐orientated two‐stage first‐trimester screening. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2005;25(3):221-6.
• Kagan K, Wright D, Spencer K, Molina F, Nicolaides K. First‐trimester screening for trisomy 21 by free beta‐human chorionic gonadotropin and pregnancy‐associated plasma protein‐A: impact of maternal and pregnancy characteristics. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2008;31(5):493-502.
• Giudice L, Conover C, Bale L, Faessen G, Ilg K, Sun I, et al. Identification and regulation of the IGFBP-4 protease and its physiological inhibitor in human trophoblasts and endometrial stroma: evidence for paracrine regulation of IGF-II bioavailability in the placental bed during human implantation. The Journal of Clinical Endocrinology & Metabolism. 2002;87(5):2359-66.
• Spencer K, Cowans N, Chefetz I, Tal J, Meiri H. First‐trimester maternal serum PP‐13, PAPP‐A and second‐trimester uterine artery Doppler pulsatility index as markers of pre‐eclampsia. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2007;29(2):128-34.
• Pummara P, Tongsong T, Wanapirak C, Sirichotiyakul S, Luewan S. Association of first-trimester pregnancy-associated plasma protein A levels and idiopathic preterm delivery: A population-based screening study. Taiwanese Journal of Obstetrics and Gynecology. 2016;55(1):72-5.
• Abdel Moety GAF, Almohamady M, Sherif NA, Raslana AN, Mohamed TF, El Moneam HMA, et al. Could first-trimester assessment of placental functions predict preeclampsia and intrauterine growth restriction? A prospective cohort study. The Journal of Maternal-Fetal & Neonatal Medicine. 2016;29(3):413-7.
• González González NL, Plasencia W, Gonzalez Davila E, Padrón E, di Renzo GC, Bartha JL. First and second trimester screening for large for gestational age infants. The Journal of Maternal-Fetal & Neonatal Medicine. 2013;26(16):1635-40.
• 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). American journal of obstetrics and gynecology. 2004;191(4):1446-51.
• Krantz D, Goetzl L, Simpson JL, Thom E, Zachary J, Hallahan TW, et al. Association of extreme first-trimester free human chorionic gonadotropin-β, pregnancy-associated plasma protein A, and nuchal translucency with intrauterine growth restriction and other adverse pregnancy outcomes. American journal of obstetrics and gynecology. 2004;191(4):1452-8.
• 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. Proceedings of the National Academy of Sciences. 1999;96(6):3149-53.
• 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: An International Journal of Obstetrics & Gynaecology. 2000;107(10):1265-70.
• Spencer K, Cowans NJ. The association between gestational diabetes mellitus and first trimester aneuploidy screening markers. Annals of clinical biochemistry. 2013;50(6):603-10.
• 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 diagnosis. 2011;31(6):523-8.
• Savvidou M, Syngelaki A, Muhaisen M, Emelyanenko E, Nicolaides K. First trimester maternal serum free β‐human chorionic gonadotropin and pregnancy‐associated plasma protein A in pregnancies complicated by diabetes mellitus. BJOG: An International Journal of Obstetrics & Gynaecology. 2012;119(4):410-6.
• Tul N, Pušenjak S, Osredkar J, Spencer K, Novak‐Antolič Ž. Predicting complications of pregnancy with first‐trimester maternal serum free‐βhCG, PAPP‐A and inhibin‐A. Prenatal Diagnosis: Published in Affiliation with the International Society for Prenatal Diagnosis. 2003;23(12):990-6.
• Visconti F, Quaresima P, Chiefari E, Caroleo P, Arcidiacono B, Puccio L, et al. First trimester combined test (FTCT) as a predictor of gestational diabetes mellitus. International Journal of Environmental Research and Public Health. 2019;16(19):3654.
• Ball S, Ekelund C, Wright D, Kirkegaard I, Nørgaard P, Petersen OB, et al. Temporal effects of maternal and pregnancy characteristics on serum pregnancy‐associated plasma protein‐A and free β‐human chorionic gonadotropin at 7–14 weeks' gestation. Ultrasound in obstetrics & gynecology. 2013;41(1):33-9.
• Peterson SE, Simhan HN. First-trimester pregnancy-associated plasma protein A and subsequent abnormalities of fetal growth. American journal of obstetrics and gynecology. 2008;198(5):e43-e5.
• Genc S, Ozer H, Emeklioglu CN, Cingillioglu B, Sahin O, Akturk E, et al. Relationship between extreme values of first trimester maternal pregnancy associated plasma Protein-A, free-β-human chorionic gonadotropin, nuchal translucency and adverse pregnancy outcomes. Taiwanese Journal of Obstetrics and Gynecology. 2022;61(3):433-40.
• Syngelaki A, Kotecha R, Pastides A, Wright A, Nicolaides KH. First-trimester biochemical markers of placentation in screening for gestational diabetes mellitus. Metabolism. 2015;64(11):1485-9.
• Morris RK, Bilagi A, Devani P, Kilby MD. Association of serum PAPP-A levels in first trimester with small for gestational age and adverse pregnancy outcomes: systematic review and meta-analysis. Prenat Diagn. 2017 Mar;37(3):253-265. doi: 10.1002/pd.5001. Epub 2017 Feb 17. PMID: 28012202.
• Liu Y, Guo F, Maraka S, Zhang Y, Zhang C, Korevaar TI, et al. Associations between human chorionic gonadotropin, maternal free Thyroxine, and gestational Diabetes mellitus. Thyroid. 2021;31(8):1282-8.
• Tul N, Pusenjak S, Osredkar J, Spencer K, Novak-Antolic Z. Predicting complications of pregnancy with first-trimester maternal serum free-betahCG, PAPP-A and inhibin-A. Prenat Diagn. 2003;23(12):990-6.
• Cheuk QK, Lo T, Wong S, Lee C. 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(1):30-8.
• 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. The Journal of Maternal-Fetal & Neonatal Medicine. 2012;25(11):2230-3.
• Savvidou MD, Syngelaki A, Muhaisen M. First trimester maternal serum free human chorionic gonadotropin and pregnancy-associated plasma protein A in.2011.
• Schaas C, Titianu M, Visinari R, Berescu A, Carp A, Onofriescu M. P06. 12: PAPP‐A—a marker for gestational diabetes? Ultrasound in Obstetrics & Gynecology. 2012;40(S1):192-.
• Spencer K, 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. Prenatal Diagnosis: Published in Affiliation With the International Society for Prenatal Diagnosis. 2005;25(10):927-9.
• 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 research and clinical practice. 2013;100(3):340-7.
• Pedersen J, Søorensen S, Mølsted-Pedersen L. Serum levels of human placental lactogen, pregnancy-associated plasma protein A and endometrial secretory protein PP14 in first trimester of diabetic pregnancy. Acta obstetricia et gynecologica Scandinavica. 1998;77(2):155-8.