Prediction of Gestational Diabetes Mellitus by Pregnancy Associated Plasma Protein-A and β-Human Chorionic Gonadotropins in First Trimester of Pregnancy

Abstract

Objective: The present study aims to assess pregnancy-associated plasma protein-A (PAPP-A) and beta human chorionic gonadotropins (β-hCG) as predictive markers to diagnose Gestational Diabetes Mellitus (GDM) in the first trimester of pregnancy in a population of India. Material and Methods A retrospective observational study was conducted, wherein the cohort of 975 pregnant women were enrolled. All the patients had first trimester aneuploidy screen and 171 pregnancies were diagnosed with GDM during pregnancy. Glucose challenge or tolerance test was carried out in each trimester for detection of GDM. Results The incidence of GDM was 17.4% in the cohort. The PAPP-A value (1.2 ± 0.69 vs 1.39 ± 0.80), age (30.1 ± 3.8 vs 28.4 ± 3.7 (years)), and Body Mass Index (24.09 ± 5.1 vs 21.71 ± 4.04) were significantly different in GDM group and non-GDM group respectively. The Receiver Operating Characteristic (ROC) curve provided the value of 0.57 as an area under the curve for the exclusion of GDM. A cutoff value of PAPP-A ≤0.95 MoM was found to have a sensitivity of 45% and a 70% specificity value for the diagnosis of GDM. The β-hCG values were statistically identical between GDM and non-GDM groups. Conclusion: This study demonstrates that PAPP-A MoM is inversely proportionate to GDM. The low normal value is associated with GDM. Hence, it can be a part of the early screening GDM tool but not sufficient as an individual screening test. Hence, glucose tolerance test is recommended for diagnosis of GDM. Pregnancies with GDM have decreased β-hCG, however, it was not significant.

Keywords

• gestational diabetes mellitus
• beta - human chorionic gonadotropins
• pregnancy associated plasma protein -a
• first-trimester aneuploidy screening