Laboratory for Infectious Diseases and Screening, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
BJOG. 2011 May;118(6):748-54. doi: 10.1111/j.1471-0528.2011.02904.x. Epub 2011 Feb 18.
To evaluate the value of first trimester placental biomarkers (fβ-hCG, PAPP-A, ADAM12, PP13 and PlGF) and fetal nuchal translucency (NT) in the prediction of macrosomia at birth in pregestational type-1 and type-2 diabetes (PGDM).
Nested case-control study.
Routine first-trimester combined test.
A total of 178 PGDM and 186 control pregnancies.
ADAM12, PP13 and PlGF concentrations were measured in stored first-trimester serum, previously tested for fβ-hCG and PAPP-A. All concentrations were expressed as multiples of the median (MoM). Where applicable, the median MoMs of PGDM and control pregnancies were compared in relation to birthweight centiles (≤90th centile, non-macrosomic, versus >90th centile, macrosomic). Model-predicted detection rates for fixed false-positive rates were obtained for statistically significant markers, separately and in combination.
Prediction of macrosomia in diabetic pregnancies.
In the PGDM group, median ADAM12 MoM (0.88; P = 0.007) was lower than in the controls. Subgroup analyses showed that median MoMs of PAPP-A (0.65), ADAM12 (0.85), PP13 (0.81) and PlGF (0.91) were only reduced in the PGDM non-macrosomic birthweight subgroup (n = 93) compared with other weight subgroups. In the PGDM macrosomic birthweight subgroup (n = 69), MoMs of all markers were comparable with the control birthweight subgroups. The screening performance for macrosomia at birth in the PGDM group provided a detection rate of 30% for a 5% false-positive rate (FPR) and 43% for a 10% FPR.
Macrosomia at birth in PGDM pregnancies may be predicted by normal levels of PAPP-A, ADAM12, PP13 and PlGF already in the first trimester of pregnancy. Fetal birthweight in PGDM offspring is partially determined by placental development during the first trimester of pregnancy. The present increase in fetal macrosomia may be related to better early glycemic control and placentation.
评估孕早期胎盘生物标志物（β-hCG、PAPP-A、ADAM12、PP13 和 PlGF）和胎儿颈项透明层（NT）在预测孕前 1 型和 2 型糖尿病（PGDM）患者出生巨大儿中的价值。
巢式病例对照研究。
常规孕早期联合筛查。
共纳入 178 例 PGDM 孕妇和 186 例对照孕妇。
在之前检测过 fβ-hCG 和 PAPP-A 的储存的孕早期血清中测量 ADAM12、PP13 和 PlGF 浓度。所有浓度均表示为中位数倍数（MoM）。在适用的情况下，比较 PGDM 和对照组孕妇的 MoM 中位数与出生体重百分位（≤第 90 百分位，非巨大儿，与>第 90 百分位，巨大儿）的关系。分别和联合应用统计学上显著的标志物，获得固定假阳性率的模型预测检出率。
预测糖尿病孕妇的巨大儿。
在 PGDM 组中，ADAM12 MoM 中位数（0.88；P=0.007）低于对照组。亚组分析显示，PGDM 非巨大儿出生体重亚组（n=93）的 PAPP-A（0.65）、ADAM12（0.85）、PP13（0.81）和 PlGF（0.91）MoM 中位数与其他体重亚组相比降低。在 PGDM 巨大儿出生体重亚组（n=69）中，所有标志物的 MoM 与对照组的出生体重亚组相似。PGDM 组出生巨大儿的筛查性能在 5%假阳性率（FPR）时提供 30%的检出率，在 10% FPR 时提供 43%的检出率。
PGDM 孕妇妊娠早期 PAPP-A、ADAM12、PP13 和 PlGF 水平正常可预测出生时巨大儿。PGDM 后代的胎儿出生体重部分由妊娠早期胎盘发育决定。目前胎儿巨大儿的增加可能与更好的早期血糖控制和胎盘形成有关。
