The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center), Institute of Ultrasound, Zerifin, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Arch Gynecol Obstet. 2019 Mar;299(3):655-663. doi: 10.1007/s00404-018-5010-3. Epub 2018 Dec 19.
To investigate the levels of maternal serum screening markers in the first and second trimester twin pregnancies, which subsequently developed gestational diabetes mellitus (GDM).
145 twin pregnancies were recruited in the first trimester. Stored blood samples were retrospectively tested for pregnancy-associated plasma protein (PAPP)-A, human chorionic gonadotrophin (hCG), placental growth factor (PlGF), placental protein (PP)13, α-fetoprotein (aFP) and inhibin A. Values were expressed in multiples of the gestation-specific median (MoMs) in singletons, adjusted for maternal weight and parity, as appropriate.
Twenty samples of first and second trimester were available from 11 twins who subsequently developed GDM and 219 samples from unaffected twins. The median PAPP-A level in the affected twins was 3.61 MoM compared with 2.46 MoM in unaffected twins (P < 0.001, Wilcoxon rank sum test, two tailed); significant results were found in both trimesters. The median PP13 was also increased but to a lesser extent. It was only statistically significant overall (P < 0.05) and in second trimester samples (P < 0.02). No other marker differed significantly. Logistic regression found that combining PAPP-A and maternal weight had a 55% detection rate for a 10% false-positive rate.
Early prenatal marker evaluation in twin pregnancies can be also useful for predicting the risk for developing GDM and should be further investigated.
研究随后发生妊娠期糖尿病（GDM）的双胎妊娠孕妇在孕早期和孕中期的血清筛查标志物水平。
本研究共纳入 145 例双胎妊娠孕妇。对储存的血样进行回顾性检测，以检测妊娠相关血浆蛋白（PAPP）-A、人绒毛膜促性腺激素（hCG）、胎盘生长因子（PlGF）、胎盘蛋白 13（PP13）、甲胎蛋白（aFP）和抑制素 A。将值表示为与单胎妊娠相比，经产妇体重和产次调整后的倍数中位数（MoMs）。
11 例随后发生 GDM 的双胎妊娠孕妇中有 20 例获得了孕早期和孕中期的样本，219 例样本来自未受影响的双胎妊娠孕妇。受影响的双胎妊娠孕妇的 PAPP-A 中位数水平为 3.61 MoM，而未受影响的双胎妊娠孕妇的 PAPP-A 中位数水平为 2.46 MoM（P<0.001，Wilcoxon 秩和检验，双侧）；在两个孕期均发现了显著差异。PP13 的中位数也升高，但程度较轻。总体上（P<0.05）和在孕中期样本中（P<0.02）差异有统计学意义。其他标志物无明显差异。Logistic 回归发现，PAPP-A 和产妇体重相结合的检测率为 55%，假阳性率为 10%。
对双胎妊娠孕妇进行早期产前标志物评估也可用于预测发生 GDM 的风险，值得进一步研究。
