Karaaslan Onur, Seckin Kerem D, Kadirogullari Pinar, Kiyak Huseyin, Bestel Melih, Simsek Erkan, Aydin Alev A
Department of Obstetric and Gynecology, Hakkari State Hospital, Hakkari, Turkey.
Department of Obstetric and Gynecology, University of İstanbul Sağlık Bilimleri, Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey.
J Obstet Gynaecol. 2020 Feb;40(2):200-204. doi: 10.1080/01443615.2019.1621809. Epub 2019 Jul 26.
This study aimed to investigate if the pregnancy associated plasma Protein-A (PAPP-A) multiples of median (MoM) levels could be used as a marker for the early prediction of RDS. The present study was designed with data gathered from 1773 patients who were referred to our institution for first trimester fetal chromosomal anomaly screening. First trimester PAPP-A MoM values and postnatal RDS occurrences in these pregnancies were retrospectively analysed. Of the 1773 neonates that were included in the study, 28 were delivered at or beyond 37 weeks, and 42 were delivered less than 37 weeks of gestation. In the group of neonates at or beyond 37 weeks, the cut-off value for RDS prediction was determined as 1.02. For this cut-off value, sensitivity was 72.41% and specificity was 91.84%. The area under curve (AUC) was determined to be statistically significant ( < .01). In conclusion, it was determined that in neonates that were delivered at or beyond 37 weeks of gestation, RDS occurrence could be predicted at a significant rate by utilising PAPP-A MoM values.IMPACT STATEMENT Respiratory distress syndrome (RDS) is one of the major global healthcare problems, and continues to effect newborns despite the improvements in diagnosis and treatments of the disease. Studies have shown that pregnancy associated plasma protein-A (PAPP-A) has a critical role in cellular proliferation and differentiation, and it is closely associated with many physiological and pathological processes via regulation of local insulin like growth factor (IGF) concentrations. In majority of the past studies in the literature regarding PAPP-A values in pregnancies, the association between low values of PAPP-A MoM and maternal-fetal complications were investigated. This study retrospectively examines the PAPP-A MoM levels and the occurence of RDS. In neonates that were delivered at or beyond 37 weeks of gestation, RDS occurrence could be predicted at a significant rate by utilising PAPP-A MoM values which was measured at the first trimester fetal anomaly screening test. In the light of these findings, in order to reduce RDS related neonatal morbidity and mortality, pregnancies with PAPP-A MoM values greater than 1.02 at the first trimester fetal anomaly screening should be more closely followed up and a higher rate of suspicion should be kept for RDS occurrence.
本研究旨在探讨妊娠相关血浆蛋白A（PAPP-A）中位数倍数（MoM）水平是否可作为早期预测呼吸窘迫综合征（RDS）的标志物。本研究收集了1773例因孕早期胎儿染色体异常筛查转诊至我院的患者的数据。对这些妊娠中孕早期PAPP-A MoM值及产后RDS发生情况进行回顾性分析。纳入研究的1773例新生儿中，28例在37周及以后分娩，42例在妊娠小于37周时分娩。在37周及以后出生的新生儿组中，RDS预测的截断值确定为1.02。对于该截断值，敏感性为72.41%，特异性为91.84%。曲线下面积（AUC）具有统计学意义（<0.01）。总之，已确定在妊娠37周及以后分娩的新生儿中，利用PAPP-A MoM值可显著预测RDS的发生。
呼吸窘迫综合征（RDS）是全球主要的医疗保健问题之一，尽管该疾病的诊断和治疗有所改善，但仍继续影响新生儿。研究表明，妊娠相关血浆蛋白A（PAPP-A）在细胞增殖和分化中起关键作用，并通过调节局部胰岛素样生长因子（IGF）浓度与许多生理和病理过程密切相关。在过去大多数关于妊娠中PAPP-A值的文献研究中，研究了PAPP-A MoM低值与母胎并发症之间的关联。本研究回顾性检查了PAPP-A MoM水平及RDS的发生情况。在妊娠37周及以后分娩的新生儿中，利用孕早期胎儿异常筛查试验测得的PAPP-A MoM值可显著预测RDS的发生。根据这些发现，为降低与RDS相关的新生儿发病率和死亡率，在孕早期胎儿异常筛查时PAPP-A MoM值大于1.02的妊娠应进行更密切的随访，并对RDS的发生保持更高的怀疑率。
