Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Obstetrics and Gynaecology, Copenhagen University Hospital - Amager-Hvidovre, Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
Early Hum Dev. 2022 Apr;167:105564. doi: 10.1016/j.earlhumdev.2022.105564. Epub 2022 Mar 14.
Cerebral palsy (CP) is the most common severe motor disability and a manifestation of early brain damage.
To analyze if abnormal levels of first-trimester biomarkers were associated with CP. Furthermore, to investigate their clinical applicability in early predicting of CP.
Nationwide cohort study.
We included 258.057 singleton live births, born during 2008-2013 with completed first-trimester assessments.
Data on beta subunit of human chorionic gonadotropin (beta-hCG), pregnancy-associated plasma protein-A (PAPP-A), nuchal translucency thickness, and biparietal diameter (BPD) were converted to multiple of the medians (MoM). Associations were analyzed by comparing mean and extreme levels between pregnancies with and without CP. All CP diagnoses were validated by trained neuropediatricians. Logistic regression was used to create an early prediction model.
The mean beta-hCG value was significantly lower in pregnancies with CP (0.96MoM [95% CI 0.91-1.02] vs 1.04MoM [1.04-1.04], p = 0.01) and the mean PAPP-A value tended to be lower (0.96MoM [0.91-1.01] vs 1.01MoM [1.00-1.01], p = 0.07). Moreover, fetuses that developed CP more likely had a BPD measurement below the fifth percentile (7.5% vs 5%, p = 0.045). The final prediction model had poor discrimination.
Pregnancies with CP tend to have lower values of beta-hCG and PAPP-A in the first trimester, however, the associations are mediated differently. Nonetheless, abnormal levels of the most common first-trimester biomarkers only have weak associations with CP; resulting in inadequate predictive abilities when included in an early prediction model.
脑瘫（CP）是最常见的严重运动障碍，也是早期脑损伤的表现。
分析早孕期生物标志物的异常水平是否与 CP 相关。此外，还研究了它们在 CP 早期预测中的临床应用。
全国性队列研究。
纳入了 2008-2013 年间出生的 258057 例单胎活产儿，且均完成了早孕期评估。
β亚单位人绒毛膜促性腺激素（β-hCG）、妊娠相关血浆蛋白-A（PAPP-A）、颈项透明层厚度和双顶间径（BPD）的数据转换为中位数的倍数（MoM）。通过比较 CP 组和非 CP 组之间妊娠的平均水平和极端水平来分析相关性。所有 CP 诊断均由经过培训的神经儿科医生进行验证。使用逻辑回归建立早期预测模型。
CP 组的β-hCG 平均值显著降低（0.96MoM [95%CI 0.91-1.02] 与 1.04MoM [1.04-1.04]，p=0.01），且 PAPP-A 平均值也有降低的趋势（0.96MoM [0.91-1.01] 与 1.01MoM [1.00-1.01]，p=0.07）。此外，患有 CP 的胎儿更有可能 BPD 测量值低于第五百分位数（7.5%与 5%，p=0.045）。最终的预测模型的区分度较差。
CP 妊娠早孕期β-hCG 和 PAPP-A 值趋于降低，但关联方式不同。然而，常见的早孕期生物标志物的异常水平与 CP 仅有微弱的关联；因此，当包含在早期预测模型中时，预测能力不足。
