Cui Jinhui, Li Ping, Chen Xinjuan, Li Ling, Ouyang Liping, Meng Zhaoran, Fan Jianhui
Department of Obstetrics and Gynecology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People's Republic of China.
Diabetes Metab Syndr Obes. 2023 Apr 1;16:947-957. doi: 10.2147/DMSO.S398530. eCollection 2023.
To investigate the relationship and predictive value of first-trimester pregnancy-associated plasma protein A (PAPP-A), maternal factors, and biochemical parameters with gestational diabetes mellitus (GDM) in southern China mothers.
This study recruited 4872 pregnant women. PAPP-A, the free beta subunit of human chorionic gonadotropin (free β-HCG), fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), and high- and low-density lipoproteins (HDL, LDL) were measured at 11-13 weeks of gestation. GDM was diagnosed based on a 75 g oral glucose tolerance test at 24-28 weeks of gestation. We performed stepwise logistic regression analysis to determine the odds ratio (OR) and the 95% confidence interval (CI) of GDM. We used Receiver Operating Characteristic (ROC) curves with the area under the curve (AUC) to evaluate the predictive value of PAPP-A, maternal factors, and biochemical markers. The significance of the differences between the AUC values was assessed using the DeLong test.
GDM was diagnosed in 750 (15.39%) women. Independent factors for GDM were age, pre-gestational BMI, GWG before a diagnosis of GDM, previous history of GDM, family history of diabetes, FPG, TG, LDL, PAPP-A, and TC. The AUC of PAPP-A was 0.56 (95% CI 0.53-0.58). The AUC of a model based on combined maternal factors, biochemical markers, and PAPP-A was 0.70 (95% CI 0.68-0.72). Differences in AUC values between PAPP-A alone and the model based on combined maternal factors, biochemical markers, and PAPP-A were statistically significant (Z= 9.983, P<0.001).
A Low serum PAPP-A level in the first trimester is an independent risk factor for developing GDM later in pregnancy. However, it is not a good independent predictor although the predictive value of a low serum PAPP-A level increases when combined with maternal factors and biochemical markers.
探讨中国南方孕妇孕早期妊娠相关血浆蛋白A（PAPP-A）、母体因素及生化参数与妊娠期糖尿病（GDM）的关系及预测价值。
本研究招募了4872名孕妇。在妊娠11-13周时测量PAPP-A、人绒毛膜促性腺激素游离β亚基（游离β-HCG）、空腹血糖（FPG）、总胆固醇（TC）、甘油三酯（TG）以及高密度和低密度脂蛋白（HDL、LDL）。在妊娠24-28周时通过75g口服葡萄糖耐量试验诊断GDM。我们进行逐步逻辑回归分析以确定GDM的比值比（OR）和95%置信区间（CI）。我们使用曲线下面积（AUC）的受试者工作特征（ROC）曲线来评估PAPP-A、母体因素和生化标志物的预测价值。使用德龙检验评估AUC值之间差异的显著性。
750名（15.39%）女性被诊断为GDM。GDM的独立因素包括年龄、孕前体重指数、GDM诊断前的孕期体重增加、既往GDM史、糖尿病家族史、FPG、TG、LDL、PAPP-A和TC。PAPP-A的AUC为0.56（95%CI 0.53-0.58）。基于母体因素、生化标志物和PAPP-A组合的模型的AUC为0.70（95%CI 0.68-0.72）。单独的PAPP-A与基于母体因素、生化标志物和PAPP-A组合的模型之间的AUC值差异具有统计学意义（Z=9.983，P<0.001）。
孕早期血清PAPP-A水平低是妊娠后期发生GDM的独立危险因素。然而，它不是一个良好的独立预测指标，尽管当与母体因素和生化标志物联合时，低血清PAPP-A水平的预测价值会增加。
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