Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland.
Research Unit of Clinical Medicine and Medical Research Center, University of Oulu, Oulu, Finland.
BMC Pregnancy Childbirth. 2024 Sep 6;24(1):580. doi: 10.1186/s12884-024-06786-4.
Maternal gestational diabetes (GDM), small (SGA) and large (LGA) for gestational age neonates are associated with increased morbidity in both mother and child. We studied how different levels of first trimester pregnancy associated plasma protein-A (PAPP-A) and free beta human chorionic gonadotropin (fβ-hCG) were associated with SGA and LGA in GDM pregnancies and controls.
Altogether 23 482 women with singleton pregnancies participated in first trimester combined screening and delivered between 2014 and 2018 in Northern Finland and were included in this retrospective case-control study. Women with GDM (n = 4697) and controls without GDM (n = 18 492) were divided into groups below 5th and 10th or above 90th and 95th percentile (pc) PAPP-A and fβ-hCG MoM levels. SGA was defined as a birthweight more than two standard deviations (SD) below and LGA more than two SDs above the sex-specific and gestational age-specific reference mean. Odds ratios were adjusted (aOR) for maternal age, BMI, ethnicity, IVF/ICSI, parity and smoking.
In pregnancies with GDM the proportion of SGA was 2.6% and LGA 4.5%, compared to 3.3% (p = 0.011) and 1.8% (p < 0.001) in the control group, respectively. In ≤ 5th and ≤ 10th pc PAPP-A groups, aORs for SGA were 2.7 (95% CI 1.5-4.7) and 2.2 (95% CI 1.4-3.5) in the GDM group and 3.8 (95% CI 3.0-4.9) and 2.8 (95% CI 2.3-3.5) in the reference group, respectively. When considering LGA, there was no difference in aORs in any high PAPP-A groups. In the low ≤ 5 percentile fβ-hCG MoM group, aORs for SGA was 2.3 (95% CI 1.8-3.1) in the control group. In fβ-hCG groups with GDM there was no association with SGA and the only significant difference was ≥ 90 percentile group, aOR 1.6 (95% CI 1.1-2.5) for LGA.
Association with low PAPP-A and SGA seems to be present despite GDM status. High PAPP-A levels are not associated with increased LGA risk in women with or without GDM. Low fβ-hCG levels are associated with SGA only in non-GDM pregnancies.
母体妊娠期糖尿病（GDM）、胎儿大小（SGA）和胎儿大小（LGA）与母亲和儿童的发病率增加有关。我们研究了不同水平的妊娠早期相关血浆蛋白 A（PAPP-A）和游离β人绒毛膜促性腺激素（fβ-hCG）与 GDM 妊娠和对照组中的 SGA 和 LGA 之间的关系。
共有 23482 名单胎妊娠妇女于 2014 年至 2018 年在芬兰北部参加了早孕期联合筛查，并在此回顾性病例对照研究中纳入了这些妇女。将 GDM 妇女（n=4697）和无 GDM 对照组妇女（n=18492）分为第 5 百分位以下和第 10 百分位以下或第 90 百分位以上和第 95 百分位以上 PAPP-A 和 fβ-hCG MoM 水平组。SGA 定义为出生体重低于性别特异性和胎龄特异性参考均值两个标准差以上，LGA 定义为出生体重高于两个标准差以上。对母亲年龄、BMI、种族、IVF/ICSI、产次和吸烟进行了调整（aOR）。
在 GDM 孕妇中，SGA 的比例为 2.6%，LGA 为 4.5%，而对照组分别为 3.3%（p=0.011）和 1.8%（p<0.001）。在≤5%和≤10%的 PAPP-A 组中，GDM 组 SGA 的 aOR 分别为 2.7（95%CI 1.5-4.7）和 2.2（95%CI 1.4-3.5），对照组分别为 3.8（95%CI 3.0-4.9）和 2.8（95%CI 2.3-3.5）。当考虑到 LGA 时，在任何高 PAPP-A 组中，aOR 均无差异。在低≤5%的 fβ-hCG MoM 组中，对照组 SGA 的 aOR 为 2.3（95%CI 1.8-3.1）。在 fβ-hCG 组中，GDM 与 SGA 无关联，唯一显著差异是≥90%组，LGA 的 aOR 为 1.6（95%CI 1.1-2.5）。
尽管存在 GDM，但与低 PAPP-A 和 SGA 似乎存在关联。高 PAPP-A 水平与 GDM 或非 GDM 妇女的 LGA 风险增加无关。低 fβ-hCG 水平仅与非 GDM 妊娠中的 SGA 相关。
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