Gao Yuge, Chen Jihong, Mi Jia
Changchun University of Chinese Medicine, Changchun, Jilin, China.
Affiliated Hospital, Changchun University of Chinese Medicine, Changchun, Jilin, China.
PeerJ. 2025 Sep 2;13:e19825. doi: 10.7717/peerj.19825. eCollection 2025.
This study assessed the effectiveness of pregnancy-associated plasma protein A (PAPP-A) in maternal serum in predicting gestational diabetes mellitus (GDM) in different geographical regions.
PubMed, Web of Science, EMBASE, and Cochrane Library databases were searched for articles assessing the diagnostic utility of PAPP-A for GDM up to December 3, 2024. Two independent researchers screened the literature. Study quality was appraised using the QUADAS-2 instrument and RevMan 5.4 software. Stata 15.1 software was leveraged to calculate the combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and heterogeneity. The summary receiver operating characteristic curve was plotted to calculate the area under the curve (AUC). Subgroup analysis was also conducted to determine the source of heterogeneity.
This study included eight cohort studies, one cross-sectional study, and three case-control studies. A total of 25,183 participants were involved, including 5,993 GDM patients and 19,190 non-GDM patients. Deek's test suggested no notable publication bias ( = 0.400). All included studies were rated as "low risk" or "unclear". The combined sensitivity was 0.71 (95% CI 0.60-0.80), specificity was 0.62 (95% CI [0.55-0.68]), positive likelihood ratio was 1.9 (95% CI [1.4-2.5]), negative likelihood ratio was 0.47 (95% CI [0.30-0.72]), and diagnostic odds ratio was 4 (95% CI [2-8]). Subgroup analysis found that sample size might be the source of heterogeneity ( < 0.05). The AUC was 0.70 (95% CI [0.65-0.73]).
PAPP-A has a certain diagnostic value for GDM and is helpful for more accurately identifying GDM and reducing the risk of related chronic diseases. Future articles with larger sample sizes and across multiple centers are warranted to explore the combined application of PAPP-A with other biomarkers. This approach may enhance the accuracy of GDM diagnosis. Registry number: PROSPERO (CRD42024617462).
本研究评估了孕妇血清中妊娠相关血浆蛋白A（PAPP-A）在不同地理区域预测妊娠期糖尿病（GDM）的有效性。
检索了PubMed、Web of Science、EMBASE和Cochrane图书馆数据库中截至2024年12月3日评估PAPP-A对GDM诊断效用的文章。两名独立研究人员筛选文献。使用QUADAS-2工具和RevMan 5.4软件评估研究质量。利用Stata 15.1软件计算合并敏感度、特异度、阳性似然比、阴性似然比、诊断比值比和异质性。绘制汇总受试者工作特征曲线以计算曲线下面积（AUC）。还进行了亚组分析以确定异质性来源。
本研究纳入了8项队列研究、1项横断面研究和3项病例对照研究。共有25183名参与者，包括5993名GDM患者和19190名非GDM患者。Deek检验表明无明显发表偏倚（ = 0.400）。所有纳入研究均被评为“低风险”或“不清楚”。合并敏感度为0.71（95%CI 0.60 - 0.80），特异度为0.62（95%CI [0.55 - 0.68]），阳性似然比为1.9（95%CI [1.4 - 2.5]），阴性似然比为0.47（95%CI [0.30 - 0.72]），诊断比值比为4（95%CI [2 - 8]）。亚组分析发现样本量可能是异质性来源（ < 0.05）。AUC为0.70（95%CI [0.65 - 0.73]）。
PAPP-A对GDM具有一定诊断价值，有助于更准确地识别GDM并降低相关慢性病风险。未来需要开展更大样本量和多中心的研究，探索PAPP-A与其他生物标志物的联合应用。这种方法可能提高GDM诊断的准确性。注册号：PROSPERO（CRD42024617462）。
