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First trimester maternal serum free β‐human chorionic gonadotropin and pregnancy‐associated plasma protein A in pregnancies complicated by diabetes mellitus
Author(s) -
Savvidou MD,
Syngelaki A,
Muhaisen M,
Emelyanenko E,
Nicolaides KH
Publication year - 2012
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2011.03253.x
Subject(s) - medicine , human chorionic gonadotropin , obstetrics , pregnancy , pregnancy associated plasma protein a , gestation , gestational diabetes , diabetes mellitus , gynecology , population , fetus , first trimester , endocrinology , biology , hormone , environmental health , genetics
Please cite this paper as: Savvidou M, Syngelaki A, Muhaisen M, Emelyanenko E, Nicolaides K. First trimester maternal serum free β‐human chorionic gonadotropin and pregnancy‐associated plasma protein A in pregnancies complicated by diabetes mellitus. BJOG 2012;119:410–416. Objective To investigate whether markers of first trimester screening for aneuploidies, including fetal nuchal translucency (NT), maternal serum free β‐human chorionic gonadotropin (β‐hCG) and pregnancy‐associated plasma protein A (PAPP‐A), are altered in women with pre‐existing type‐1 and type‐2 diabetes mellitus, and in women that subsequently develop gestational diabetes mellitus (GDM). Design Retrospective analysis of prospective combined screening for aneuploidies in singleton pregnancies at 11 +0 –13 +6 weeks of gestation. Setting Antenatal clinic. Population Singleton pregnancies at 11 +0 –13 +6 weeks of gestation resulting in the delivery of phenotypically normal neonates. The study included 194 women with type‐1 diabetes, 122 women with type‐2 diabetes, 779 women who developed GDM and 41 007 non‐diabetic controls. Methods Maternal free β‐hCG and PAPP‐A levels were expressed as multiples of the respective normal median (MoM), and fetal NT was expressed as a difference from the expected median (Δ). Main outcome measures Comparison of median MoM maternal free β‐hCG and PAPP‐A, and fetal NT, in the four outcome groups. Results There were no significant differences between the groups in median ΔNT and maternal free β‐hCG MoM. Maternal median PAPP‐A in type‐2 diabetes, compared with the non‐diabetic group, was reduced (0.75 MoM, IQR 0.50–1.09 MoM versus 1.00 MoM, IQR 0.68–1.42 MoM; P < 0.001), which resulted in doubling in the false‐positive rate in the combined screening in this population. There were no significant differences in maternal PAPP‐A between the other groups. Conclusions In women with type‐2 diabetes, the estimation of accurate patient‐specific risk in the first trimester combined screening for aneuploidies necessitates an adjustment of maternal serum PAPP‐A.