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Archives of Gynecology and Obstetrics

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19.12.2018 | Maternal-Fetal Medicine

Maternal serum screening marker levels in twin pregnancies affected by gestational diabetes

verfasst von: Ron Maymon, Hamutal Meiri, Ran Svirski, Eran Weiner, Howard Cuckle

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 3/2019

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Abstract

Purpose

To investigate the levels of maternal serum screening markers in the first and second trimester twin pregnancies, which subsequently developed gestational diabetes mellitus (GDM).

Methods

145 twin pregnancies were recruited in the first trimester. Stored blood samples were retrospectively tested for pregnancy-associated plasma protein (PAPP)-A, human chorionic gonadotrophin (hCG), placental growth factor (PlGF), placental protein (PP)13, α-fetoprotein (aFP) and inhibin A. Values were expressed in multiples of the gestation-specific median (MoMs) in singletons, adjusted for maternal weight and parity, as appropriate.

Results

Twenty samples of first and second trimester were available from 11 twins who subsequently developed GDM and 219 samples from unaffected twins. The median PAPP-A level in the affected twins was 3.61 MoM compared with 2.46 MoM in unaffected twins (P < 0.001, Wilcoxon rank sum test, two tailed); significant results were found in both trimesters. The median PP13 was also increased but to a lesser extent. It was only statistically significant overall (P < 0.05) and in second trimester samples (P < 0.02). No other marker differed significantly. Logistic regression found that combining PAPP-A and maternal weight had a 55% detection rate for a 10% false-positive rate.

Conclusions

Early prenatal marker evaluation in twin pregnancies can be also useful for predicting the risk for developing GDM and should be further investigated.

Hod M, Kapur A, Sacks DA, Hadar E, Agarwal M, Di Renzo GC, Cabero Roura L, McIntyre HD, Morris JL, Divakar H (2015) The international federation of gynecology and obstetrics (FIGO) initiative on gestational diabetes mellitus: a pragmatic guide for diagnosis, management, and care. Int J Gynaecol Obstet 131(Suppl 3):S173–S211. https://doi.org/10.1016/s0020-7292(15)30007-2 CrossRefPubMed

Sacks DA, Hadden DR, Maresh M, Deerochanawong C, Dyer AR, Metzger BE, Lowe LP, Coustan DR, Hod M, Oats JJ, Persson B, Trimble ER, HAPO Study Cooperative Research Group (2012) Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Diabetes Care 35(3):526–528. https://doi.org/10.2337/dc11-1641 CrossRefPubMedPubMedCentral

American Diabetes Association (2003) Gestational diabetes mellitus. Diabetes Care 26(Suppl 1):S103–S105

The Guideline Development Group (2008) Guidelines: management of diabetes from preconception to the postnatal period: summary of NICE guidance. BMJ 336:714–717. https://doi.org/10.1136/bmj.39505.641273.AD CrossRefPubMedCentral

Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, Wapner RJ, Varner MW, Rouse DJ, Thorp JM Jr, Sciscione A, Catalano P, Harper M, Saade G, Lain KY, Sorokin Y, Peaceman AM, Tolosa JE, Anderson GB, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network (2009) A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 361:1339–1348. https://doi.org/10.1056/NEJMoa0902430 CrossRefPubMedPubMedCentral

Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva Ad, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJ, Omori Y, Schmidt MI, International Association of Diabetes and Pregnancy Study Groups consensus panel (2010) International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33:676–682. https://doi.org/10.2337/dc09-1848 CrossRefPubMed

Boney CM, Verma A, Tucker R, Vohr BR (2005) Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics 115(3):e290–e296CrossRef

Arabin B, Baschat AA (2017) Pregnancy: an underutilized window of opportunity to improve long-term maternal and infant health-an appeal for continuous family care and interdisciplinary communication. Front Pediatr 5:69. https://doi.org/10.3389/fped.2017.00069.eCollection2017 CrossRefPubMedPubMedCentral

Ong CY, Liao AW, Spencer K, Munim S, Nicolaides KH (2000) First trimester maternal serum free beta human chorionic gonadotrophin and pregnancy associated plasma protein A as predictors of pregnancy complications. BJOG 107(10):1265–1270CrossRef

10.

Tul N, Pusenjak S, Osredkar J, Spencer K, Novak-Antolic Z (2003) Predicting complications of pregnancy with first-trimester maternal serum free-beta hCG, PAPP-A and inhibin-A. Prenat Diagn 23(12):990–996CrossRef

11.

Beneventi F, Simonetta M, Lovati E, Albonico G, Tinelli C, Locatelli E, Spinillo A (2011) First trimester pregnancy-associated plasma protein-A in pregnancies complicated by subsequent gestational diabetes. Prenat Diagn 31(6):523–528. https://doi.org/10.1002/pd.2733 CrossRefPubMed

12.

Savvidou MD, Syngelaki A, Muhaisen M, Emelyanenko E, Nicolaides KH (2012) First trimester maternal serum free β-human chorionic gonadotropin and pregnancy-associated plasma protein A in pregnancies complicated by diabetes mellitus. BJOG 119(4):410–416. https://doi.org/10.1111/j.1471-0528.2011.03253.x CrossRefPubMed

13.

Husslein H, Lausegger F, Leipold H, Worda C (2012) Association between pregnancy-associated plasma protein-A and gestational diabetes requiring insulin treatment at 11–14 weeks of gestation. J Matern Fetal Neonatal Med 25(11):2230–2233. https://doi.org/10.3109/14767058.2012.684170 CrossRefPubMed

14.

Lovati E, Beneventi F, Simonetta M, Laneri M, Quarleri L, Scudeller L, Albonico G, Locatelli E, Cavagnoli C, Tinelli C, Spinillo A, Corazza GR (2013) Gestational diabetes mellitus: including serum pregnancy-associated plasma protein-A testing in the clinical management of primiparous women? A case-control study. Diabetes Res Clin Pract 100(3):340–347. https://doi.org/10.1016/j.diabres.2013.04.002 CrossRefPubMed

15.

Kulaksizoglu S, Kulaksizoglu M, Kebapcilar AG, Torun AN, Ozcimen E, Turkoglu S (2013) Can first-trimester screening program detect women at high risk for gestational diabetes mellitus? Gynecol Endocrinol 29(2):137–140. https://doi.org/10.3109/09513590.2012.708800 CrossRefPubMed

16.

Spencer K, Cowans NJ (2013) The association between gestational diabetes mellitus and first trimester aneuploidy screening markers. Ann Clin Biochem 50(Pt 6):603–610. https://doi.org/10.1177/0004563213480493 CrossRefPubMed

17.

Beneventi F, Simonetta M, Locatelli E, Cavagnoli C, Badulli C, Lovati E, Garbin G, Genini E, Albertini R, Tinelli C, Martinetti M, Spinillo A (2014) Temporal variation in soluble human leukocyte antigen-G (sHLA-G) and pregnancy-associated plasma protein A (PAPP-A) in pregnancies complicated by gestational diabetes mellitus and in controls. Am J Reprod Immunol 72(4):413–421. https://doi.org/10.1111/aji.12270 CrossRefPubMed

18.

Wells G, Bleicher K, Han X, McShane M, Chan YF, Bartlett A, White C, Lau SM (2015) Maternal diabetes, large-for-gestational-age births, and first trimester pregnancy-associated plasma protein-A. J Clin Endocrinol Metab 100(6):2372–2379. https://doi.org/10.1210/jc.2014-4103 CrossRefPubMed

19.

Syngelaki A, Kotecha R, Pastides A, Wright A, Nicolaides KH (2015) First-trimester biochemical markers of placentation in screening for gestational diabetes mellitus. Metabolism 64(11):1485–1489. https://doi.org/10.1016/j.metabol.2015.07.015 CrossRefPubMed

20.

Cheuk QK, Lo TK, Wong SF, Lee CP (2016) Association between pregnancy-associated plasma protein-A levels in the first trimester and gestational diabetes mellitus in Chinese women. Hong Kong Med J 22(1):30–38. https://doi.org/10.1016/j.metabol.2015.07.015 CrossRefPubMed

21.

Farina A, Eklund E, Bernabini D, Paladino M, Righetti F, Monti G, Lambert-Messerlian G (2017) A first-trimester biomarker panel for predicting the development of gestational diabetes. Reprod Sci 24(6):954–959. https://doi.org/10.1177/1933719116675057 CrossRefPubMed

22.

Xiao D, Chenhong W, Yanbin X, Lu Z (2018) Gestational diabetes mellitus and first trimester pregnancy-associated plasma protein A: a case-control study in a Chinese population. J Diabetes Investig 9(1):204–210. https://doi.org/10.1111/jdi.12672 CrossRefPubMed

23.

Gabbay-Benziv R, Doyle LE, Blitzer M, Baschat AA (2015) First trimester prediction of maternal glycemic status. J Perinat Med 43(3):283–289. https://doi.org/10.1515/jpm-2014-0149 CrossRefPubMed

24.

Svirsky R, Meiri H, Herzog A, Kivity V, Cuckle H, Maymon R (2013) First trimester maternal serum placental protein 13 levels in singleton versus twin pregnancies with and without severe pre-eclampsia. J Perinat Med 41:561–566. https://doi.org/10.1515/jpm-2013-0011 CrossRefPubMed

25.

Svirsky R, Levinsohn-Tavor O, Feldman N, Klog E, Cuckle H, Maymon R (2016) First and second trimester maternal serum markers of pre-eclampsia in twin pregnancies. Ultrasound Obstet Gynecol 47(6):560–564. https://doi.org/10.1002/uog.14873 CrossRefPubMed

26.

Svirsky R, Maymon R, Melcer Y, Klog E, Cuckle H (2016) First and second trimester maternal serum inhibin A levels in twins with pre-eclampsia. Prenat Diagn 36(11):1071–1074. https://doi.org/10.1002/pd.4937 CrossRefPubMed

27.

Maymon R, Trahtenherts A, Svirsky R, Melcer Y, Madar-Shapiro L, Klog E, Meiri H, Cuckle H (2017) Developing a new algorithm for first and second trimester pre-eclampsia screening in twins pregnancies. Hypertens Pregnancy 36(1):108–115. https://doi.org/10.1080/10641955.2016.1242605 CrossRefPubMed

28.

Hadlock FP, Shah YP, Kanon DJ, Lindsey JV (1992) Fetal crown-rump length: reevaluation of relation to menstrual age (5–18 weeks) with high-resolution real-time US. Radiology 182:501–505CrossRef

29.

Committee on Practice Bulletins—Obstetrics (2013) Practice Bulletin No. 137: gestational diabetes mellitus. Obstet Gynecol 122(2 Pt 1):406–416. https://doi.org/10.1097/01.AOG.0000433006.09219.f1 CrossRef

30.

Hod M, Kapur A, Sacks DA, Hadar E, Agarwal M, Di Renzo GC, Cabero Roura L, McIntyre HD, Morris JL, Divakar H (2015) The International Federation of Gynecology and Obstetrics (FIGO) initiative on gestational diabetes mellitus: a pragmatic guide for diagnosis, management, and care. Int J Gynaecol Obstet 131(Suppl 3):S173–S211. https://doi.org/10.1016/S0020-7292(15)30007-2 CrossRefPubMed

31.

Madhuvrata P, Govinden Gemma, Bustani R, Song S, Farrell TA (2015) Prevention of gestational diabetes in pregnant women with risk factors for gestational diabetes: a systematic review and meta-analysis of randomised trials. Obstet Med 8(2):68–85. https://doi.org/10.1177/1753495X15576673 CrossRefPubMedPubMedCentral

32.

Tieu J, Shepherd E, Middleton P, Crowther CA (2017) Dietary advice interventions in pregnancy for preventing gestational diabetes mellitus. Cochrane Database Syst Rev 1:CD006674. https://doi.org/10.1002/14651858.CD006674.pub3 CrossRefPubMed

33.

Petry CJ, Ong KK, Hughes IA, Acerini CL, Frystyk J, Dunger DB (2017) Early pregnancy-associated plasma protein a concentrations are associated with third trimester insulin sensitivity. Clin Endocrinol Metab 102(6):2000–2008. https://doi.org/10.1210/jc.2017-00272 CrossRef

34.

Ihara M, Mitao M, Yamasaki H, Kodama T, Murakami T, Hirai G, Sugiyama T, Toyoda N (2002) Analysis of glucose tolerance in twin gestations using an oral glucose load. Horm Metab Res 34:338–340CrossRef

35.

Costa MA (2016) The endocrine function of human placenta: an overview. Reprod Biomed Online 32:14–43. https://doi.org/10.1016/j.rbmo.2015.10.005 CrossRef

36.

McGrath RT, Hocking SL, Scott ES, Seeho SK, Fulcher GR, Glastras SJ (2017) Outcomes of twin pregnancies complicated by gestational diabetes: a meta-analysis of observational studies. J Perinatol 37(4):360–368. https://doi.org/10.1038/jp.2016.254 CrossRefPubMed

37.

Drobnjak T, Gizurarson S, Gokina NI, Meiri H, Mandalá M, Huppertz B, Osol G (2017) Placental protein 13 (PP13)-induced vasodilation in pregnant and non-pregnant rat arteries occurs via endothelial signaling pathways. Hypertens Pregnancy 36(3):186–195. https://doi.org/10.1080/10641955.2017.1295052 CrossRefPubMed

38.

Loke YJ, Novakovic B, Ollikainen M, Wallace EM, Umstad MP, Permezel M, Morley R, Ponsonby AL, Gordon L, Galati JC, Saffery R, Craig JM (2013) The Peri/postnatal epigenetic twins study (PETS). Twin Res Hum Genet 16(1):13–20. https://doi.org/10.1017/thg.2012.114 CrossRefPubMed

39.

Weissman A, Drugan A (2016) Glucose tolerance in singleton, twin and triplet pregnancies. J Perinat Med 44(8):893–897. https://doi.org/10.1515/jpm-2016-0186 CrossRefPubMed

40.

Schwartz DB, Daoud Y, Zazula P, Goyert G, Wright D, Copes J (1999) Gestational diabetes mellitus: metabolic and blood glucose parameters in singleton versus twin pregnancies. Am J Obstet Gynecol 181(4):912–914CrossRef

41.

Cho HJ, Shin JS, Yang JH, Ryu HM, Kim MY, Han JY, Kim JO, Ahn HK, Choi JS, Chung JH, Park SH, Kim MH, Choi KH (2006) Perinatal outcome in twin pregnancies complicated by gestational diabetes mellitus: a comparative study. J Korean Med Sci 21(3):457–459CrossRef

42.

Rauh-Hain JA, Rana S, Tamez H, Wang A, Cohen B, Cohen A, Brown F, Ecker JL, Karumanchi SA, Thadhani R (2009) Risk for developing gestational diabetes in women with twin pregnancies. J Matern Fetal Neonatal Med 22(4):293–299. https://doi.org/10.1080/14767050802663194 CrossRefPubMed

43.

Simões T, Queirós A, Correia L, Rocha T, Dias E, Blickstein I (2011) Gestational diabetes mellitus complicating twin pregnancies. J Perinat Med 39:437–440. https://doi.org/10.1515/JPM.2011.048 CrossRefPubMed

44.

Utzschneider KM, Kratz M, Damman CJ, Hullarg M (2016) Mechanisms linking the gut microbiome and glucose metabolism. J Clin Endocrinol Metab 101(4):1445–1454. https://doi.org/10.1210/jc.2015-4251 CrossRefPubMedPubMedCentral

45.

Coate KC, Smith MS, Shiota M, Irimia JM, Roach PJ, Farmer B, Williams PE, Moore MC (2013) Hepatic glucose metabolism in late pregnancy: normal versus high-fat and -fructose diet. Diabetes 62(3):753–761. https://doi.org/10.2337/db12-0875 CrossRefPubMedPubMedCentral

46.

Weiner E, Barber E, Feldstein O, Schreiber L, Mizrachi Y, Bar J, Kovo M (2018) The placental component and neonatal outcome in singleton vs. twin pregnancies complicated by gestational diabetes melitous. Placenta 9(1):204–210. https://doi.org/10.1016/j.placenta.2018.01.010 CrossRef

47.

Kibel M, Kahn M, Sherman C, Kingdom J, Zaltz A, Barrett J, Melamed N (2017) Placental abnormalities differ between small for gestational age fetuses in dichorionic twin and singleton pregnancies. Placenta 60:28–35. https://doi.org/10.1016/j.placenta.2017.10.002 CrossRefPubMed

48.

Wein P, Warwick MM, Beischer NA (1992) Gestational diabetes in twin pregnancy: prevalence and long-term implications. Aust N Z J Obstet Gynaecol 32:325–327CrossRef

49.

Buhling KJ, Henrich W, Starr E, Lubke M, Bertram S, Siebert G, Dudenhausen JW (2003) Risk for gestational diabetes and hypertension for women with twin pregnancy compared to singleton pregnancy. Arch Gynecol Obstet 269:33–36CrossRef

50.

Pinborg A, Loft A, Schmidt L, Langhoff-Roos J, Andersen AN (2004) Maternal risks and perinatal outcome in a Danish national cohort of 1005 twin pregnancies: the role of in vitro fertilization. Acta Obstet Gynecol Scand 83:75–84CrossRef

51.

Nicolaides KH (2011) Turning the pyramid of prenatal care. Fetal Diagn Ther 29(3):183–196. https://doi.org/10.1159/000324320 CrossRefPubMed

52.

Dollberg S, Haklai Z, Mimouni FB, Gorfein I, Gordon ES (2005) Birth weight standards in the live-born population in Israel. Isr Med Assoc J 7(5):311–314PubMed

Titel: Maternal serum screening marker levels in twin pregnancies affected by gestational diabetes
verfasst von: Ron Maymon
Hamutal Meiri
Ran Svirski
Eran Weiner
Howard Cuckle
Publikationsdatum: 19.12.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Gynecology and Obstetrics / Ausgabe 3/2019
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-018-5010-3

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Maternal serum screening marker levels in twin pregnancies affected by gestational diabetes

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