妊娠期糖尿病
产科
医学
妊娠相关血浆蛋白A
妊娠期
怀孕
非整倍体
妇科
子痫
子宫动脉
队列
胎龄
人口
内科学
孕早期
生物
生物化学
遗传学
基因
染色体
环境卫生
作者
Arianne Sweeting,Jencia Wong,Heidi Appelblom,Glynis P. Ross,Heikki Kouru,Paul F. Williams,Mikko Sairanen,Jon Hyett
标识
DOI:10.1080/14767058.2017.1336759
摘要
Objective: We examined whether first trimester aneuploidy and pre-eclampsia screening markers predict gestational diabetes mellitus (GDM) in a large multi-ethnic cohort and the influence of local population characteristics on markers.Methods: Clinical and first trimester markers (mean arterial pressure (MAP), uterine artery pulsatility index (UtA PI), pregnancy associated plasma protein A (PAPP-A), free-β human chorionic gonadotropin (free-hCGβ)) were measured in a case-control study of 980 women (248 with GDM, 732 controls) at 11 to 13 + 6 weeks’ gestation. Clinical parameters, MAP-, UtA PI-, PAPP-A-, and free-hCGβ-multiples-of-the-median (MoM) were compared between GDM and controls; stratified by ethnicity, parity, and GDM diagnosis <24 versus ≥24 weeks’ gestation. GDM model screening performance was evaluated using AUROC.Results: PAPP-A- and UtA PI-MoM were significantly lower in GDM versus controls (median ((IQR) PAPP-A-MoM 0.81 (0.58–1.20) versus 1.00 (0.70–1.46); UtA PI-MoM 1.01 (0.82–1.21) versus 1.05 (0.84–1.29); p < .05). Previous GDM, family history of diabetes, south/east Asian ethnicity, parity, BMI, MAP, UtA PI, and PAPP-A were significant predictors in multivariate analysis (p < .05). The AUC for a model based on clinical parameters was 0.88 (95%CI 0.85–0.92), increasing to 0.90 (95%CI 0.87–0.92) with first trimester markers combined. The combined model best predicted GDM <24 weeks’ gestation (AUC 0.96 (95%CI 0.94–0.98)).Conclusions: Addition of aneuploidy and pre-eclampsia markers is cost-effective and enhances early GDM detection, accurately identifying early GDM, a high-risk cohort requiring early detection, and intervention. Ethnicity and parity modified marker association with GDM, suggesting differences in pathophysiology and vascular risk.
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