title: Maternal Diabetes, Large-for-Gestational-Age Births, and First Trimester Pregnancy-Associated Plasma Protein-A.
abstract: BACKGROUND
  Maternal pregnancy-associated plasma protein-A (PAPP-A) is measured at nuchal translucency scanning to assess the risk of fetal chromosomal disorders.
  
  
  OBJECTIVE
  The aim of this study was to examine whether PAPP-A might also be a predictor of gestational diabetes (GDM), type 2 diabetes (T2D), or large-for-gestational-age (LGA) births.
  
  
  METHODS
  PAPP-A levels were measured in serum from 1664 women at their 10-14-week nuchal translucency scan at a tertiary referral hospital. Maternal diabetes was categorized as T2D, "early GDM" (GDM diagnosed < 22 wk), and "late GDM" (GDM diagnosed ≥ 22 wk). The relationship between PAPP-A multiples of the median (MoM), maternal diabetes, and LGA was examined with multivariate regression models.
  
  
  RESULTS
  PAPP-A MoM was significantly lower in women with T2D and women who developed GDM than in nondiabetic women. PAPP-A MoM was 41.3% lower in T2D, 22.6% lower in early GDM, and 8.6% lower in late GDM. Women in the lowest quartile of PAPP-A MoM were 2.7 times more likely to have early GDM (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.2-6.1) compared with the highest quartile. Birth weight had a positive linear association with PAPP-A MoM. Women in the highest PAPP-A MoM quartile were twice as likely to have an LGA baby (OR, 2.2; 95% CI, 1.39-3.46; P = .0007).
  
  
  CONCLUSIONS
  Routinely tested first-trimester PAPP-A is a novel biomarker for maternal diabetes and LGA. PAPP-A decreased with increasing severity of maternal diabetes. Although this cannot infer causality, low PAPP-A may help identify women at risk of GDM, and high PAPP-A may help identify pregnancies at risk of LGA.
authors.affiliation: Prince of Wales Clinical School (G.W., C.W., S.M.L.), University of New South Wales, Randwick, Australia, 2031; Concord Clinical School (Medicine) (K.B.), University of Sydney, Concord, Australia, 2137; Department of Endocrinology, South Eastern Area Laboratory Services (X.H., M.M., C.W.), Department of Diabetes and Endocrinology (Y.F.C., C.W., S.M.L.), Prince of Wales Hospital, Randwick, Australia, 2031; and The Royal Hospital for Women (A.B., C.W., S.M.L.), Randwick, Australia, 2031.
authors.forename: George
authors.initials: G
authors.lastname: Wells
authors.affiliation: Prince of Wales Clinical School (G.W., C.W., S.M.L.), University of New South Wales, Randwick, Australia, 2031; Concord Clinical School (Medicine) (K.B.), University of Sydney, Concord, Australia, 2137; Department of Endocrinology, South Eastern Area Laboratory Services (X.H., M.M., C.W.), Department of Diabetes and Endocrinology (Y.F.C., C.W., S.M.L.), Prince of Wales Hospital, Randwick, Australia, 2031; and The Royal Hospital for Women (A.B., C.W., S.M.L.), Randwick, Australia, 2031.
authors.forename: Kerrin
authors.initials: K
authors.lastname: Bleicher
authors.affiliation: Prince of Wales Clinical School (G.W., C.W., S.M.L.), University of New South Wales, Randwick, Australia, 2031; Concord Clinical School (Medicine) (K.B.), University of Sydney, Concord, Australia, 2137; Department of Endocrinology, South Eastern Area Laboratory Services (X.H., M.M., C.W.), Department of Diabetes and Endocrinology (Y.F.C., C.W., S.M.L.), Prince of Wales Hospital, Randwick, Australia, 2031; and The Royal Hospital for Women (A.B., C.W., S.M.L.), Randwick, Australia, 2031.
authors.forename: Xuguang
authors.initials: X
authors.lastname: Han
authors.affiliation: Prince of Wales Clinical School (G.W., C.W., S.M.L.), University of New South Wales, Randwick, Australia, 2031; Concord Clinical School (Medicine) (K.B.), University of Sydney, Concord, Australia, 2137; Department of Endocrinology, South Eastern Area Laboratory Services (X.H., M.M., C.W.), Department of Diabetes and Endocrinology (Y.F.C., C.W., S.M.L.), Prince of Wales Hospital, Randwick, Australia, 2031; and The Royal Hospital for Women (A.B., C.W., S.M.L.), Randwick, Australia, 2031.
authors.forename: Monika
authors.initials: M
authors.lastname: McShane
authors.affiliation: Prince of Wales Clinical School (G.W., C.W., S.M.L.), University of New South Wales, Randwick, Australia, 2031; Concord Clinical School (Medicine) (K.B.), University of Sydney, Concord, Australia, 2137; Department of Endocrinology, South Eastern Area Laboratory Services (X.H., M.M., C.W.), Department of Diabetes and Endocrinology (Y.F.C., C.W., S.M.L.), Prince of Wales Hospital, Randwick, Australia, 2031; and The Royal Hospital for Women (A.B., C.W., S.M.L.), Randwick, Australia, 2031.
authors.forename: Yuk Fun
authors.initials: YF
authors.lastname: Chan
authors.affiliation: Prince of Wales Clinical School (G.W., C.W., S.M.L.), University of New South Wales, Randwick, Australia, 2031; Concord Clinical School (Medicine) (K.B.), University of Sydney, Concord, Australia, 2137; Department of Endocrinology, South Eastern Area Laboratory Services (X.H., M.M., C.W.), Department of Diabetes and Endocrinology (Y.F.C., C.W., S.M.L.), Prince of Wales Hospital, Randwick, Australia, 2031; and The Royal Hospital for Women (A.B., C.W., S.M.L.), Randwick, Australia, 2031.
authors.forename: Amanda
authors.initials: A
authors.lastname: Bartlett
authors.affiliation: Prince of Wales Clinical School (G.W., C.W., S.M.L.), University of New South Wales, Randwick, Australia, 2031; Concord Clinical School (Medicine) (K.B.), University of Sydney, Concord, Australia, 2137; Department of Endocrinology, South Eastern Area Laboratory Services (X.H., M.M., C.W.), Department of Diabetes and Endocrinology (Y.F.C., C.W., S.M.L.), Prince of Wales Hospital, Randwick, Australia, 2031; and The Royal Hospital for Women (A.B., C.W., S.M.L.), Randwick, Australia, 2031.
authors.forename: Chris
authors.initials: C
authors.lastname: White
authors.affiliation: Prince of Wales Clinical School (G.W., C.W., S.M.L.), University of New South Wales, Randwick, Australia, 2031; Concord Clinical School (Medicine) (K.B.), University of Sydney, Concord, Australia, 2137; Department of Endocrinology, South Eastern Area Laboratory Services (X.H., M.M., C.W.), Department of Diabetes and Endocrinology (Y.F.C., C.W., S.M.L.), Prince of Wales Hospital, Randwick, Australia, 2031; and The Royal Hospital for Women (A.B., C.W., S.M.L.), Randwick, Australia, 2031.
authors.forename: Sue Mei
authors.initials: SM
authors.lastname: Lau
mesh_terms: D000328:Adult; D001724:Birth Weight; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D016640:Diabetes, Gestational / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D005320:Fetal Macrosomia / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D036801:Parturition; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000097:blood*; D011254:Pregnancy in Diabetics / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D011379:Prognosis
chemical_list: D011266:Pregnancy-Associated Plasma Protein-A