title: First-trimester biochemical markers of placentation in screening for gestational diabetes mellitus.
abstract: OBJECTIVE
  To investigate whether first-trimester biochemical markers of placentation, including pregnancy-associated plasma protein-A (PAPP-A) and placental growth factor (PLGF), are altered in women that subsequently develop gestational diabetes mellitus (GDM) and to examine their potential value in improving the performance of screening for GDM by maternal characteristics and medical history.
  
  
  METHODS
  The study population of 31,225 singleton pregnancies, including 787 cases that developed GDM, was drawn from women undergoing routine prospective screening for pregnancy complications at 11-13 weeks' gestation. Maternal serum PAPP-A and PLGF were measured and the levels were expressed as multiples of the median (MoM) after adjustment for maternal characteristics and medical history. The performance of screening for GDM by maternal factors and MoM values of PAPP-A and PLGF was evaluated by receiver operating characteristic (ROC) curves.
  
  
  RESULTS
  In the GDM group, compared to the unaffected group, the median PAPP-A was reduced (0.949, 95% CI 0.913-0.987 MoM) (p=0.0009) and median PLGF was increased (1.053, 95% CI 1.023-1.083 MoM) (p=0.004). The performance of screening for GDM by maternal factors was not improved by the addition of PAPP-A and/or PLGF.
  
  
  CONCLUSIONS
  First trimester maternal serum PAPP-A and PLGF are not useful in screening for GDM.
authors.affiliation: Harris Birthright Research Centre of Fetal Medicine, King's College Hospital, London, UK.
authors.forename: Argyro
authors.initials: A
authors.lastname: Syngelaki
authors.affiliation: Harris Birthright Research Centre of Fetal Medicine, King's College Hospital, London, UK.
authors.forename: Reena
authors.initials: R
authors.lastname: Kotecha
authors.affiliation: Harris Birthright Research Centre of Fetal Medicine, King's College Hospital, London, UK.
authors.forename: Alice
authors.initials: A
authors.lastname: Pastides
authors.affiliation: Institute of Health Research, University of Exeter, Exeter, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Wright
authors.affiliation: Harris Birthright Research Centre of Fetal Medicine, King's College Hospital, London, UK. Electronic address: kypros@fetalmedicine.com.
authors.forename: Kypros H
authors.initials: KH
authors.lastname: Nicolaides
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006801:Humans; D000072483:Placenta Growth Factor; D011247:Pregnancy; D011257:Pregnancy Proteins / Q000097:blood*; D011261:Pregnancy Trimester, First; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; C000608036:PGF protein, human; D011257:Pregnancy Proteins; D000072483:Placenta Growth Factor; D011266:Pregnancy-Associated Plasma Protein-A
keywords: First trimester screening; Gestational diabetes mellitus; Placental growth factor; Pregnancy-associated plasma protein A