The Correlation Of PAPP-A And β-HCG With GDM,PE And FGR In Pregnant Women

BackgroundIn recent years,the incidence of gestational diabetes is increasing year by year.gestational diabetes mellitus（GDM）is a serious impact on mother son outcome of pregnancy complications.Studies have shown that GDM not only has a huge impact on the health of mothers,but also has a long-term impact on the health of children.Preeclampsia（PE）is a special pregnancy complication and can lead to maternal and infant death.Preeclampsia is a serious pregnancy complication characterized by acquired hypertension and proteinuria,often involving the liver,kidney,brain and coagulation system.Fetal growth restriction（FGR）mainly refers to a fetus that fails to reach its growth potential and is smaller than that of the gestational age.FGR is a serious pregnancy complication,which increases the risk of fetal adverse pregnancy outcome.Pregnancy Associated Plasma Protein A（papp-a）is A large molecular weight glycoprotein,which is mainly produced by the placenta during Pregnancy and released into the maternal blood.β-hcg is a glycoprotein secreted by placental syncytiotrophoblast cells that maintains pregnancy by stimulating the corpus luteum to produce progesterone.In addition to maintaining luteal function,β-hcg also promotes angiogenesis,cytotrophoblast differentiation,immunosuppression,and the prevention of invasion of trophoblast cell phagocytosis,suggesting that it can be considered as a marker of placental function.β-hcg and PAPP-A can be detected in early pregnancy and can be used as diagnostic markers with high sensitivity and specificity.The purpose of this study was to explore the correlation between biochemical indicators of Tang sieveβ-hcg and papp-a in early pregnancyandgestationaldiabetesmellitus,preeclampsiaand fetal growth restriction.ObjectiveThis study retrospectively analyzed and compared the differences between GDM,PE,FGR and the control group in the early pregnancy screening biochemical indexes ofβ-hcg and papp-a,so as to explore the correlation betweenβ-hcg and papp-a and the three pregnancy complications.Research methodFrom March 2016 to February 2019,the second affiliated hospital of zhengzhou university conducted early down’s screening for pregnancy at 11-13⁺⁶ weeks and delivered in our hospital as the research objects,including 210 cases of GDM group,127 cases of PE group and 54 cases of FGR group.Meanwhile,240 cases of normal pregnancy and delivery during the same period of time were selected as the control group.β-hcg and PAPP-A values were obtained by elisa and converted into median multiples（MOM）.The pregnant women are between 20 and 35 years old.All the pregnant women who participated in the study filled in the basic information registration form,including age,birth time,last menstrual period and birth history.They filled in the form completely and collected it to tang sihai’s office.Risk factors during pregnancy,pre-natal age,weight,average weight gain during pregnancy,Body Mass Index（BMI）,fetal birth weight,gestational gestational weeks,gender and birth frequency of newborns were collected.SPSS22.0 statistical software was used for statistical analysis of the data of each group.Normality test was carried out for the measurement data.The data of normal distribution were represented by（x±s）.Logarithmic transformation was performed for the data of skewed distribution,and t test was used for the comparison between the two groups.One-way analysis of variance（ANOVA）was used to compare groups.The counting data were expressed as percentages,chi-square test was used for comparison between groups,and Pearson analysis was used for correlation.Graphpad Prism 6 software was used to draw curves（Receiver Operating Characteristic（ROC））and calculate Area Under the Curve（AUC）.Papp-a andβ-hcg measurements were converted into median multiples（MoM）.P<0.05 indicated statistically significant difference.Result1.The mean gestational weight gain of GDM group was 13.6±3.7,higher than that of control group 12.7±3.2,and the difference was statistically significant（P<0.05）.The gestational age of birth in PE group was 35.1±1.6,lower than 39.6±1.8 in the control group,and the birth weight of the newborn was 3.0±0.6,lower than3.6±0.8 in the control group,with statistically significant differences（P<0.05）.The gestational age of FGR group was 38.8±1.3,lower than the control group’s 39.6±1.8,and the birth weight of the newborn was 2.4±0.3,lower than the control group’s3.6±0.8,the differences were statistically significant（P<0.05）.2.The papp-a（MoM）values of GDM,PE mild,PE severe,and FGR groups were0.87±0.39,0.83±0.33,0.81±0.38,and 0.62±0.46,respectively,lower than those of the control group 1.01±0.47,（P<0.05）,PAPP-A was not associated with the severity of preeclampsia（r=-0.04,P=0.66）;Compared with the control group,there was no significant difference in the values ofβ-hcg（MOM）in the three groups of GDM,PE and FGR in the early pregnancy（P>0.05）.3.Papp-a MOM value predicted that the area under the ROC curve of GDM,PE and FGR was 0.739（95%CI 0.716⁰.842）,0.781（95%CI 0.705⁰.913）and0.867（95%CI 0.813⁰.922）,respectively.4.MOM values ofβ-hcg predicted the area under the ROC curve of GDM,PE and FGR were 0.556（95%CI 0.503⁰.609）,0.547（95%CI 0.496⁰.618）and0.581（95%CI 0.495⁰.661）,respectively.5.The cut-off values predicted by papp-a（MOM）for GDM,PE and FGR were0.754,0.871 and 0.541,respectively.conclusion1.The expression of serum papp-a in early pregnancy was significantly reduced in gestational diabetes mellitus,preeclampsia and fetal growth restriction,Papp-a was correlated with the incidence of three pregnancy complications and had certain predictive value for the three pregnancy complications.2.There was no correlation betweenβ-hcg and GDM,PE and FGR.