Diagnostic validity of a marker model of first trimester in pregnancy in prediction of birth weight

Slavica Vujović; Andjelka Šćepanović; Milan Terzić; Milena Djurović

doi:10.2298/VSP200328068V

Slavica Vujović University of Montenegro, Faculty of Medicine, Department of Pharmacy, Podgorica, Montenegro
Andjelka Šćepanović Faculty of Science, University of Montenegro, Montenegro, Faculty of Medicine, Department of Pharmacy, University of Montenegro, Montenegro
Milan Terzić Nazarbayev University, School of Medicine, Department of Medicine, Astana, Kazakhstan
Milena Djurović Human Reproduction, Budva, Montenegro

DOI: https://doi.org/10.2298/VSP200328068V

Keywords: chorionic gonadotropin, beta subunit, human;, diagnosis;, fetal growth retardation;, forecasting;, pregnancy;, pregnancy-associated plasma protein-a;, pregnancy trimester, first;, ultrasonography

Abstract

Background/Aim. Nowadays, low birth weight is considered to be one of the main causes of cardiovascular diseases or metabolic syndrome occurring later in life. Many studies have shown a strong impact of abnormal birth weight onto the future development, however, due to its stronger influence onto the development, a special emphasis is placed on low birth weight as compared to higher one. There is still no high-percentage accuracy test that will clearly classify expectant women under the risk of giving birth to a child too low or too big for gestational age. The aim of this paper was to set up a model that may indicate future low or high birth weight. Methods. This study included 191 expectant women who were divided into three groups, based on the birth weight (group 1: ˂ 3,000 g; group 2: 3,000–4,000 g; group 3: ˃ 4,000 g). The values of biochemical (pregnancy associated plasma protein A – PAPP-A, free β human chorionic gonadotropin) and ultrasonographic markers (nuchal translucency) as well as their multiple of the median (MoM) were determined and compared among groups. Results. It was shown that the values of PAPP-A MoM were considerably lower in groups of expectant women that had a fetus with low body weight (p = 0.003, p = 0.001). Statistically significant correlation between PAPP-A MoM and the newborn’s weight (r_s= 0.221, p = 0.001) was proven among the groups examined within this study. Conclusion. The usage of a combination of biochemical parameters, sonographic and demographic data in screening program increases the chances for early identification of fetuses that are under higher risk for growth restriction or increased growth. Also, the increase in the value of PAPP- A MoM causes the increase of fetus’ body weight.

References

Cetin I, Alvino G, Radaelli T, Pardi G. Fetal nutrition: a review. Acta Paediatr Suppl 2005; 94(449): 7‒13.

Barjaktarovic M, Korevaar TI, Jaddoe VW, de Rijke YB, Visser TJ, Peeters RP, et al. Human chorionic gonadotropin (hCG) concentrations during the late first trimester are associated with fetal growth in a fetal sex-specific manner. Eur J Epi-demiol 2017; 32(2): 135‒44.

Cignini P, Maggio Savasta L, Gulino FA, Vitale SG, Mangiafico L, Mesoraca A, et al. Predictive value of pregnancy-associated plasma protein-A (PAPP-A) and free beta-hCG on fetal growth restriction: results of a prospective study. Arch Gyne-col Obstet 2016; 293(6): 1227–33.

Abdel Moety GA, Almohamady M, Sherif NA, Raslana AN, Mo-hamed TF, El Moneam HM, et al. Could first-trimester assess-ment of placental functions predict preeclampsia and intrau-terine growth restriction? A prospective cohort study. J Ma-tern Fetal Neonatal Med 2016; 29(3): 413‒7.

Law LW, Leung TY, Sahota DS, Chan LW, Fung TY, Lau TK. Which ultrasound or biochemical markers are independent predictors of small-for-gestational age? Ultrasound Obstet Gynecol 2009; 34(3): 283‒7.

Tran HA. Biochemical tests for abnormalities in pregnancy. Aust Prescr 2006; 29: 48‒52.

Joseph KS, Kramer MS. Recent trends in infant mortality rates and proportions of low birth weight live births in Canada. CMAJ 1997; 157(6): 535‒41.

Barker DJ. The developmental origins of adult disease. J Am Coll Nutr 2004; 23(6 Suppl): 588S‒95S.

Bishop JC, Dunstan FD, Nix BJ, Reynolds TM, Swift A. All MoMs are not equal: some statistical properties associated with reporting results in the form of multiples of median". Am J Hum Genet 1993; 52(2): 425–30.

Patil M, Panchanadikar TM, Wagh G. Variation of Papp-A Lev-el in the First Trimester of Pregnancy and Its Clinical Out-come. J Obstet Gynaecol India 2014; 64(2): 116–9.

Goto E. Maternal Blood Biomarkers of Placentation to Predict Low-Birth-Weight Newborns: A Meta-Analysis. J Obstet Gyneacol Canada 2017; 39(8): 635‒44.

Gentile M, Schifano M, Lunardi S, Naninin C, Moscuzza F, Ser-giampietri C, at al. Maternal PAPP-A levels at 11-13 weeks of gestation predict fetal and neonatal growth. Open J Obstetric Gyneoloc 2015; 5(6) 365‒72.

Huynh L, Kingdom J, Akhtar S. Low pregnancy-associated plas-ma protein A level in the first trimester. Can Fam Physician 2014; 60(10): 899‒903. (English, French)

Baer RJ, Lyell DJ, Norton ME, Currier RJ, Jelliffe-Pawlowski LL. First trimester pregnancy-associated plasma protein-A and birth weight. Eur J Obstet Gynecol Reprod Biol 2016; 198: 1‒6.

Pedersen JF, Sørensen S, Ruge S. Human placental lactogen and pregnancy-associated plasma protein A in first trimester and subsequent fetal growth. Acta Obstet Gynecol Scand 1995; 74(7): 505‒8.

Langhoff-Roos J, Wibell L, Gebre-Medhin M, Lindmark G. Pla-cental hormones and maternal glucose metabolism. A study of fetal growth in normal pregnancy. Br J Obstet Gynaecol 1989; 96(3): 320‒6.

Tarim E, Hacivelioglu SO, Çok T, Bagis HT. First trimester ma-ternal serum PAPP-A levels and macrosomia in nondiabetic mothers. Turk J Med Sci 2011; 41(4): 581‒6.

Sung KU, Roh JA, Eoh KJ, Kim EH. Maternal serum placental growth factor and pregnancy-associated plasma protein A measured in the first trimester as parameters of subsequent pre-eclampsia and small-for-gestational-age infants: A pro-spective observational study. Obstet Gynecol Sci 2017; 60(2): 154–62.

Tul N, Pusenjak S, Osredkar J, Spencer K, Novak-Antolic Z. Pre-dicting complications of pregnancy with first-trimester mater-nal serum free-betahCG, PAPP-A and inhibin-A. Prenat Di-agn 2003; 23(12): 990–6. doi:10.1002/pd.735

Korevaar TI, Steegers EA, de Rijke YB, Schalekamp-Timmermans S, Visser WE, Hofman A, et al. Reference ranges and determi-nants of total hCG levels during pregnancy: the Generation R Study. Eur J Epidemiol 2015; 30(9): 1057–66.

Chang YS, Chen CN, Jeng SF, Su YN, Chen CY, Chou HC, et al. The sFlt-1/PlGF ratio as a predictor for poor pregnancy and neonatal outcomes. Pediatr Neonatol 2017; 58(6): 529–33.

Güdücü N, Gönenç G, İşçi H, Yiğiter AB, Dünder İ. First and second trimester hCG levels have no value in predicting small for gestational age infants. Cumhuriyet Med J 2013; 35: 215‒20.

Kirkegaard I, Henriksen TB, Uldbjerg N. Early fetal growth, PAPP-A and free beta-hCG in relation to risk of delivering a small-for-gestational age infant. Ultrasound Obstet Gynecol 2011; 37(3): 341–7.

Ong KK, Dunger DB. Birth weight, infant growth and insulin resistance. Eur J Endocrinol 2004; 151 Suppl 3: U131‒9.

Smith GC, Stenhouse EJ, Crossley JA, Aitken DA, Cameron AD, Connor JM. Early pregnancy levels of papp-a a and the risk of intrauterine growth restriction premature birth, preeclampsia and stillbirth. J Clin Endocrinol Metab 2002; 87(4): 1762‒7.

Lin CC, Lindheimer MD, River P, Moawad AH. Fetal outcome in hypertensive disorders of pregnancy. Am J Obstet Gynecol 1982; 142(3): 255–60.

Nwabuobi Ch, Arlier S, Schatz F, Guzeloglu-Kayisli O, Lockwood CJ, and Kayisli U. hCG: Biological Functions and Clinical Ap-plications. Int J Mol Sci 2017; 18(10): 2037.

Poon LC, Maiz N, Valencia C, Pasencia W, Nicolaides KH. First trimester maternam serum papp-a and preeclampsia. Ultra-sound Obstet Gynecol 2009; 33(1): 23‒33.