Abstract
Objective: To investigate whether maternal serum pregnancy associated plasma protein-A (PAPP-A), total β human chorionic gonadotropin (hCG) levels and nuchal translucency (NT) measurements differ in women with pre-gestational diabetes mellitus (PGDM) compared to non-diabetic controls and to assess whether correction factors are needed for diabetic women in calculation of aneuploidy risks. Study Design: We performed a retrospective study of all women who underwent first trimester aneuploidy screening (11 + 0 to 13 + 6 weeks) from 2005 to 2011. The primary study outcome was the difference in PAPP-A, β-hCG and NT multiples of median between women with PGDM and non-diabetic women. Results: Of 6741 eligible patients, 103 patients with PGDM were using insulin and 4 patients were using oral hypoglycemic agents; the latter were excluded due to small number. There was 12% reduction of median PAPP-A (p = 0.001) and 18% reduction of median hCG (p = 0.006) in women with PGDM receiving insulin. There was no difference in NT. Conclusions: In women with PGDM receiving insulin, PAPP-A and β-hCG levels are significantly lower compared to non-diabetic women. This suggests that when calculating risks for aneuploidy, correction factors should be considered to adjust PAPP-A and β-hCG concentrations to those seen in non-diabetic women.
Highlights
Maternal factors such as weight, race, parity, multiple gestation, smoking, in vitro fertilization and diabetes mellitus are known to affect the detection rates and false positive rates of the screening tests for autosomal trisomies [1,2]
Gestational diabetes mellitus was diagnosed in 64 women (4.8%) who delivered at University of Connecticut Health Center, and these patients were excluded leaving 6673 for final analysis (Figure 1)
Our findings show that the levels of maternal serum analytes, plasma protein-A (PAPP-A) and total beta human chorionic gonadotropin (hCG) used in first trimester aneuploidy screening are decreased in women with pre-gestational diabetes mellitus (PGDM) receiving insulin
Summary
Maternal factors such as weight, race, parity, multiple gestation, smoking, in vitro fertilization and diabetes mellitus are known to affect the detection rates and false positive rates of the screening tests for autosomal trisomies [1,2]. Elevated MSAFP values could identify pregnancies at risk for open neural tube defects [3]. It was reported low MSAFP values are useful as a screen for pregnancies at risk of fetal Down syndrome [4]. In women with pre-gestational diabetes (PGDM), the second trimester MSAFP is decreased. Unless a correction factor is applied, this falsely increases the calculated risk for Down’s syndrome [5]
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