Prognostic Impact of Pregnancy-Associated Plasma Protein-A (PAPP-A) for Gestational Diabetes Mellitus (GDM): An Updated Systematic Review and Meta-Analysis of More Than 90 000 Pregnancies

IF 2.5 3区医学 Q3 IMMUNOLOGY

American Journal of Reproductive Immunology Pub Date : 2025-06-06 DOI:10.1111/aji.70087

Ing-Luen Shyu, Yung-Chieh Tsai, Tian-Ni Kuo, Yow-Ling Shiue

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引用次数: 0

Abstract

Objective

Gestational diabetes mellitus (GDM) constitutes a significant health concern during pregnancy, warranting a thorough investigation into potential prognostic markers. Pregnancy-associated plasma protein-A (PAPP-A), which is present at high levels during pregnancy, exhibits altered concentrations even before the clinical diagnosis of GDM, highlighting its potential as an early biomarker for this condition. This systematic review and meta-analysis aimed to review and synthesize the latest evidence comprehensively to explore the correlation between maternal PAPP-A levels and the development of GDM, drawing from the most recent publications available.

Methods

PubMed, EMBASE, and Cochrane CENTRAL were searched systematically up to June 2, 2024. Cohort and case-control studies reporting PAPP-A levels in GDM and non-GDM women with singleton pregnancy were eligible for inclusion. The quality of studies was measured using the Newcastle-Ottawa scale (NOS). Standardized mean differences (SMDs) of PAPP-A levels between GDM and non-GDM, and odds ratios (ORs) of the association between PAPP-A and GDM were pooled, with heterogeneity assessed using the Cochran Q test and I² statistic. Sensitivity analysis was employed (PROSPERO ID: CRD42024580169).

Results

Nineteen studies involving 92 200 pregnant women were included in the systematic review and meta-analysis. The gestational age at sampling varied from 10 to 14 weeks. Meta-analysis revealed a significantly lower PAPP-A level among women with GDM compared with those without (pooled SMD = −0.31, 95% CI: −0.56 to −0.06). Furthermore, meta-analysis revealed that women with a low PAPP-A level had a significantly higher risk of developing GDM (pooled OR = 1.75, 95% CI: 1.45–2.11). Despite observed publication bias, sensitivity analysis affirmed the robustness of the results.

Conclusions

This updated systematic review and meta-analysis underscored the prognostic significance of maternal PAPP-A levels with respect to the development of GDM. Low PAPP-A level is associated with an increased risk of GDM. These findings advocate for the inclusion of PAPP-A assessment in the clinical evaluation of GDM risk.

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妊娠相关血浆蛋白a （ppap - a）对妊娠糖尿病（GDM）预后的影响：一项超过9万例妊娠的最新系统综述和荟萃分析

目的妊娠期糖尿病（GDM）是妊娠期的重要健康问题，需要对其潜在预后指标进行深入研究。妊娠相关血浆蛋白a（妊娠相关血浆蛋白a）在妊娠期间处于高水平，甚至在GDM临床诊断之前就表现出浓度变化，突出了其作为GDM早期生物标志物的潜力。本系统综述和荟萃分析旨在全面回顾和综合最新的证据，以探讨母体ppap -a水平与GDM发展之间的相关性，并借鉴最新的出版物。方法系统检索PubMed、EMBASE和Cochrane CENTRAL，检索时间截止到2024年6月2日。报告单胎妊娠的GDM和非GDM妇女中pap - a水平的队列和病例对照研究符合入选条件。研究质量采用纽卡斯尔-渥太华量表（NOS）进行测量。汇总GDM与非GDM患者ppap - a水平的标准化平均差异（SMDs），以及ppap - a与GDM相关的比值比（ORs），并采用Cochran Q检验和I2统计量评估异质性。采用敏感性分析（PROSPERO ID: CRD42024580169）。结果系统评价和荟萃分析纳入了19项研究，涉及92 200名孕妇。取样时的胎龄从10周到14周不等。荟萃分析显示，与未患GDM的女性相比，GDM女性的ppap -a水平显著降低（合并SMD = - 0.31, 95% CI: - 0.56至- 0.06）。此外，荟萃分析显示，低ppap -a水平的女性发生GDM的风险明显更高（合并OR = 1.75, 95% CI: 1.45-2.11）。尽管观察到发表偏倚，敏感性分析证实了结果的稳健性。这项最新的系统综述和荟萃分析强调了母体ppap -a水平对GDM发展的预后意义。低pap - a水平与GDM风险增加相关。这些发现提倡将pap - a评估纳入GDM风险的临床评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Reproductive Immunology 医学-免疫学

CiteScore

6.20

自引率

5.60%

发文量

314

审稿时长

2 months

期刊介绍： The American Journal of Reproductive Immunology is an international journal devoted to the presentation of current information in all areas relating to Reproductive Immunology. The journal is directed toward both the basic scientist and the clinician, covering the whole process of reproduction as affected by immunological processes. The journal covers a variety of subspecialty topics, including fertility immunology, pregnancy immunology, immunogenetics, mucosal immunology, immunocontraception, endometriosis, abortion, tumor immunology of the reproductive tract, autoantibodies, infectious disease of the reproductive tract, and technical news.