妊娠早期PLGF和PAPP-A与胎盘介导并发症的风险：预测前瞻性研究。

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada Pub Date : 2025-02-01 DOI:10.1016/j.jogc.2024.102732

Marie-Laurence Côté MD , Yves Giguère MD, PhD , Jean-Claude Forest MD, PhD , Francois Audibert MD, MSc , Jo Ann Johnson MD , Nan Okun MD , Paul Guerby MD, PhD , Louise Ghesquiere MD, PhD , Emmanuel Bujold MD, MSc

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引用次数: 0

摘要

目的：评估低妊娠前期母亲血清胎盘生长因子（PlGF）和妊娠相关血浆蛋白A （PAPP-A）与胎盘介导的并发症风险之间的关系。方法：我们对预测研究进行了二次分析，包括在怀孕11-14周招募的未分娩参与者。孕早期PlGF和pap - a的报告是根据产妇特征和胎龄调整的中位数（MoM）的倍数。根据是否存在低(结果：在7262名参与者中，86名（1.2%）在37周之前出现了综合结局，其中35名（0.4%）在34周之前出现了综合结局。与单独低PlGF（7%和3%）、单独低pap - a（2%和1%）或两者均不存在（分别为1%和0.4%,P < 0.001）相比，低pap - a和低PlGF联合治疗在37周前（21%）和34周前（12%）发生不良结局的风险最大。特别是在早产子痫前期，低pap - a和低PlGF的组合与单独低PlGF（6%）、低pap - a（0.5%）或两者都不存在（0.7%,P < 0.001）相比，风险更高（12%）。结论：低PAPP-A和低PlGF合并在34周和37周前发生不良结局的风险非常高。孤立的低pap - a不应被视为不良妊娠结局的危险因素。

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First-Trimester PlGF and PAPP-A and the Risk of Placenta-Mediated Complications: PREDICTION Prospective Study

Objectives

This study aimed to estimate the association between low first-trimester maternal serum PlGF (placental growth factor) and PAPP-A (pregnancy-associated plasma protein A) and the risk of placenta-mediated complications.

Methods

We performed a secondary analysis of the PREDICTION study, including nulliparous participants recruited at 11 to 14 weeks of pregnancy. First-trimester PlGF and PAPP-A levels were reported in multiples of the median (MoM) adjusted for maternal characteristics and gestational age. Participants were stratified into 4 groups based on absence/presence of low (<0.4 MoM) PlGF and PAPP-A values. A composite of adverse pregnancy outcomes (including preeclampsia, fetal growth restriction, fetal death, and placental abruption) was calculated for deliveries occurring before 34 weeks, before 37 weeks, and at or after 37 weeks.

Results

Out of the 7262 participants, 86 (1.2%) experienced the composite outcome before 37 weeks of gestation, including 35 (0.4%) before 34 weeks. The combination of low PAPP-A and low PlGF levels was associated with the greatest risk of adverse outcomes before 37 weeks (21%) and before 34 weeks (12%) compared with low PlGF alone (7% and 3%), low PAPP-A alone (2% and 1%), or neither marker (1% and 0.4%, respectively; P < 0.001). For preterm preeclampsia specifically, the combination of low PAPP-A and low PlGF was also associated with a greater risk (12%) compared with low PlGF alone (6%), low PAPP-A alone (0.5%), or neither marker (0.7%; P < 0.001).

Conclusions

The combination of low PAPP-A and low PlGF levels is associated with a very high risk for adverse outcomes before 34 and 37 weeks. An isolated low PAPP-A should not be considered a risk factor for adverse pregnancy outcomes.

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来源期刊

Journal of obstetrics and gynaecology Canada OBSTETRICS & GYNECOLOGY-

CiteScore

3.30

自引率

5.60%

发文量

302

审稿时长

32 days

期刊介绍： Journal of Obstetrics and Gynaecology Canada (JOGC) is Canada"s peer-reviewed journal of obstetrics, gynaecology, and women"s health. Each monthly issue contains original research articles, reviews, case reports, commentaries, and editorials on all aspects of reproductive health. JOGC is the original publication source of evidence-based clinical guidelines, committee opinions, and policy statements that derive from standing or ad hoc committees of the Society of Obstetricians and Gynaecologists of Canada. JOGC is included in the National Library of Medicine"s MEDLINE database, and abstracts from JOGC are accessible on PubMed.