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Prediction of macrosomia at birth in type-1 and 2 diabetic pregnancies with biomarkers of early placentation.
MedLine Citation:
PMID:  21332636     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Please cite this paper as: Kuc S, Wortelboer E, Koster M, de Valk H, Schielen P, Visser G. Prediction of macrosomia at birth in type-1 and 2 diabetic pregnancies with biomarkers of early placentation. BJOG 2011; DOI: 10.1111/j.1471-0528.2011.02904.x. Objective  To evaluate the value of first trimester placental biomarkers (fβ-hCG, PAPP-A, ADAM12, PP13 and PlGF) and fetal nuchal translucency (NT) in the prediction of macrosomia at birth in pregestational type-1 and type-2 diabetes (PGDM). Design  Nested case-control study. Setting  Routine first-trimester combined test. Population  A total of 178 PGDM and 186 control pregnancies. Methods  ADAM12, PP13 and PlGF concentrations were measured in stored first-trimester serum, previously tested for fβ-hCG and PAPP-A. All concentrations were expressed as multiples of the median (MoM). Where applicable, the median MoMs of PGDM and control pregnancies were compared in relation to birthweight centiles (≤90th centile, non-macrosomic, versus >90(th) centile, macrosomic). Model-predicted detection rates for fixed false-positive rates were obtained for statistically significant markers, separately and in combination. Main outcome measures  Prediction of macrosomia in diabetic pregnancies. Results  In the PGDM group, median ADAM12 MoM (0.88; P = 0.007) was lower than in the controls. Subgroup analyses showed that median MoMs of PAPP-A (0.65), ADAM12 (0.85), PP13 (0.81) and PlGF (0.91) were only reduced in the PGDM non-macrosomic birthweight subgroup (n = 93) compared with other weight subgroups. In the PGDM macrosomic birthweight subgroup (n = 69), MoMs of all markers were comparable with the control birthweight subgroups. The screening performance for macrosomia at birth in the PGDM group provided a detection rate of 30% for a 5% false-positive rate (FPR) and 43% for a 10% FPR. Conclusions  Macrosomia at birth in PGDM pregnancies may be predicted by normal levels of PAPP-A, ADAM12, PP13 and PlGF already in the first trimester of pregnancy. Fetal birthweight in PGDM offspring is partially determined by placental development during the first trimester of pregnancy. The present increase in fetal macrosomia may be related to better early glycemic control and placentation.
Authors:
S Kuc; Ej Wortelboer; Mph Koster; Hw de Valk; Pcji Schielen; Gha Visser
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-18
Journal Detail:
Title:  BJOG : an international journal of obstetrics and gynaecology     Volume:  -     ISSN:  1471-0528     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100935741     Medline TA:  BJOG     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.
Affiliation:
Laboratory for Infectious Diseases and Screening, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht (UMCU), Utrecht, the Netherlands Department of Internal Medicine, University Medical Centre Utrecht (UMCU), Utrecht, the Netherlands.
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