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Komplikasyonsuz Gebeliklerde Pregnancy Associated Plasma Protein-A ve Serbest Human Koryonik Gonadotropin Değerlerinin Bebeğin Cinsiyeti, Kilosu ve Boyunu Belirlemedeki Yeri

Year 2021, Volume: 16 Issue: 3, 388 - 392, 01.11.2021

Filiz Alkan Baylan Selim Karaküçük

https://doi.org/10.17517/ksutfd.886383

Abstract

Amaç: Maternal serumda 0.5-2.5 MoM aralığındaki sß-HCG ve PAPP-A MoM değerlerinin fetal cinsiyet, yenidoğan ağırlığı ve boyunu tahmin etmede etkinliğini değerlendirmek.
Gereç ve Yöntemler: Birinci trimester taraması için anomali taraması yapılan 519 tekil, komplikasyonsuz gebelikte ölçülen tarama testi biyokimyasal bileşenlerinden sß-HCG ve PAPP-A değerleri ile doğum sonu yenidoğanın cinsiyet, boy ve ağırlık verileri retrospektif olarak bulunarak karşılaştırıldı.
Bulgular: sß-HCG MoM değerinin, yenidoğan cinsiyeti ile ilişkili olduğu (U: 29240.5, p: 0.01) ve kız cinsiyete sahip fetüslerde daha yüksek olduğu bulundu. ROC analizinde sß-HCG MoM değerinin kız cinsiyeti tanımada istatistiksel olarak anlamlı (AUC: %56.6, güven aralığı: 0.516-0.615, p: 0.01) olduğu tespit edildi. sß-HCG MoM değerinin, yenidoğan cinsiyetini doğru tahmin etmedeki sensitivitesinin %66.3, spesifitesinin ise %51.9 olduğu (cut off değeri: 0.855 MoM) görüldü. PAPP-A MoM değerinin yeni doğan ağırlığı (r: 0.175, p: <0.001) ve boyu (r: 0.166, p: <0.001) ile pozitif bir korelasyon gösterdiği ve sß-HCG MoM değeri ile yenidoğan boyu arasında çok zayıf bir korelasyon olduğu (r: 0.099, p: <0.005) izlendi.
Sonuç: Çalışmamız birinci trimester tarama testi biyokimyasal belirteçlerinden sß-HCG MoM değerinin fetal cinsiyet ile ilişkili olduğunu göstermiştir. Bu ilişki günümüzde fetal cinsiyeti %100 doğruluk ile tahmin edebilen yöntemler mevcut olduğundan klinik anlamda kullanabilmek için yeterli değildir ancak yine de genetik geçişli bazı hastalıkların değerlendirilmesinde fetal cinsiyet için fikir verebilir. Ayrıca çalışmamızda komplikasyonsuz gebelerde PAPP-A MoM seviyesinin, yenidoğanın boyu ve ağırlığı gibi fetal gelişimi gösteren parametreler ile ilgili bilgi verdiği görülmüştür. Bu ilişkinin fetal gelişimi etkileyen birçok sosyo-demografik etkenin hesaba katıldığı geniş kapsamlı prospektif çalışmalar yapılarak daha da netleşeceği kanaatindeyiz.

Keywords

PAPP-A sBHCG fetal cinsiyet yenidoğan kilosu

References

  • 1- Blakely SB, Binghampton NY. The diagnosis of sex of the human fetus in utero. Am J Obstet Gynecol.1937;34:322-35.
  • 2- Stephens JD, Shermen S. Determination of fetal sex by ultrasound. N. Engl J Med. 1983;309:984-949.
  • 3- Weldner BM. Accuracy of fetal sex determination by ultrasound. Acta Obstet Gynecol Scand. 1981;60:333-334.
  • 4- Unterscheider j, O’donoghue K, Malone FD. Guidelines on fetal growth restriction: a comprasion of recent national publications. Am J Perinalol. 2015;32:307-316.
  • 5- Mehta SH, Sokol RJ. Shoulder dystocia: risk factors, predictability and preventability. Semin Perinatol. 2014;38:188-193.
  • 6- Pan X, Zhang C, Li X, Chen S, Ge H, Zhang Y, et al. Non-invasive fetal sex determination by maternal plasma sequencing and application in X-linked disorder counseling. J Matern Fetal Neonatal Med. 2014 Dec;27(18):1829-33.
  • 7- Manzanares S, Benítez A, Naveiro-Fuentes M, López-Criado MS, Sánchez-Gila M. Gebeliğin ilk üç ayında ultrason muayenesinde fetal cinsiyet tayininin doğruluğu . J Clin Ultrason. 2016;44:272-277.
  • 8- Odeh M, Granin V, Kais M, Ophir E, Bornstein J. Sonografik fetal cinsiyet tayini. Obstet Gynecol Surv. 2009;64:50–57.
  • 9- Jones TM, Montero FJ. Chorionic Villus Sampling. 2020 Oct 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–.
  • 10- Breveglieri G, D'Aversa E, Finotti A, Borgatti M. Non-invasive Prenatal Testing Using Fetal DNA. Mol Diagn Ther. 2019 Apr;23(2):291-299.
  • 11- Bal T, Karakucuk S, Karakucuk SN. The correlation between amniotic fluid and neonatal weight. MKÜ Tıp Dergisi. 2019;10(37):36-40.
  • 12- Kale İ, Gülerman HC, Moraloğlu Ö, Gürlek B, Yenicesu O, Sarıkaya E, at al. Association between low levels of maternal serum PAPP-A in the first trimester and complications of pregnancy. Turkiye Klinikleri J Gynecol Obst. 2012;22(1):25-35.
  • 13- Whittle W, Chaddha V, Wyatt P, Huppertz B, Kingdom J. Ultrasound detection of placental insufficiency in women with ‘unexplained’ abnormal maternal serum screening results. Clin Genet. 2006;69(2):97–104.
  • 14- Morris RK, Bilagi A, Devani P, Kilby MD. Association of serum PAPP-A levels in first trimester with small for gestational age and adverse pregnancy outcomes: systematic review and meta-analysis. Prenat Diagn. 2017 Mar;37(3):253-265.
  • 15- Scott F, Coates A, McLennan A. Pregnancy outcome in the setting of extremely low first trimester PAPP-A levels. Aust N Z J Obstet Gynaecol. 2009;49(3):258-262.
  • 16- Kaijomaa M, Ulander VM, Hämäläinen E, Alfthan H, Markkanen H, Heinonen S, et al. The risk of adverse pregnancy outcome among pregnancies with extremely low maternal PAPP-A. Prenat Diagn. 2016 Dec;36(12):1115-1120.
  • 17- Spencer CA, Allen VM, Flowerdew G, Dooley K, Dodds L. Low levels of maternal serum PAPP-A in early pregnancy and the risk of adverse outcomes. Prenat Diagn. 2008;28(11):1029-1036.
  • 18- Livrinova V, Petrov I, Samardziski I, Jovanovska V, Simeonova-Krstevska S, Todorovska I, et al. Obstetric Outcome in Pregnant Patients with Low Level of Pregnancy-Associated Plasma Protein A in First Trimester. Open Access Maced J Med Sci. 2018 Jun 6;6(6):1028-1031.
  • 19- Sirikunalai P, Wanapirak C, Sirichotiyakul S, Tongprasert F. Associations between maternal serum free beta human chorionic gonadotropin (β-hCG) levels and adverse pregnancy outcomes. Journal of Obstetrics and Gynaecology. 2016;36(2):178-182.
  • 20- Cignini P, Savasta LM, Gulino FA, Vitale SG, Mangiafico L, Mesoraca A, Giorlandino C. Predictive value of pregnancy-associated plasma protein-A (PAPP-A) and free beta-hCG on fetal growth restriction: results of a prospective study. Arch Gynecol Obstet. 2016;293(6):1227-1233.
  • 21- Illescas T, Fernández C, Ortega D, de la Puente M, Coronado P, Montalvo J. Influence of gravidity and foetal gender on the value of screening variables in the first trimester of pregnancy. Eur J Obstet Gynecol Reprod Biol. 2013 Mar;167(1):14-17.
  • 22- Cowans NJ, Stamatopoulou A, Maiz N, Spencer K and Nicolaides KH. The impact of fetal gender on first trimester nuchal translucency and maternal serum free β-hCG and PAPP-A MoM in normal and trisomy 21 pregnancies. Prenat Diagn 2009;29:578-581.
  • 23- Hsiao CH, Wang HC, Hsieh CF, Hsu JJ. Fetal gender screening by ultrasound at 11 to 13(+6) weeks. Acta Obstet Gynecol Scand. 2008;87(1):8-13.
  • 24- Chelli D, Methni A, Dimassi K, Boudaya F, Sfar E, Zouaoui B, et al. Fetal sex assignment by first trimester ultrasound: a Tunisian experience. Prenat Diagn. 2009 Dec;29(12):1145-1148. doi: 10.1002/pd.2374.
  • 25- Has R, Topuz S, Yıldırım E, İbrahmoglu L, Fetal sex determination by ultrasound in the first trimester. T Klin Jinekol Obst. 2002;12:228-231.
  • 26- Hackett LK, Tarsa M, Wolfson TJ, Kaplan G, Vaux KK, Pretorius DH. Use of multiplanar 3-dimensional ultrasonography for prenatal sex identification. J Ultrasound Med. 2010 Feb;29(2):195-202.
  • 27- D'Aversa E, Breveglieri G, Pellegatti P, Guerra G, Gambari R, Borgatti M. Non-invasive fetal sex diagnosis in plasma of early weeks pregnants using droplet digital PCR. Mol Med. 2018 Apr 5;24(1):14.
  • 28- Mahdavi S, Karami F, Sabbaghi S. Non-invasive prenatal diagnosis of foetal gender through maternal circulation in first trimester of pregnancy. J Obstet Gynaecol. 2019 Nov;39(8):1071-1074.
  • 29- Canini S, Prefumo F, Pastorino D, Crocetti L, Afflitto CG, Venturini PL, et al. Association between birth weight and first-trimester free beta-human chorionic gonadotropin and pregnancy-associated plasma protein A. Fertil Steril. 2008;89: 174-178.
  • 30- Dane B, Afacan İ, Dane C, Seval H, Koray M, Çetin A. Serum PAPP-A değeri ile doğum kilosu ve gebelik komplikasyonlarını öngörebilir miyiz? Türkiye Klinikleri J Gynecol Obst. 2008;18:372-376.
  • 31- Aytan H, Çalışkan AC, Demirtürk F, Çimşir H, Bekar Ö, Acar MT. The association of first trimester PAPP-A, free b-hcg and nuchal translucency with fetal birth weight and length in uncomplicated pregnancies. TJOD Derg 2009;6:266-272.
  • 32- Leung TY, Sahota DS, Chan LW, Law LW, Fung TY, Leung TN, et al. Prediction of birth weight by fetal crown-rump length and maternal serum levels of pregnancy-associated plasma protein-A in the first trimester. Ultrasound Obstet Gynecol. 2008;31:10-14.
  • 33- Senses DA, Coskun A, Kiseli M, Berberoglu M, Kandemir O, Yalvac S, et al. Is there a relationship between cord blood pregnancy-associated plasma protein-A and birth weight and length? Early Hum Dev. 2007;83:479-482.

The Role of Pregnancy Associated Plasma Protein-A and Free Human Chorionic Gonadotropin Values in Determining Baby's Gender, Weight and Height in Uncomplicated Pregnancies

Year 2021, Volume: 16 Issue: 3, 388 - 392, 01.11.2021

Filiz Alkan Baylan Selim Karaküçük

https://doi.org/10.17517/ksutfd.886383

Abstract

Purpose: To evaluate the effectiveness of sß-HCG and PAPP-A MoM values in the range of 0.5-2.5 MoM in maternal serum in predicting fetal sex, newborn weight and height.
Material and methods: The sß-HCG and PAPP-A values of the screening test biochemical components of 519 single, uncomplicated pregnancies that were screened for anomaly for the first trimester screening were retrospectively compared with the sex, height and weight data of the postpartum newborn.
Results: It was found that sß-HCG MoM value was associated with newborn gender (U: 29240.5, p: 0.01) and was higher in fetuses of female gender. In the ROC analysis, it was found that the sß-HCG MoM value was statistically significant (AUC: 56.6%, confidence interval: 0.516-0.615, p: 0.01) in identifying the female gender. The sensitivity of sß-HCG MoM value in predicting the newborn gender was 66.3% and the specificity was 51.9% (cut off value: 0.855 MoM). PAPP-A MoM value was positively correlated with newborn weight (r: 0.175, p: <0.001) and height (r: 0.166, p: <0.001) and there was a very weak correlation between sß-HCG MoM value and newborn height. (r: 0.099, p: <0.005) were monitored.
Conclusion: Our study showed that sß-HCG MoM value, which is one of the first trimester screening test biochemical markers, is associated with fetal gender. This relationship is not sufficient to be used clinically, as there are methods that can predict fetal sex with 100% accuracy today, but it can still give an idea for fetal sex in the evaluation of some genetic inherited diseases. In addition, in our study, it was observed that the PAPP-A MoM level in uncomplicated pregnant women gave information about parameters showing fetal development such as the height and weight of the newborn. We believe that this relationship will be further clarified by conducting comprehensive prospective studies in which many socio-demographic factors affecting fetal development are taken into account.

Keywords

PAPP-A fBHCG fetal sex newborn weight

References

  • 1- Blakely SB, Binghampton NY. The diagnosis of sex of the human fetus in utero. Am J Obstet Gynecol.1937;34:322-35.
  • 2- Stephens JD, Shermen S. Determination of fetal sex by ultrasound. N. Engl J Med. 1983;309:984-949.
  • 3- Weldner BM. Accuracy of fetal sex determination by ultrasound. Acta Obstet Gynecol Scand. 1981;60:333-334.
  • 4- Unterscheider j, O’donoghue K, Malone FD. Guidelines on fetal growth restriction: a comprasion of recent national publications. Am J Perinalol. 2015;32:307-316.
  • 5- Mehta SH, Sokol RJ. Shoulder dystocia: risk factors, predictability and preventability. Semin Perinatol. 2014;38:188-193.
  • 6- Pan X, Zhang C, Li X, Chen S, Ge H, Zhang Y, et al. Non-invasive fetal sex determination by maternal plasma sequencing and application in X-linked disorder counseling. J Matern Fetal Neonatal Med. 2014 Dec;27(18):1829-33.
  • 7- Manzanares S, Benítez A, Naveiro-Fuentes M, López-Criado MS, Sánchez-Gila M. Gebeliğin ilk üç ayında ultrason muayenesinde fetal cinsiyet tayininin doğruluğu . J Clin Ultrason. 2016;44:272-277.
  • 8- Odeh M, Granin V, Kais M, Ophir E, Bornstein J. Sonografik fetal cinsiyet tayini. Obstet Gynecol Surv. 2009;64:50–57.
  • 9- Jones TM, Montero FJ. Chorionic Villus Sampling. 2020 Oct 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–.
  • 10- Breveglieri G, D'Aversa E, Finotti A, Borgatti M. Non-invasive Prenatal Testing Using Fetal DNA. Mol Diagn Ther. 2019 Apr;23(2):291-299.
  • 11- Bal T, Karakucuk S, Karakucuk SN. The correlation between amniotic fluid and neonatal weight. MKÜ Tıp Dergisi. 2019;10(37):36-40.
  • 12- Kale İ, Gülerman HC, Moraloğlu Ö, Gürlek B, Yenicesu O, Sarıkaya E, at al. Association between low levels of maternal serum PAPP-A in the first trimester and complications of pregnancy. Turkiye Klinikleri J Gynecol Obst. 2012;22(1):25-35.
  • 13- Whittle W, Chaddha V, Wyatt P, Huppertz B, Kingdom J. Ultrasound detection of placental insufficiency in women with ‘unexplained’ abnormal maternal serum screening results. Clin Genet. 2006;69(2):97–104.
  • 14- Morris RK, Bilagi A, Devani P, Kilby MD. Association of serum PAPP-A levels in first trimester with small for gestational age and adverse pregnancy outcomes: systematic review and meta-analysis. Prenat Diagn. 2017 Mar;37(3):253-265.
  • 15- Scott F, Coates A, McLennan A. Pregnancy outcome in the setting of extremely low first trimester PAPP-A levels. Aust N Z J Obstet Gynaecol. 2009;49(3):258-262.
  • 16- Kaijomaa M, Ulander VM, Hämäläinen E, Alfthan H, Markkanen H, Heinonen S, et al. The risk of adverse pregnancy outcome among pregnancies with extremely low maternal PAPP-A. Prenat Diagn. 2016 Dec;36(12):1115-1120.
  • 17- Spencer CA, Allen VM, Flowerdew G, Dooley K, Dodds L. Low levels of maternal serum PAPP-A in early pregnancy and the risk of adverse outcomes. Prenat Diagn. 2008;28(11):1029-1036.
  • 18- Livrinova V, Petrov I, Samardziski I, Jovanovska V, Simeonova-Krstevska S, Todorovska I, et al. Obstetric Outcome in Pregnant Patients with Low Level of Pregnancy-Associated Plasma Protein A in First Trimester. Open Access Maced J Med Sci. 2018 Jun 6;6(6):1028-1031.
  • 19- Sirikunalai P, Wanapirak C, Sirichotiyakul S, Tongprasert F. Associations between maternal serum free beta human chorionic gonadotropin (β-hCG) levels and adverse pregnancy outcomes. Journal of Obstetrics and Gynaecology. 2016;36(2):178-182.
  • 20- Cignini P, Savasta LM, Gulino FA, Vitale SG, Mangiafico L, Mesoraca A, Giorlandino C. Predictive value of pregnancy-associated plasma protein-A (PAPP-A) and free beta-hCG on fetal growth restriction: results of a prospective study. Arch Gynecol Obstet. 2016;293(6):1227-1233.
  • 21- Illescas T, Fernández C, Ortega D, de la Puente M, Coronado P, Montalvo J. Influence of gravidity and foetal gender on the value of screening variables in the first trimester of pregnancy. Eur J Obstet Gynecol Reprod Biol. 2013 Mar;167(1):14-17.
  • 22- Cowans NJ, Stamatopoulou A, Maiz N, Spencer K and Nicolaides KH. The impact of fetal gender on first trimester nuchal translucency and maternal serum free β-hCG and PAPP-A MoM in normal and trisomy 21 pregnancies. Prenat Diagn 2009;29:578-581.
  • 23- Hsiao CH, Wang HC, Hsieh CF, Hsu JJ. Fetal gender screening by ultrasound at 11 to 13(+6) weeks. Acta Obstet Gynecol Scand. 2008;87(1):8-13.
  • 24- Chelli D, Methni A, Dimassi K, Boudaya F, Sfar E, Zouaoui B, et al. Fetal sex assignment by first trimester ultrasound: a Tunisian experience. Prenat Diagn. 2009 Dec;29(12):1145-1148. doi: 10.1002/pd.2374.
  • 25- Has R, Topuz S, Yıldırım E, İbrahmoglu L, Fetal sex determination by ultrasound in the first trimester. T Klin Jinekol Obst. 2002;12:228-231.
  • 26- Hackett LK, Tarsa M, Wolfson TJ, Kaplan G, Vaux KK, Pretorius DH. Use of multiplanar 3-dimensional ultrasonography for prenatal sex identification. J Ultrasound Med. 2010 Feb;29(2):195-202.
  • 27- D'Aversa E, Breveglieri G, Pellegatti P, Guerra G, Gambari R, Borgatti M. Non-invasive fetal sex diagnosis in plasma of early weeks pregnants using droplet digital PCR. Mol Med. 2018 Apr 5;24(1):14.
  • 28- Mahdavi S, Karami F, Sabbaghi S. Non-invasive prenatal diagnosis of foetal gender through maternal circulation in first trimester of pregnancy. J Obstet Gynaecol. 2019 Nov;39(8):1071-1074.
  • 29- Canini S, Prefumo F, Pastorino D, Crocetti L, Afflitto CG, Venturini PL, et al. Association between birth weight and first-trimester free beta-human chorionic gonadotropin and pregnancy-associated plasma protein A. Fertil Steril. 2008;89: 174-178.
  • 30- Dane B, Afacan İ, Dane C, Seval H, Koray M, Çetin A. Serum PAPP-A değeri ile doğum kilosu ve gebelik komplikasyonlarını öngörebilir miyiz? Türkiye Klinikleri J Gynecol Obst. 2008;18:372-376.
  • 31- Aytan H, Çalışkan AC, Demirtürk F, Çimşir H, Bekar Ö, Acar MT. The association of first trimester PAPP-A, free b-hcg and nuchal translucency with fetal birth weight and length in uncomplicated pregnancies. TJOD Derg 2009;6:266-272.
  • 32- Leung TY, Sahota DS, Chan LW, Law LW, Fung TY, Leung TN, et al. Prediction of birth weight by fetal crown-rump length and maternal serum levels of pregnancy-associated plasma protein-A in the first trimester. Ultrasound Obstet Gynecol. 2008;31:10-14.
  • 33- Senses DA, Coskun A, Kiseli M, Berberoglu M, Kandemir O, Yalvac S, et al. Is there a relationship between cord blood pregnancy-associated plasma protein-A and birth weight and length? Early Hum Dev. 2007;83:479-482.
There are 33 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Araştırma Makaleleri
Authors

Filiz Alkan Baylan 0000-0003-3117-7768

Selim Karaküçük 0000-0002-9317-7926

Publication Date November 1, 2021
Submission Date February 24, 2021
Acceptance Date March 24, 2021
Published in Issue Year 2021 Volume: 16 Issue: 3

Cite

AMA Alkan Baylan F, Karaküçük S. Komplikasyonsuz Gebeliklerde Pregnancy Associated Plasma Protein-A ve Serbest Human Koryonik Gonadotropin Değerlerinin Bebeğin Cinsiyeti, Kilosu ve Boyunu Belirlemedeki Yeri. KSU Medical Journal. November 2021;16(3):388-392. doi:10.17517/ksutfd.886383
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