II-201
NAPOVEDOVANJE PORODNIŠKIH ZAPLETOV
S POMOČJO PROSTEGA β hCG, PAPP-A IN INHIBINA A
V SERUMU NOSEČNIC V PRVEM TRIMESEČJU
PREDICTION OF PREGNANCY COMPLICATIONS BY MEANS OF FREE β hCG, PAPP-A AND
INHIBIN A IN MATERNAL SERUM IN THE FIRST TRIMESTER
Nataša Tul, Stanko Pušenjak, Živa Novak-Antolič
Klinični oddelek za perinatologijo, Ginekološka klinika, Klinični center, Šlajmerjeva 3, 1525 Ljubljana
Key words: free β hCG; PAPP-A; inhibin A; pregnancy com-
plications
Abstract – Background. Calculation of risk on the basis of
maternal age, fetal nuchal translucency (NT), free β  human
chorionic gonadotropin (fβ hCG) and PAPP-A (Pregnancy As-
sociated Plasma Protein A) is the most efficient first trimester
screening test in detection of chromosomopathies (90-percent
detection rate of trisomy 21 [T21], 5% false positive results).
The aim of this study was to evaluate whether the levels of
fβ hCG, PAPP-A and inhibin A, measured at 10–14 gestational
week, predict complications later in pregnancy.
Methods. In the study 1136 women with chromosomally nor-
mal fetuses were enrolled. At 10–14 gestational week we
measured fetal the crown-rump length and NT, and the levels
of fβ hCG, PAPP-A and inhibin A in maternal serum. From
the records we collected the data on the method of conception,
course and outcome of pregnancy and the neonatal condi-
tion. We compared all these parameters between the mothers,
in whom perinatal complications occurred (small [SGA] or
large for gestational age babies [LGA], gestational diabetes,
pregnancy hypertension, preterm delivery), and those, not ex-
periencing any pregnancy complication. We constructed mul-
tivariate models for prediction of risk of individual complica-
tions.
Results. Low PAPP-A levels were associated with the delivery
of an SGA baby, high PAPP-A levels with the delivery of an
LGA baby. In the women who developed diabetes in pre-
gnancy, and in those who delivered an LGA baby, PAPP-A
levels were decreased. Inhibin A levels were more frequently
increased in women with hypertensive disorders and in tho-
se who delivered before the completed 34th week.
Conclusions. PAPP-A, fβ hCG and inhibin A levels are not use-
ful in the detection of women at high risk of pregnancy com-
plications. However, a high or a low level of any of the bioche-
mical marker indicates the occurrence of an extra event that
requires most careful monitoring of the woman.
Ključne besede: prosti β hCG; PAPP-A; inhibin A; zapleti v
nosečnosti
Izvleček – Izhodišča. Najučinkovitejši presejalni test za kro-
mosomopatije v prvem trimesečju nosečnosti je izračunava-
nje tveganja na podlagi starosti nosečnice, nuhalne svetline
(NS) ploda, prostega β  humanega horionskega gonadotropi-
na (fβ hCG) in PAPP-A (Pregnancy Associated Plasma Prote-
in A) (90% odkritih plodov s trisomijo 21 [T21], 5% lažno
pozitivnih rezultatov). Želeli smo oceniti vrednosti fβ hCG,
PAPP-A in inhibina A med 10. in 14. tednom nosečnosti za
napovedovanje porodniških zapletov kasneje v nosečnosti.
Metode. Vključili smo 1136 nosečnic s kromosomsko normal-
nimi plodovi. Med 10. in 14. tednom smo izmerili razdalje
teme – trtica in NS pri plodu, ter določili vrednosti fβ hCG,
PAPP-A in inhibina A v serumih nosečnic. Zbrali smo podat-
ke o načinu zanositve, poteku in izidu nosečnosti in zdrav-
stvenem stanju novorojenčka. Primerjali smo vrednosti vseh
označevalcev pri nosečnicah, pri katerih so se pojavili peri-
natalni zapleti – (rojstvo otrok, premajhnih [SGA] ali preveli-
kih [LGA] za nosečnostno starost, nosečnostna sladkorna bo-
lezen [NSB], hipertenzija v nosečnosti, prezgodnji porod), z
vrednostmi označevalcev pri nosečnicah brez zapletov. Izde-
lali smo multivariantne modele za napovedovanje tveganja
za posamezen zaplet.
Rezultati. Nizke vrednosti PAPP-A so bile povezane z rojstvom
SGA otrok, visoke vrednosti PAPP-A pa z rojstvom LGA otrok.
Nosečnice, ki so razvile NSB, so imele statistično nepomemb-
no znižane vrednosti vseh treh biokemičnih označevalcev.
Nosečnice z NSB, ki so rodile LGA otroke, so imele znižane
vrednosti PAPP-A. Inhibin A je bil pogosteje visok pri nosečni-
cah, pri katerih so se pojavili hipertenzivni zapleti ali so rodi-
le pred dopolnjenim 34. tednom gestacije.
Zaključki. PAPP-A, fβ hCG in inhibin A niso uporabni kot pre-
sejalni test za odkrivanje nosečnic z visokim tveganjem za
porodniške zaplete. Vendar pa visoke ali nizke vrednosti ka-
terega koli biokemičnega označevalca opozarjajo, da se do-
gaja nekaj posebnega. Zato priporočamo, da v teh primerih
nadzorovanje nosečnice poostrimo.
POSTERJI