The first-trimester serum high-temperature requirement protease A4 and uterine artery Doppler for the prediction of preeclampsia

The objective of this study was to investigate the predictive value of serum high-temperature requirement protease A4 (HtrA4) and the first-trimester uterine artery in predicting preeclampsia in singleton pregnancy. Pregnant women at gestational age 11-13+6 weeks, who visited the antenatal clinic at King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University during April 2020-July 2021 were included. Serum HtrA4 levels and transabdominal uterine artery Doppler ultrasound were performed to evaluate this combination for calculating the predictive value of preeclampsia. While 371 singleton pregnant women enrolled in this study, 366 completed it. Thirty-four (9.3%) women had preeclampsia. Mean serum HtrA4 levels were higher in the preeclampsia group than in the control group (9.4 ± 3.9 vs 4.6 ± 2.2 ng/ml, p < 0.001). The mean uterine artery pulsatility index (UtA-PI) was higher in the group with early onset preeclampsia than in the control group (2.3 ± 0.5 vs 1.7 ± 0.5, p = 0.002). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 76.5%, 90.7%, 45.6%, and 97.4%, respectively, when using serum HtrA4 levels above 1.8 multiples of the median for the gestational age as a cut-off value for predicting preeclampsia. A combination of serum HtrA4 levels and UtA-PI > 95th percentile yielded sensitivity, specificity, PPV, and NPV of 79.4%, 86.1%, 37% and 97.6%, respectively, for the prediction of preeclampsia. A combination of serum HtrA4 levels and uterine artery Doppler in the first trimester had good sensitivity for predicting preeclampsia.

Diagnostic accuracy of HbA1c in detecting gestational diabetes mellitus

Objective: To investigate the diagnostic value of glycated hemoglobin A1c (HbA1c) in detecting gestational diabetes mellitus (GDM).Methods: Pregnant women at gestational age 24 weeks or more, who had abnormal GDM screening test, were enrolled in this prospective study. A HbA1c assessment was performed at the same time of 3-h 100 g oral glucose tolerance test (OGTT). GDM was diagnosed according to the National Diabetes Data Group for a 3-h 100 g OGTT. Sensitivity and specificity of HbA1c were evaluated and pregnancy outcome were recorded in aspects of gestational age at delivery, preeclampsia, primary cesarean section rate, birth weight, fetal macrosomia, and neonatal intensive care unit admission.Results: One hundred fourteen women were enrolled. There were 35 women with GDM using NDDG criteria. The area under the curve of the receiver operating characteristic curve for HbA1c detection of GDM was 0.725 (95% confidence interval 0.621-0.829). Cut-off value of HbA1c was 5.8%. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 17.1, 100, 100, 73.2, and 74.6%, respectively. Pregnancy outcome in both groups in this study has no statistical significance.Conclusions: HbA1c values cannot replace OGTT for the diagnosis of GDM. However, HbA1c might be a useful tool to reduce the number of OGTT, associated costs and patient inconvenience.