PAPP-A y β-hCG libre como predictores de preeclampsia y bajo peso al nacer en una población latina
| Contribuinte(s) |
Trillos Peña, Carlos Enrique |
|---|---|
| Data(s) |
07/11/2012
|
| Resumo |
Introducción: La Preeclampsia ocurre entre el 2-7% de los embarazos. Previos estudios han sugerido la asociación entre los niveles alterados de PAPP-A y la β-hCG libre con el desarrollo de Preeclampsia (PE) y/o Bajo Peso al Nacer (BPN). Metodología: El diseño del estudio es de Prueba Diagnóstica con enfoque de casos y controles. Las mediciones séricas de PAPP-A y la β-hCG libre, fueron realizadas entre la semana 11-13.6 días durante 2 años. Resultados: La cohorte incluyó 399 pacientes, la incidencia de PE fue de 2,26% y de BPN fue de 14.54%. El punto de corte del percentil 10 fue MoM PAPP-A: 0,368293 y MoM β-hCG libre: 0,412268; la especificidad en PE leve fue de 90,5 y para BPN de 90. Los MoM de la β-hCG libre, la edad y el peso materno se comportan como factores de riesgo, mientras que mayores valores de MoM de la PAPP-A y mayor número de partos factores de protección. Para el BPEG severo la edad materna y la paridad se comportan como factores de riesgo, mientras que un aumento promedio de los valores de los MoM de la PAPP-A y la β-hCG libre, como factores de protección en el desarrollo de BPEG Severo. Conclusiones: Existe una relación significativa entre los valores alterados de PAPP-A y de β-hCG libre, valorados a la semana 11 a 13 con la incidencia de Preeclampsia y de Bajo Peso al nacer en fetos cromosómicamente normales, mostrando unos niveles significativamente más bajos a medida que aumentaba la severidad de la enfermedad. Diagnostico Prenatal Ltda Introduction: Preeclampsia occurs between 2% and 7% of pregnancies. Previous studies have suggested an association between altered levels of PAPP-A and the free β-hCG with the development of preeclampsia (PE) or infant’s small for gestational age (LBW) Methodology: The design of the study is diagnostic tests. Serum measurements of PAPP-A and free β-hCG were performed between 11-136/7 weeks and 6 days, for a period of 2 years. Results: The cohort included 399 patients; the incidence of PE was 2.26% and 14.54% was LBW. The 10th percentile cutoff for MoM PAPP-A was 0.368293 and for MoM β-hCG: 0.412268; the specificity for PE was 90,5% and for LBW 90%. The MoM free β-hCG, the maternal age and weight behave as risk factors, while higher MoM values of PAPP-A and higher parity as protection factors. For severe SGA, maternal age and parity behave as risk factors, whereas an average increase of MoM values of PAPP-A and free β-hCG, as protective factors in the development of severe SGA. Conclusions: There is a significant relationship between the altered levels of PAPP-A and free β-hCG, measured at week 11 to 136/7 with the incidence of preeclampsia and low birth weight in chromosomally normal fetuses, showing significantly lower levels with increasing severity of disease. |
| Formato |
application/pdf |
| Identificador | |
| Idioma(s) |
spa |
| Publicador |
Facultad de medicina |
| Direitos |
info:eu-repo/semantics/restrictedAccess |
| Fonte |
reponame:Repositorio Institucional EdocUR instname:Universidad del Rosario United Nations Millennium Declaration, Fifty-fifth Session of the United Nations General Assembly. New York: United Nations; 18 September 2000 (General Assembly document, No.A/RES/55/2). Padilla K, Mc Naughton H. La mortalidad materna en Nicaragua, una mirada rápida a los años 2000-2002, Managua, Nicaragua, IPAS Centro América. Disponible en http://www.ipas.org/Publications/asset_upload_file786_2836.pdf OMS, UNICEF, FNUAP. La tasa de mortalidad materna es desproporcionadamente alta en los países en desarrollo. Disponible en http://www.who.int/mediacentre/news/releases/2003/pr77/es/index.html Herrera M. Mortalidad materna en el mundo. Rev Chil Obstet Ginecol 2003; 68 (6):536-543. UNICEF. Oficina Regional para América Latina y el Caribe. Mortalidad materna: violencia por omisión, 1999. Disponible en: http://www.uniceflac.org/espanol/mortmat.htm Gagnon A, Wilson RD, SOGC Genetics committee. Obstetrical complications associated with abnormal maternal serum markers analytes. J Obstet Gynaecol Can 2008 oct; 217: 917 -932 Horton R. Healthy motherhood: an urgent call to action. Lancet [Revista en línea] 2006; 368:1129, 30 September. Disponible en: http://www. thelancet.com Ruiz AME, Fernández DJM. Servicios integrados para luchar contra la mortalidad materna en Nicaragua. Banco Mundial 2004; 47:1-3 Starrs AM. Safe motherhood initiative: 20 years and counting. Comment, The Lancet [Revista en línea] 2006; 368(30):1130-1132. Disponible en http://www.thelancet.com OMS. La tasa de mortalidad materna es desproporcionadamente alta en los países en desarrollo. Disponible enhttp://www.who.int/mediacentre/news/releases/2003/pr77/es/index.html Elena Prada Salas, op.cit., p. 19 Stella Cl, Sibai BM. Preeclampsia: Diagnosis and management of the atypical presentation. J Matern Fetal Neonatal Med. 2006 Jul; 19 (7): 381-6 República De Colombia, Ministerio de la Salud, Mortalidad Materna en Colombia. Bogotá: Imprenta Nacional, 1996. P.18. Soydemira Fatimah, Louise Kenny. Hypertension in pregnancy. Current Obstetrics& Gynecology. 2006, 16, 315–320 Buitrago M, Torres C, Duque M. Guías para el manejo de la Preeclampsia severa y la eclampsia. Controversias en Ginecología y Obstetricia 2009; 20 (119): 4190-4204 Baha M. Sibai. Diagnosis and Management of Gestational Hypertension and Preeclampsia. High-Risk Pregnancy Series: An Expert´s View. Vol 102, No. 1, JULY 2003. González Rogelio, Gómez Ricardo, Castro Rene. CEDIP. Guías Perinatales. Síndrome Hipertensivo del embarazo. Edición Final. Abril 2003 ACOG Practice Bulletin. Clinical Management guidelines for obstetrician and gynecologist. Number 33. January 2002. Diagnosis and management of preeclampsia and eclampsia Roberts James M. Report of the Working Group on Research on Hypertension During Pregnancy, Meeting Held April 27, 2001. National Heart, Lung, and Blood Institut Villanueva Egan Alberto, Collado Peña Susana Patricia. Conceptos actuales sobre la preeclampsia-eclampsia. Rev Fac Med UNAM Vol.50 No.2 Marzo-Abril, 2007 KaeNienJyh, Gonzalez Rogelio. Restricción del Crecimiento Intrauterino. Boletín Perinatal. Volumen 2, año 2002 Wang Alice, Rana Sarosh, Karumanchi Ananth. Preeclampsia: The role of angiogenic Factors in Its Pathogenesis. Physiology. 2009. Jun; 24:147-58 Conde-Agudelo A, Belizan JM, Risk factors for preeclampsia in a large cohort of Latin American and Caribbean Women. BJOG.2000; 107:75-83. Zuluaga, NA, Londoño JG. Genética de la preeclampsia: una aproximación a los estudios de ligamiento genético. Biomédica, Vol.24 No.2 (jun. 2004). p 207-225 FARAG, Khalid; HASSAN, Ismail; LEDGER William. Prediction of preeclampsia: Can it be achieved? Obstetrical and Gynecological Survey. 2004. Vol 59, Number 6 Aquilina J, Barnett A, Thompson O, Harrington K, Second-trimester maternal serum inhibin A concentration as an early marker for preeclamsia. Am. J. Obstet. Gynecol. 1999; 181:131-36 Roberts JM, Hubel CA, Is oxidative stress the link in the two-stage mode of pre-eclampsia? Lancet 1999:354:788-89 Papageorghiou AT, Yu CK, Bindra R, Pondis G, Nikolaides KH. Multicenter screening for preeclampsia and fetal growth restriction by transvaginal uterine Doppler at 23 weeks gestation. Ultrasound Obstet Ginecol. 2001; 18:441-9 Roche Al día. Enero 2010, Edición Especial. Marcadores Bioquímicos en la predicción de preeclampsia Morssink LP, Kornman LH, Hallahan TW, Kloosterman MD, Beekhuis JR, De Wolf BTHM, et al. Maternal serum levels of free β-hCG and PAPP-A in the first trimester of pregnancy are not associated with subsequent fetal growth retardation or preterm delivery. Prenat Diagn 1998; 18:147–52 OMS. Plan de choque contra la mortalidad materna: Un compromiso muy serio del gobierno colombiano. Bogotá, 16 de agosto de 2004. Disponible en http://www.col.ops-oms.org/noticias/ 2004/02mortalidadmaterna.asp Dugoff L, Hobbins JC, Malone FD, Porter TF, Luthy D, Comstock CH,et al. First trimester maternal serum PAPP-A and free beta subunit human gonadotropin concentrations and nuchal translucency are associated with obstetric complications: A population-based screening study (The FASTER trial). Am J Obstet Gynecol 2004; 191:1446–51 Ong CY, Liao AW, Spencer K, Munim S, Nicolaides KH. First trimester serum free beta human chorionic gonadotrophin and pregnancy associated plasma protein A as predictors of pregnancy complications. BJOG 2000; 107:1265–1270 Meloni P, DÁngeli L, Piazze J, Cerekya A, Cimari T, Pala A. First trimester PAPP-A associated with early prediction pregnancy induced hypertension. Hypertension in Pregnancy 2009; 28:361-68 Yaron Y, Heifetz S, Ochshorn Y, Lehavi O, Orr-Urtreger A. Decreased first trimester PAPP-A is a predictor of adverse pregnancy outcome. Prenat Diagn 2002; 22:778-82 Smith GCS, Shah I, Crossley JA, Aitken DA, Pell JP, Nelson SM, et al. Pregnancy-associated plasma protein A and Alpha-fetoprotein and prediction of adverse perinatal outcome. Obstet Gynecol 2006; 107(1):161–6. Smith GCS, Stenhouse EJ, Crossley JA, Aitken DA, Cameron AD, Connor JM. Early pregnancy levels of pregnancy-associated plasma protein and the risk of intrauterine growth restriction, premature birth, preeclampsia, and stillbirth. J Clin Endocrinol Metab 2002;87:1762-67. Spencer K,Cowans NJ, Avgidou K, Molina F, Nicolaides KH. First-trimester biochemical markers of aneuploidy and the prediction of small-for-gestational age fetuses. Ultrasound Obstet Gynecol 2008; 31:15–9 Spencer K,Cowans NJ, Molina F, Kagan KO, Nicolaides KH. First-trimester ultrasound and biochemical markers of aneuploidy and the prediction of preterm or early preterm delivery. Ultrasound Obstet Gynecol 2008; 31:147–52. Spencer K,Cowans NJ, Avgidou K, Nicolaides K. First trimester ultrasound and biochemical markers of aneuploidy and the prediction of impending fetal death. Ultrasound Obstet Gynecol 2006; 28:637–43 Smith GCS, Crossley JA, Aitken DA, Pell JP, Cameron AD, Connor JM, et al. First-trimester placentation and the risk of antepartum stillbirth. Obstet Gynecol Surv 2005; 60(4):211–2 Spencer K,Cowans NJ, Nicolaides KH. Low levels of maternal serum PAPP-A in the first trimester and the risk of preeclampsia. Prenat Diagn 2008; 28:7–10. Poon LC, Maiz N, Valencia C, Plasencia W, Nicolaides KH. First-trimester maternal serum pregnancy-associated plasma protein-A and pre-eclampsia. Ultrasound Obstet Gynecol 2009; 33:23-33. Herraiz I. Cribado combinado del primer trimestre para la predicción de la Preeclampsia en gestantes con factores de alto riesgo (tesis doctoral) Madrid: Universidad Complutense de Madrid; 2010. Staboulidou I, Galindo A, Maiz N, Karagiannis G, Nicolaides KH. First-trimester uterine artery Doppler and serum pregnancy-associated plasma protein-a in preeclampsia and chromosomal defects. Fetal Diagn Ther 2009; 25:336-39. Spencer K, Yu CK, Cowans NJ, Otigbah C, Nicolaides KH. Prediction of pregnancy complications by first-trimester maternal serum PAPP-A and free beta-hCG and with second-trimester uterine artery Doppler. Prenat Diagn 2005; 25:949-53. Pilalis A, Souka AP, Antsaklis P, Daskalakis G, Papantoniou N, Mesogitis S et al. Screening for pre-eclampsia and fetal growth restriction by uterine artery Doppler and PAPP-A at 11-14 weeks' gestation. Ultrasound Obstet Gynecol 2007; 29:135-40 K, Cowans NJ, Chefetz I, Tal J, Meiri H. First-trimester maternal serum PP-13, PAPP-A and second-trimester uterine artery Doppler pulsatility index as markers of pre-eclampsia. Ultrasound Obstet Gynecol 2007; 29:128-34. Herraiz I, Lopez-Jimenez EA, García-Burguillo A, Nieto O, Villar OP, Escribano D et al. Role of uterine artery Doppler in interpreting low PAPP-A values in first-trimester screening for Down syndrome in pregnancies at high risk of impaired placentation. Ultrasound Obstet Gynecol 2009; 33:518-23 Spencer K, Yu CKH, Cowans NJ, Otigbah C, Nicolaides KH. Prediction of pregnancy complications by first-trimester maternal serum PAPP-A and free β-hCG and with second-trimester uterine artery Doppler. Prenat Diagn2005; 25:949–53. Zhong Y. Bradshaw R, Stanley AP, Odibo AO. Plasma Proteín A and Human Chorionic Gonadotropin and Adverse Pregnancy Outcomes. Prenat Diagn 2010; 30 (12-13):1138-42. Rivera E, Guzmán C, Orjuela J, Rebolledo M, Valencia C. Rendimiento operativo de la tamización doble ajustada por raza para la detección de aneuploidías en población colombiana. Trabajo de grado, Repositorio Universidad del Rosario, 31 enero 2011. http://hdl.handle.net/10336/2308 NICE Clinical Guideline. Hypertension in pregnancy: The management hipertensive disorders during pregnancy. Royal College of Obstetricians and Gyneacologists. January 2011 Versión oficial de la Lista de Códigos CIE-10 en la página web de la OMS (WHO.int) TEME 0087 2012 |
| Palavras-Chave | #PREECLAMPSIA - INVESTIGACIONES #EMBARAZO - INVESTIGACIONES #ENFERMEDADES TRANSMISIBLES #ENFERMEDADES DE LOS NIÑOS RECIEN NACIDOS #PAPP-A #free β-hCG #Preeclampsia #newborn with LBW #small for gestational age (SGA) |
| Tipo |
info:eu-repo/semantics/bachelorThesis info:eu-repo/semantics/acceptedVersion |
