PAPP-A

This study examined the relationship between first-trimester pregnancy-associated plasma protein A (PAPP-A) concentrations and the subsequent risk of gestational diabetes mellitus (GDM), gestational hypertension, and associated metabolic parameters in the Cambridge Baby Growth Study cohort. Higher PAPP-A levels at week 15 were associated with a lower risk of GDM (odds ratio 0.623, P = 0.0035) and lower mean arterial blood pressures (P = 0.0017 to 0.0069). Additionally, increased PAPP-A was negatively correlated with fasting and 60-minute glucose levels during the week 28 oral glucose tolerance test (P < 0.001) and with insulin resistance (HOMA-IR: P = 1.7 × 10?13). Higher PAPP-A was also linked to improved insulin secretion relative to insulin sensitivity (insulin disposition index: P = 6.5 × 10??). These findings suggest that the relationship between early pregnancy PAPP-A levels and later glucose regulation and blood pressure may be mediated by changes in insulin sensitivity and secretion, offering insight into the potential metabolic role of PAPP-A in pregnancy.