Maternal serum screening marker levels in twin pregnancies affected by gestational diabetes

  • Ron Maymon
  • Hamutal Meiri
  • Ran Svirski
  • Eran WeinerEmail author
  • Howard Cuckle
Maternal-Fetal Medicine



To investigate the levels of maternal serum screening markers in the first and second trimester twin pregnancies, which subsequently developed gestational diabetes mellitus (GDM).


145 twin pregnancies were recruited in the first trimester. Stored blood samples were retrospectively tested for pregnancy-associated plasma protein (PAPP)-A, human chorionic gonadotrophin (hCG), placental growth factor (PlGF), placental protein (PP)13, α-fetoprotein (aFP) and inhibin A. Values were expressed in multiples of the gestation-specific median (MoMs) in singletons, adjusted for maternal weight and parity, as appropriate.


Twenty samples of first and second trimester were available from 11 twins who subsequently developed GDM and 219 samples from unaffected twins. The median PAPP-A level in the affected twins was 3.61 MoM compared with 2.46 MoM in unaffected twins (P < 0.001, Wilcoxon rank sum test, two tailed); significant results were found in both trimesters. The median PP13 was also increased but to a lesser extent. It was only statistically significant overall (P < 0.05) and in second trimester samples (P < 0.02). No other marker differed significantly. Logistic regression found that combining PAPP-A and maternal weight had a 55% detection rate for a 10% false-positive rate.


Early prenatal marker evaluation in twin pregnancies can be also useful for predicting the risk for developing GDM and should be further investigated.


Screening Maternal serum biomarkers Gestational diabetes Twins PAPP-A PP13 


Author contributions

RM: clinical protocol and project development, data management, data analysis, manuscript writing and editing. HM: clinical protocol development, data analysis, manuscript writing and editing, and others—test biomarkers. RS: protocol development, data collection and management, data analysis, and manuscript writing. EW: data analysis and manuscript writing. HC: project development, data analysis, manuscript writing and editing


Partial support from ASPRE FP7 # 601852 grant (HM), Institute of Ultrasound in Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center) (RM) and PerkinElmer Inc.

Compliance with ethical standards

Conflict of interest

Howard Cuckle is a consultant to PerkinElmer Inc. Hamutal Meiri holds partial patent rights for placental protein 13. Ron Maymon, Ran Svirski, and Eran Weiner have no conflicts of interest to declare. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Upon recruitment to the study, all women signed an informed consent and the study received our institutional ethical review board permission #217/13.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.The Yitzhak Shamir Medical Center (Formerly Assaf Harofeh Medical Center)Institute of UltrasoundZerifinIsrael
  2. 2.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  3. 3.Tel Aviv UniversityTel AvivIsrael
  4. 4.ASPRE Project, Telemarpe LtdTel AvivIsrael
  5. 5.Hy-Laboratories LtdRehovotIsrael
  6. 6.Wolfson Medical CenterHolonIsrael

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