Estimation of Serum Glycodelin A, Insulin-Like Growth Factor-1 and Insulin-Like Growth Factor Binding Protein-3 at 4th Week Gestational Age as Predictors for Early Pregnancy Loss in Pregnant Women With Polycystic Ovary Syndrome.

Abstract

Objectives: To evaluate predictability of estimation of serum levels of glycodelin A (GdA), insulin growth factor-1 (IGF-1) and its binding protein-3 (IGFBP-3) at the 4 th week gestation age (GA) for development of early pregnancy loss (EPL) in primigravida with polycystic ovary syndrome (PCOS). Patients & Methods: The study included 45 primigravida PCOS women developed EPL (Study group) and 45 primigravida PCOS women completed the observation period uneventfully (Control group). At the 4 th wk GA, all women underwent clinical examination and pregnancy was assured, then all women gave fasting blood samples for estimation of fasting blood glucose (FBG), serum insulin, GdA, IGF-1 and IGFBP-3. Insulin resistance (IR) was evaluated using the homeostasis model assessment IR (HOMA-IR) score. Results: Study women had significantly higher FBG and HOMA-IR score than control women. Estimated 4-wk GA serum levels of IGF-1 were significantly higher, while serum IGFBP-3 and GdA were significantly lower in study versus control PCOS women. Development of EPL showed positive significant correlation with high FBG, HOMA-IR score and high serum IGF-1 levels, while showed negative significant correlation with serum IGFBP-3 and GdA levels. Statistical analyses defined high serum IGF-1 as significant sensitive predictor, while low serum glycodelin A, IGFBP-1 and FBG as specific predictors for development of EPL, in decreasing order of significance. Conclusion: Low serum GdA and IGFBP-3 levels and high IGF-1 levels estimated at the 4 th wk GA may underlie the development of EPL in pregnant PCOS women. Estimation of three markers as multiple marker panels could predict EPL with high sensitivity and specificity.