PERIODIC ESTIMATION OF SERUM GLYCODELIN A AND INSULIN-LIKE GROWTH FACTOR-1 CAN HELP TO PREDICT EARLY PREGNANCY LOSS IN POLYCYSTIC OVARY PREGNANT WOMEN 1Hesham M. Abu Ragab, 2Manal M. Hassaan, 3Ibrahem M. Rageh 1Department of Obstetrics & Gynecology, Faculty of Medicine, Benha University 2Department of Medical Biochemistry, Faculty of Applied Medical Sciences, Oct.6 University Department of Clinical Pathology, Faculty of Medicine, Benha University
Objectives: To evaluate the predictability of periodic estimations of serum levels of glycodelin A (GdA) and insulin-like growth factor-1 (IGF-1) and its binding protein-3 (IGFBP-3) for development of early pregnancy loss (EPL) in polycystic ovary syndrome (PCOS) pregnant women. Patients & Methods: The study included 70 PCOS and 70 control pregnant women. All women had complete history taking, full clinical examination and laboratory estimation of fasting blood glucose (FBG) and fasting serum levels of insulin, IGF-1, IGFBP-3 and GdA. Insulin resistance (IR) was evaluated by homeostasis model assessment (HOMA). All pregnant women underwent estimation of IR parameters at the 4th week with periodic estimation of other laboratory parameters at the 4th, 8th and 12th weeks of assuring pregnancy. Study outcome was defined as the frequency of EPL during the 1st 12 weeks after assuring pregnancy. Results: Thirty women had EPL; 8 controls (11.4%) and 22 PCOS women (31.4%) with significantly higher frequency among PCOS women. PCOS women had significantly higher body weight and BMI and showed significantly higher IR parameters with higher HOMA-IR index than control women. Mean serum levels of IGF-1 were significantly higher in PCOS versus control women with significantly higher levels at 8th week than at the 4th and 12th in both groups. Serum levels of IGFBP-3 were significantly lower in PCOS than in control women, but showed steady increments reaching a peak at the 8th week in both groups. Serum GdA levels were significantly lower in PCOS than control women at the 4th and 8th weeks, but non-significantly lower at the 12th week. In PCOS women, serum GdA levels were significantly higher at the 12th week compared to levels estimated at the 4th and 8th weeks, while were significantly higher at the 4th and 12th week than at the 8th week with significantly higher levels at the 12th week than at the 4th week in control women. Development of EPL showed negative significant correlation with body weight and BMI, serum IGFBP-3 and GdA levels, while showed a positive significant correlation with serum IGF-1. Statistical analyses defined high BMI, low serum GdA and IGFBP-3 as significant predictors for EPL among PCOS pregnant women. Conclusion: PCOS pregnant women had a significantly higher frequency of EPL and early low serum GdA and IGFBP-3 in association with high BMI could predict the possibility for commencing EPL in PCOS pregnant women.