Abstract
OBJECTIVE: This study assessed the effectiveness of pregnancy-associated plasma protein A (PAPP-A) in maternal serum in predicting gestational diabetes mellitus (GDM) in different geographical regions. METHODS: PubMed, Web of Science, EMBASE, and Cochrane Library databases were searched for articles assessing the diagnostic utility of PAPP-A for GDM up to December 3, 2024. Two independent researchers screened the literature. Study quality was appraised using the QUADAS-2 instrument and RevMan 5.4 software. Stata 15.1 software was leveraged to calculate the combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and heterogeneity. The summary receiver operating characteristic curve was plotted to calculate the area under the curve (AUC). Subgroup analysis was also conducted to determine the source of heterogeneity. RESULTS: This study included eight cohort studies, one cross-sectional study, and three case-control studies. A total of 25,183 participants were involved, including 5,993 GDM patients and 19,190 non-GDM patients. Deek's test suggested no notable publication bias (P = 0.400). All included studies were rated as "low risk" or "unclear". The combined sensitivity was 0.71 (95% CI 0.60-0.80), specificity was 0.62 (95% CI [0.55-0.68]), positive likelihood ratio was 1.9 (95% CI [1.4-2.5]), negative likelihood ratio was 0.47 (95% CI [0.30-0.72]), and diagnostic odds ratio was 4 (95% CI [2-8]). Subgroup analysis found that sample size might be the source of heterogeneity (p < 0.05). The AUC was 0.70 (95% CI [0.65-0.73]). CONCLUSIONS: PAPP-A has a certain diagnostic value for GDM and is helpful for more accurately identifying GDM and reducing the risk of related chronic diseases. Future articles with larger sample sizes and across multiple centers are warranted to explore the combined application of PAPP-A with other biomarkers. This approach may enhance the accuracy of GDM diagnosis. Registry number: PROSPERO (CRD42024617462).