Participant recruitment

Patient characteristics such as age, pre-gestation body mass index, parity, smoking status, and mode of conception, were recorded. Additionally, data on serum concentration of PAPP-A and free β-hCG were collected. Gestational age was calculated using crown rump length ultrasound measurement (CRL) or the last menstrual period. pregnancy outcomes at delivery were also documented. Multiples of the median (MoM) of PAPP-A and free β‐hCG were adjusted by maternal characteristics, including weight, height ethnicity, and smoking [16]. participants were categorized into two groups based on their PAPP-A levels: (1) those with MOM PAPP-A > 0.4 (normal) and (2) those with MOM PAPP-A < 0.4 (low) [17].

The cases received the same antenatal care and were monitored throughout their pregnancies. All participants underwent a screening test for gestational diabetes mellitus with 75-g glucose between 24 and 28 weeks of gestation The diagnosis of GDM was confirmed if the glucose level equaled or exceeded 92 mg/dl, 180 mg/dl, 153 mg/dl for the fasting, 1 and 2 postprandial respectively [18]. Pregnant women with GDM were treated with lifestyle modification or medical therapy.