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

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 4th 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 4th 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 4th 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.