PAPPA and gestational diabetes: First trimester PAPP-A MoM mean levels were not as low among women who later developed GDM in the two studies performed in Asia compared to the studies performed in Europe (n = 9) or Australia (n = 2) (MD -0.07; 95% CI -0.13, -0.00 vs. MD -0.21; 95% CI -0.33, -0.10 and MD -0.17; 95% CI -0.24, -0.10; p = 0.03) (S2 Fig).