Furthermore, the definition of normality parameters for these markers is influenced by the presence or absence of diabetes mellitus, parity (multiparous patients have lower PAPP-A values than nulliparous patients), twinhood (who have higher levels of PAPP-A and PIGF than those observed in single pregnancies), advanced maternal age (women over 35 years of age presented lower values of the markers in question), among other elements [76]. This evidence concerns the gene PAPPA and diabetes mellitus.