PAPP-A concentrations below the 10th percentile were associated with a more than three-fold increased risk of GDM (RR 3.5; 95% CI 1.7–6.9), while those above the 90th percentile were related to a significantly higher risk of IUD (RR 8.9; 95% CI 3.1–11.5). The gene discussed is PAPPA; the disease is gestational diabetes.