Objective To compare the potential value of maternal serum total hCG and free β‐hCG in predicting the risk for fetal trisomies during the first trimester of pregnancy and to examine whether data on maternal hCG and fetal nuchal translucency thickness can be combined to derive risks. Methods Maternal serum total hCG and free β‐hCG were measured in samples from 83 singleton pregnancies with fetal chromosomal abnormalities (trisomy 21 (n= 41), trisomy 18 (n= 19), trisomy 13 (n= 8) sex chromosome aneuploidies (n= 1l), triploidy (n= 4)) and 394 chromosomally normal controls at 10 to 13 weeks gestation. In all cases, the fetal nuchal translucency thickness was measured at the time of fetal karyotyping. Results In the 249 chromosomally normal controls with fetal nuchal translucency less than 3 mm, total hCG and free β‐hCG decreased significantly with increased fetal crowt‐rump length. In 145 chromosomally normal fetuses with nuchal translucency 3 to 9 mm total hCG and free β‐hCG were not significantly different from the 249 with nuchal translucency less than 3 mm. In fetuses with trisomy 21, total hCG and free β‐hCG were significantly higher, whereas in trisomies 18 and 13 levels were lower than in chromosomally normal controls. When the cutoff levels for total hCG and free β‐hCG were selected to include 4% of chromosomally normal fetuses, the detection rates for trisomy 21 were 24% and 32%, respectively. There was no significant association between hCG and nuchal translucency thickness in either the chromosomally normal (r=–0.01) or abnormal group (r=–0.15). Conclusion An improved estimate of risk for fetal trisomies at 10 to 13 weeks gestation can be derived by combining data on maternal age, maternal serum total or free β‐hCG and fetal nuchal translucency thickness.
The rate of neonatal polycythemia was determined prospectively in 34 infants of diabetic mothers pair-matched to 34 infants of nondiabetic mothers (control group) for site of sampling, time of sampling, time of cord clamping, gestational age, mode of delivery, and one- and five-minute Apgar scores. Polycythemia (venous hematocrit greater than or equal to 65%) was present in 29.4% of infants of diabetic mothers and 5.9% of control subjects (P less than .03). Mean nucleated red blood cell counts were significantly higher in infants of diabetic mothers than in controls. Polycythemia did not correlate with higher maternal hemoglobin A1 concentration or with increased infant weight percentile, but did correlate with neonatal hypoglycemia. The authors speculate that increased erythropoiesis exists in infants of diabetic mothers and might be subsequent to fetal hypoxemia due to fetal hyperglycemia, hyperinsulinism, and hyperketonemia.
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