Differences in Serum Human Chorionic Gonadotropin Rise in Early Pregnancy by Race and Value at Presentation

Barnhart, Kurt T.; Guo, Wensheng; Cary, Mark; Morse, Christopher B.; Chung, Karine; Takács, Péter; Senapati, Suneeta; Sammel, Mary D.

doi:10.1097/aog.0000000000001568

Cited by 48 publications

(41 citation statements)

References 15 publications

(22 reference statements)

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“…In conclusion, we have shown for the first time that the relative expression of PER between 4 weeks of gestation and control ultrasound in the 6th week of gestation is significantly altered in asymptomatic women with subsequent miscarriage compared to women with ongoing pregnancy, therefore suggesting systemic PER levels as a potential promising biomarker for pregnancy outcome assessment. The development of an early-screening test to identify patients who are at risk of miscarriage in the actual pregnancy would be useful for several reasons: a miscarriage means an enormous distress for the patient and a predictive test with a negative result could be used to reassure anxious patients [ 31 , 32 , 36 , 37 , 39 , 40 ]. On the other hand, a predictive test with a positive result can warn the patients in a very early stage of pregnancy [ 39 ], and will prohibit unnecessary prolongation of the current pregnancy by supplementation of high doses of progesterone, as often done in women after ART.…”

Section: Discussionmentioning

confidence: 99%

Serum periostin levels in early in pregnancy are significantly altered in women with miscarriage

Freis

Schlegel

Kuon

et al. 2017

Reprod Biol Endocrinol

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BackgroundMiscarriage is a common complication in pregnancy and there is still a lack of biomarkers usable in asymptomatic patients before the event occurs. Periostin (PER), whose levels rise particularly during injury or inflammation, has been shown to play an important local role in implantation and early embryonic development. As PER has been described as a biomarker in various medical conditions we intended to evaluate if changes in PER serum levels may help to identify women at risk for spontaneous abortion in the first trimester.MethodsWomen between 18 and 42 years without confounding comorbidities who conceived by IVF/ICSI and ovarian hyperstimulation were analysed in the study after informed consent. Maternal serum samples from 41 patients were assessed at the time of pregnancy testing (PT) and the following first ultrasound checkup (US). Patients were subsequently divided in two groups: (1) patients with subsequent miscarriage in the first trimester (n = 18) and (2) patients with ongoing pregnancy (n = 23), allowing for statistical analysis and investigating the change of PER levels per individual. PER levels were measured using enzyme-linked immunosorbent assay. Statistical analysis was performed using the Fisher exact and Student’s t test. p ≤ 0.05 was considered to be significant.ResultsThere was no significant difference concerning possible confounders between the two groups. We did not find any significant difference in PER levels at the time point of PT or US. By investigating the interindividual changes of PER between the two time points however, we observed that patients with a following miscarriage showed increasing levels of PER at the time point of PT compared to US in contrast to patients with an ongoing pregnancy who demonstrated a decrease in PER levels. These alterations were significant in the absolute as well as in the relative comparison.ConclusionThe relative expression of PER between PT and US is significantly altered in asymptomatic women with subsequent miscarriage compared to women with ongoing pregnancy. Therefore systemic PER levels might represent a potential promising biomarker for the assessment of pregnancy outcome.Trial registrationNot applicable.

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Section: Discussionmentioning

confidence: 99%

Serum periostin levels in early in pregnancy are significantly altered in women with miscarriage

Freis

Schlegel

Kuon

et al. 2017

Reprod Biol Endocrinol

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“…More recently, a study of 1,249 patients with PUL showed, with a 99.9% CI, that the minimal increase in hCG in cases of progressive IUP over 48 hours was 35% (24). The increase in hCG at 48 hours in cases of progressive pregnancy differs depending on the initial concentration of this hormone: it increases 49% of the time when hCG is initially below 1,500 mIU/mL, 40% of the time when the initial hormone concentrations are between 1,500 and 3,000 mIU/mL, and 33% of the time when initial hCG is higher than 3,000 mIU/mL (25). Thus, a viable IUP can increase hCG more slowly than previously imagined and thereby decrease the risk of inadvertently interrupting a progressive gestation.…”

Section: Hcgmentioning

confidence: 99%

Pregnancy of unknown location

Pereira

Cabar²,

Gomez

et al. 2019

Clinics

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Pregnancy of unknown location is a situation in which a positive pregnancy test occurs, but a transvaginal ultrasound does not show intrauterine or ectopic gestation. One great concern of pregnancy of unknown location is that they are cases of ectopic pregnancy whose diagnosis might be postponed. Transvaginal ultrasound is able to identify an ectopic pregnancy with a sensitivity ranging from 87% to 94% and a specificity ranging from 94% to 99%. A patient with pregnancy of unknown location should be followed up until an outcome is obtained. The only valid biomarkers with clinical application and validation are serum levels of the beta fraction of hCG and progesterone. A single serum dosage of hCG is used only to determine whether the value obtained is above or below the discriminatory zone, that means the value of serum hCG above which an intrauterine gestational sac should be visible on ultrasound. Serum progesterone levels are a satisfactory marker of pregnancy viability, but they are unable to predict the location of a pregnancy of unknown location: levels below 5 ng/mL are associated with nonviable gestations, whereas levels above 20 ng/mL are correlated with viable intrauterine pregnancies. Most cases are low risk and can be monitored by expectant management with transvaginal ultrasound and serial serum hCG levels, in addition to the serum progesterone levels. To minimize diagnostic error and intervene during progressive intrauterine gestation, protocol indicates active treatment only in situations when progressive intrauterine pregnancy is excluded and a high possibility of ectopic pregnancy exists.

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“…Two of the variables considered in our analysis that merit further discussion are the rate of hCG rise and the outcome in ART pregnancies. Studies of the 48‐hour hCG rise when the initial measurement is less than 5000 mIU/mL have found that the minimum (1st percentile) rise is approximately 30% to 50%, 26 and the median (50th percentile) rise is 124% (2.24‐fold change), 22 the latter corresponding closely to doubling in 48 hours. A below‐minimum increase is abnormal and indicates an extremely low likelihood of a normal intrauterine pregnancy, whereas a below‐median increase indicates an elevated risk of pregnancy loss but does not rule out a normal outcome.…”

Section: Discussionmentioning

confidence: 99%

First‐Trimester Prognosis When an Early Gestational Sac is Seen on Ultrasound Imaging

Doubilet

Phillips

Durfee

et al. 2020

J of Ultrasound Medicine

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Objectives To determine the factors that jointly and independently affect first‐trimester outcome of very early intrauterine pregnancies (those whose sonogram shows a gestational sac with no identifiable yolk sac or embryo) and develop a mathematical model and Web‐based calculator that computes prognosis based on these factors. Methods Our study population included 590 very early pregnancies scanned between January 1, 2012, and June 30, 2018, with known outcomes (live or spontaneous loss) at 14 weeks. We recorded patient age, mean sac diameter (MSD), human chorionic gonadotropin (hCG) rise, and presence/absence of: vaginal bleeding, history of infertility, prior miscarriage, and pregnancy via assisted reproductive technology. We assessed the correlation between each of these factors and outcome and performed stepwise logistic regression to determine the subset that independently correlated with outcome. Results Patient age, MSD, hCG rise, vaginal bleeding, history of infertility, and assisted reproductive technology pregnancy were significantly correlated with outcome (P < .05, t test for age and MSD, χ2 for the others). Stepwise logistic regression identified age, MSD, hCG rise, and vaginal bleeding as the subset of factors that independently predicted outcome. The regression model's area under the receiver operating characteristic curve was 0.823. We incorporated the regression model into a Web‐based calculator (https://tinyurl.com/Prognosis-PD) that predicts the outcome of an early intrauterine pregnancy based on these 4 key variables. Conclusions The prognosis of very early intrauterine pregnancies is related to several clinical, biochemical, and sonographic factors. The factors that independently correlate with first‐trimester outcome are patient age, MSD, hCG rise, and vaginal bleeding. The logistic regression model predicts outcome based on these variables.

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Differences in Serum Human Chorionic Gonadotropin Rise in Early Pregnancy by Race and Value at Presentation

Cited by 48 publications

References 15 publications

Serum periostin levels in early in pregnancy are significantly altered in women with miscarriage

Serum periostin levels in early in pregnancy are significantly altered in women with miscarriage

Pregnancy of unknown location

First‐Trimester Prognosis When an Early Gestational Sac is Seen on Ultrasound Imaging

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