The magnitude of elevated maternal serum human chorionic gonadotropin and pregnancy complications

Abstract

This study assessed the correlation between the magnitude of the elevation in maternal serum human chorionic gonadotropin (MShCG) levels and pregnancy complications. Among 80,716 screened pregnancies, 120 with moderately elevated MShCG (3.00-5.99 MoM) were compared to 84 with extremely elevated MShCG >6.00 MoM. A control series of 120 women with normal MShCG (<3.00 MoM) were matched. Rates of intrauterine growth restriction, preterm labour, antepartum foetal death (APFD), pre-eclampsia, and placental abruption were analysed. We found that the study group had more adverse outcomes than the control group (73/204 [36%] vs. 18/120 [15%]; p < .0001). The rate was higher in the extremely elevated group than in the moderately elevated group (43/84 [51%] vs. 30/120 [25%]; p < .0001). All 12 cases of APFD (14%) occurred among the extremely elevated series. In conclusion, adverse pregnancy outcomes are more common in women with extremely elevated MShCG. The patients should receive counselling regarding this trend and undergo close pregnancy monitoring. Impact statement • What is already known on this subject?In addition to its contribution to Down syndrome (DS) screening, maternal serum human chorionic gonadotropin (MShCG) levels are a marker for pregnancy complications such as intrauterine growth restriction (IUGR), preterm labour (PTL), antepartum fatal death (APFD), pre-eclampsia (PE), placental abruption (PA) and fetal malformations with or without chromosomal aberrations. • What the results of this study add? We found that in the presence of elevated MShCG levels, the incidence of IUGR and PTL increased. PE increased clinically, but statistical significance was seen only when MShCG was extremely elevated (≥ 6.00 MoM). APFD and PA were associated with very high MShCG levels only. • What the implications are of these findings for clinical practice and/or further research? Women with high MShCG levels should be counselled. In case of very high levels (≥ 6.00 MoM), the risk of APFD and PA should be discussed. The pregnancy should be monitored for IUGR, PTL and PE. In view of the limited number of enrolled patients with very high levels of MShCG, the experience of other institutions is needed to corroborate these findings.

The Effect of Serum β-Human Chorionic Gonadotropin on Pregnancy Complications and Adverse Pregnancy Outcomes: A Systematic Review and Meta-Analysis

“…Literature. In this study, a total of 1031 literatures were retrieved from the above databases, 1018 literatures were excluded, and 13 literatures were included for this study [16][17][18][19][20][21][22][23][24][25][26][27][28]. The literature screening flowchart was shown in Figure 1.…”

Fetal growth velocity and body proportion in the assessment of growth

“…[6][7][8][9][10][11] Accordingly, improved detection of FGR has been identified as 1 of the top-10 interventions needed to reduce the global burden of stillbirth. 12 Although various tools are available to screen for FGR, including maternal obstetric history 13,14 and serum markers, [15][16][17][18][19][20][21] the most commonly screening approach is through sonographic fetal weight estimation to detect fetuses that are small for gestational age (SGA), defined empirically as an estimated fetal weight (EFW) <10th percentile for gestational age. [22][23][24][25][26] This approach, however, has a high false-positive rate for FGR, as the majority of SGA fetuses are healthy constitutionally small fetuses rather than growth restricted.…”

Adverse Pregnancy Outcomes by Degree of Maternal Serum Analyte Elevation: A Retrospective Cohort Study

“…Our findings are consistent with prior studies demonstrating adverse pregnancy outcomes with elevated hCG; we identified an ongoing increase in risk based on degree of MoM elevation. 10,11,17,25 The cause of isolated elevation of hCG is not entirely understood; however, it is known that hypoxic cytotrophoblasts proliferate at a higher rate thus producing higher degrees of serum hCG. 25 It is possible that cytotrophoblast hypoxia impairs implantation, which in turn leads to poor placentation and related adverse pregnancy outcomes.…”

“…While previous studies have characterized outcomes for pregnancies complicated by abnormal maternal serum analytes, these studies do not provide data stratified by degree of analyte elevation (i.e., MoM subgroup > 2.5). 1 4 5 6 10 11 12 14 17 By using a large dataset, we were able to assess for uncommon analyte elevations with sufficient sample size to analyze based on analyte subgroups. Our analysis provides specific information based on analyte and elevation subgroup to better allow for personalized patient counseling and guide antepartum surveillance for a unique population at high risk of adverse pregnancy outcome.…”

“…The body of existing literature on pregnancy outcomes with elevated maternal serum analytes tends to report outcome data for multiples of the median (MoM) ≥ 2.0 or ≥ 2.5 MoM (vs. those < 2.0 MoM or < 2.5 MoM, respectively) 1 9 17 or by centile (MoM ≥ 95th centile vs. < 95th centile). 5 8 Outcomes have also been examined by subgroup of elevated analyte, up to ≥ 2.5 MoM.…”