Weekly change in serum β-human chorionic gonadotropin, estradiol, and progesterone levels for pregnancy assessment in women with unexplained recurrent miscarriage

Abstract

Objective To investigate the efficacy of weekly changes in β-human chorionic gonadotropin (β-hCG), estradiol (E2), and progesterone (Prog) levels for pregnancy assessment in patients with unexplained recurrent miscarriage. Methods We included 140 patients with unexplained recurrent miscarriage whose serum β-hCG, E2, and Prog levels were measured three or more times within early pregnancy. The weekly change in serum β-hCG, E2, and Prog levels (Δβ-hCG, ΔE2, and ΔProg) was calculated according to the following formula: [(serum level at third visit) - (serum level at initial visit)]/interval days×7. Participants were divided into two groups according to pregnancy outcomes, which were determined as ongoing pregnancy or miscarriage, at the 20th week of gestation. The Δβ-hCG, ΔE2, and ΔProg levels of the two groups were compared, and the cutoff values of Δβ-hCG, ΔE2, and ΔProg were determined using receiver operating characteristic (ROC) analyses for predicting pregnancy outcome. Results Serum levels of Δβ-hCG identified ongoing pregnancy or miscarriage with an area under the ROC curve (AUC) of 0.841 (95% CI 0.769–0.914), diagnostic cutoff value of 30,632.855 mIU/ml, sensitivity of 0.971, and specificity of 0.642. ΔE2 levels had an AUC of 0.839 (95% CI 0.752–0.926), cutoff value of 45.055 pg/ml, sensitivity of 0.706, and specificity of 0.915. Conclusion Higher increases in the serum levels of Δβ-hCG and ΔE2 are associated with favorable pregnancy outcomes. Weekly remeasurement of serum β-hCG and E2 may be useful for pregnancy risk assessment in patients with unexplained recurrent miscarriage throughout clinical practice.