Elevated midtrimester maternal serum human chorionic gonadotropin (HCG) levels, but not progesterone or estriol, are associated with the subsequent development of preeclampsia (PRE)

Abstract

122 123 ELEVATED MIDTRIMESTER MATERNAL SERUM HUMAN CHORIONIC GONADOTROPIN (HCG) LEVELS, BUT NOT PROGESTERONE OR ESTRIOL, ARE ASSOCIATED WITH THE SUBSEQUENT DEVELOPMENT OF PREECLAMPSIA (PRE) PATRICK RAMSEY, RICHARD PARKER, National Institutes of Health, Obstetrics/Gynecology, Bethesda, MD University of Alabama at Birmingham, Obstetrics/Gynecology, Birmingham, AL OBJECTIVE: Abnormal levels of hCG and other endocrine markers have been associated with adverse pregnancy outcomes. We sought to determine whether midtrimester maternal serum levels of hCG, progesterone, and estriol were associated with the subsequent development of PRE. STUDY DESIGN: As an ancillary investigation to a multicenter trial of aspirin therapy in women at high risk for PRE, serum specimens were collected at the initial study visit (11-26 wks). HCG, progesterone, and estriol levels were assessed using commercial immunoassays. Mild and severe PRE were defined using standard definitions. RESULTS: Specimens from 515 non-hypertensive/non-proteinuric women were available for study. The incidence of PRE was 13.2%. Median serum levels of hCG (28,069 vs 23,767 mIU/mL, P = 0.12), progesterone (79 vs 75 ng/mL, P = 0.84), and estriol (2.3 vs 2.4 ng/mL, P = 0.71) were similar between women with and without PRE. Hormone levels were then dichotomized by the 90th%ile cutoff for the study cohort (hCG-58,577 mIU/mL, progesterone-151 ng/mL, estriol-5.6 ng/mL) to evaluate the association of elevated levels with the development of PRE (Table). Elevated hCG levels were associated with both mild PRE (OR 2.6, 95%CI: 1.1-6.5) and severe PRE (OR 3.0, 95% CI: 1.3-7.7). In multivariate analysis, adjusting for gestational age at specimen collection, maternal age, study treatment, race, smoking status, BMI, diabetes, and multifetal gestations, an elevated hCG level remained significantly associated with subsequent PRE. CONCLUSION: In women at risk, elevated midtrimester serum levels of hCG, but not progesterone or estriol, are significantly associated with the subsequent development of PRE. December 2003 Am J Obstet Gynecol S98 SMFM Abstracts