Maternal Urine β-core hCG Fragment Level and Small for Gestational Age Neonates

Abstract

In Brief Objective To determine whether second-trimester urine β-core fragments of hCG predict small for gestational age (SGA) neonates. Methods Spot urine β-core levels were measured in 733 nonhypertensive women with singleton pregnancies who presented for amniocentesis and had karyotypically normal fetuses. The β-core level was standardized to urine creatinine and expressed as multiples of the median. The area under a receiver operating characteristics curve was used to determine the screening efficiency of the urine analyte for prediction of small for gestational age (SGA) births. In a subgroup of cases, serum markers (alpha-fetoprotein [AFP], hCG, and unconjugated estriol) were compared using stepwise regression analysis to urine β-core fragment for SGA prediction. Results There were 23 (3.0%) SGA neonates. The mean ± standard deviation (SD) gestation at urine collection was 16.4 ± 1.3 weeks and collection to delivery interval was 23.0 ± 2.2 weeks. Mean β-core (± SD) fragment levels were significantly higher in those who later had SGA infants compared with appropriately grown infants (2982.8 ng/mg creatinine versus 1447.4 ng/mg creatinine, P < .001). Stepwise logistic regression found that urine β-core fragment and serum AFP were the only significant predictors of SGA, with statistically significant χ2 values (P < .001 and P = .038, respectively). The urine analyte was significantly superior. Second-trimester urine β-core fragment had a 78.3% sensitivity and 70% specificity for SGA prediction. Exclusion of preeclamptic cases resulted in a sensitivity of 84.2% and a specificity of 71.2%. Conclusion Second-trimester elevated maternal urine β-core fragment of hCG predicted SGA infants, and was superior to other serum analytes in that prediction. Maternal urine β-core fragment of hCG during the second trimester predicts small for gestational age neonates.