Maternal Serum hCG Research Articles

Hemodynamical parameters in functional system "motherplacenta-fetus" in women had higher levels of alpha-fetoprotein (AFP) and horionic gonadotropin (HG) in 11 trimester of pregnancy

Haemodinamic parameters in the functional system mother-placenta-fetus in 49 women with elevated mildtrimester maternal serum AFP (2MoM) and in 38 women with elevated maternal serum hCG (2MoM) were studed. The control group included 32 women with normal mildtnmester serum AFP and hCG. Indexes of impedance to flow in the uterine arteries were significantly higher in patients with elevated MSAFP or MShCG comparing with women of the control group, beginning from 28 weeks of pregnancy. There was a significant association between the maternal serum AFP levels and indexes of impedance to flow in the uterine artery, umbilical artery and fetal aorta during pregnancy. In patients with abnormal (more then 95th centile) uterine arteries Resistance Index at 2024 weeks, abnormal dynamic of MSAFP and MShCC levels from 16 until 24 weeks was observed. We suppose that unexplained elevated mildtri mester maternal serum AFP and hCC сaп be associated with disturbed utero-placental circulation.

472 G6PD deficiency is associated with decreased maternal serum Alpha-fetoprotein levels

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an inherited X-linked recessive disorder, being the most common enzymatic defect of erythrocytes in humans. Since G6PD deficiency has been associated with metabolic comorbidities and placental dysfunction, we aimed to examine whether this disorder can affect the levels of maternal serum biochemical screening markers. For this retrospective study, we collected data of all pregnant women delivering in our medical center between January 2015 to December 2019. The inclusion criteria were any documentation of maternal serum biochemical screening markers: free beta-human chorionic gonadotropin (HCG), pregnancy-associated plasma protein A (PAPP-A), maternal serum alpha-fetoprotein (AFP), HCG and unconjugated estriol. Overall, 6,186 women with documented maternal serum biochemical screening markers were detected, 63 of these (1.0%) with G6PD deficiency. No difference in demographic or obstetrical characteristics was noted between G6PD-deficient women to the remaining cohort (including maternal age, body mass index, gestational age and birth weight). In G6PD-deficient women, significantly lower levels of maternal AFP were found compared to the remaining cohort (0.87±0.28 vs. 1.05±0.28 multiples of median, respectively, p<0.001, Table 1). In addition, marginally lower second trimester HCG levels were found in G6PD deficiency (1.0±0.58 vs. 1.15±0.69 multiples of median in the remaining cohort, p=0.07). Since the placenta plays a major role in HCG synthesis, as well as in transferring the fetal AFP to maternal circulation, the placental effects of G6PD deficiency may explain lower levels of these markers. As maternal serum AFP measurement serves as a screening tool for neural tube defects, as well as a component of biochemical screening for Down syndrome, G6PD status may affect the screening results. Thus, the findings of our study may be of great importance in prenatal surveillance, and should be further explored.

Increased maternal serum hCG concentrations in the presence of a female fetus as early as 2 weeks after IVF-ET

BackgroundMaternal serum human chorionic gonadotropin (hCG) is produced in trophoblast cells during pregnancy. Whether there are sex-related growth differences of hCG concentrations in early pregnancy is still controversial. ObjectiveTo explore the association between hCG concentrations and fetal sex as early as 2 weeks after in vitro fertilization and embryo transfer (IVF-ET). MethodsThis study involved 6669 women ≤ 38 years of age. These 6669 patients all delivered singletons; 3531 had a male fetus and 3138 had a female fetus. The maternal serum hCG concentrations on Day 14 and Day 21 were determined using a Beckman DxI800 immunoassay system. ResultsAmong the 6669 patients who delivered singletons, 3531 had a male fetus and 3138 had a female fetus. The hCG concentrations on day 14 of gestation were 516.12 (342.12–757.34) IU/L in the group of male fetuses and 552.69 (359.35–772.83) IU/L in group of female fetuses. The hCG concentration on day 21 was 8839.60 (5975.00–12615.00) IU/L in male fetuses and 9289.10 (6162.00–13146.00) IU/L in female fetuses. Maternal serum hCG levels were significantly higher in those with female fetuses than those with male fetuses. After adjusting for confounding factors, the hCG levels were significantly associated with fetal sex. ConclusionsOur results showed pregnant women with female fetuses have significantly higher hCG levels than those bearing male fetuses.

Positive Association of the Number of Oocyte Retrievals With the Maternal hCG Concentration in Early Pregnancy After &lt;i&gt;in vitro&lt;/i&gt; Maturation

In vitro maturation (IVM), which is widely used for infertile women, offers many benefits, and it does not involve ovarian hyperstimulation. In addition, the serum human chorionic gonadotropin (hCG) level is significantly higher in women with early pregnancies achieved by IVM than in those with pregnancies achieved by traditional IVF. In the present study, we explored the association between the number of oocyte retrievals and the maternal hCG concentration on days 14 and 21 after IVM. Data from 51 women who delivered singletons were analyzed. The mean number of oocytes retrieved was 16.78 ± 11.23, and the hCG concentration was 614.47 ± 445.50 IU/L on day 14 and 10930.20 ± 7223.17 IU/L on day 21. After adjusting for confounding factors, the concentration of maternal serum hCG on days 14 and 21 associated significantly with the number of oocyte retrievals. Crude linear regression analysis showed a positive relationship between the number of oocytes retrieved and the hCG concentration. Our results showed that the number of oocytes retrieved associated positively with the serum hCG concentration in women with early pregnancies that underwent IVM. Our results partially explain the transient changes in the early maternal serum hCG concentration after IVM.

Evaluation of Maternal Serum PAPP-A and hCG Levels at 10-14 Weeks of Gestation in Hyperemesis Gravidarum

Evaluation of Maternal Serum PAPP-A and hCG Levels at 10-14 Weeks of Gestation in Hyperemesis Gravidarum

The Association of Raised Mid-trimester Serum Human Chorionic Gonadotrophin (hCG) and Alpha-Fetoprotein with adverse Pregnancy Outcome

Background: Placenta is a temporary endocrine organ formed during pregnancy, which produces hormones important in the maintenance of a healthy pregnancy. hCG is the first one of these hormone that is measured in pregnancy test and used in the follow up of adverse pregnancy outcome, Alpha fetoprotein is a major plasma protein produced by the yolk sac and the fetal liver during fetal development.Aim of study :to study relationship between gestational complications and levels of maternal serum HCG and AFP and determine whether the semarkers are effective predictors adverse pregnancy outcomes. Patients &amp; Methods:Prospective cohorts study in AlDiwaniyah maternity and pediatrics teaching hospital.We enrolled a total of 230 women at 14-23 gestational weeks and measurement of maternal serum HCG &amp; AFP were done, of those with normal HCG &amp; AFP formed (group l), group 2 involved women with elevated AFP , group 3 with elevated HCG &amp; group 4 involved women with elevated both HCG &amp; AFP.Follow up weekly of the patients for the development of adversepregnancy outcome.Results: A significant relationship between adverse pregnancy outcomes and abnormal elevation of HCG &amp; AFP levels in the second trimester. In group 2 the patients developed higher rate of preterm labour &amp; pre-eclampsia compared with the group 1. In group 3 with raised HCG the rate of pre-eclampsia &amp; IUGR development were higher than group 1. In group 4 with elevated both HCG &amp; AFP higher incidence of pre-eclampsia &amp; placental abruption , with a specificity(p&lt;0.001). Conclusion: In the second trimester unexplained high AFP and HCG rates related to adverse maternal and perinatal outcomes.

A live birth with unexpectedly low serum human chorionic gonadotropin level on day 11 after blastocyst embryo transfer: a case report

ObjectiveTo report a very rare case of live birth with unexpectedly low serum hCG level on day 11 after blastocyst embryo transfer.DesignCase report.SettingPrivate infertility center.Patient(s)A 30-year-old nulliparous woman presented with PCOS and 1 year of infertility.Interventions(s)Conventional IVF was scheduled and a long-acting agonist protocol was selected.Main Outcome Measure(s)Maternal serum hCG levels and transvaginal ultrasound exams for the embryo’s well-being.Result(s)The hCG level was 11.6 IU/L on day 11 after the transfer of two blastocyst embryos, which was considered as either failing or extrauterine pregnancy. After blood titration, there were delayed hCG increases. A series of transvaginal ultrasounds also indicated a delayed but normal-appearing intrauterine pregnancy. A healthy baby boy was delivered at term by means of cesarean section.Conclusion(s)A low initial serum hCG level may be associated with certain maternal or fetal characteristics and IVF treatment variables. Close conservative observation is warranted before undertaking any therapeutic intervention.

Normative Values of Second-Trimester Maternal Serum Markers Using an Automated Assay Platform for Down Syndrome Screening

Objective: Automated chemiluminescent immunoassay has several advantages over manual ELISA with comparable test performance. Few studies have reported the reference values of the second-trimester serum markers maternal serum alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3), and inhibin A (Inh A) by automated immunoassay in Asian population. Accordingly, this study aimed to determine the median values of second trimester serum markers as a function of gestational age (GA) in Thai population using an automated immunoassay. Methods: This prospective cross-sectional study of serum markers in healthy singleton second trimester (14-22 weeks) pregnant women was conducted at Siriraj Hospital from September 2012 to April 2015. Maternal serum AFP, hCG, uE3, and Inh A were analyzed by automated immunoassay. Predicted median values as a function of GA were calculated from best-fit regression equations. Results: A total of 1,526 women were included. Median values serum markers were constructed from the following optimal models: AFP (ng/mL) = 99.082 - 14.195 GA + 0.662 GA 2 , r 2 =0.995; hCG (mIU/mL) = 39, 0168.106 - 35 968.397GA + 876.708GA 2 , r 2 =0.972; uE3 (ng/mL) = -3.388 + 0.274 GA, r 2 =0.997; and, Inh-A (pg/mL) = 1,206.875 - 114.171 GA + 3.174 GA 2 , r 2 =0.882. Using the same platform analysis and maternal weight adjustment, the reference values in Thai population were shown to be different from those of other ethnicities. Conclusion: Median values of second-trimester serum markers for Thai population were determined. Maternal weight and the use of population-specific normal values have to be taken into account for Down syndrome screening in the second trimester.

Antenatal placental assessment in the prediction of adverse pregnancy outcome after reduced fetal movement.

ObjectiveTo assess the value of in utero placental assessment in predicting adverse pregnancy outcome after reported reduced fetal movements (RFM).MethodA non-interventional prospective cohort study of women (N = 300) with subjective RFM at ≥28 weeks’ gestation in singleton non-anomalous pregnancies at a UK tertiary maternity hospital. Clinical, sonographic (fetal weight, placental size and maternal, fetal and placental arterial Doppler) and biochemical (maternal serum hCG, hPL, progesterone, PlGF and sFlt-1) assessment was conducted. Multiple logistic regression identified combinations of measurements (models) most predictive of adverse pregnancy outcome (perinatal mortality, birth weight <10th centile, five minute Apgar score <7, umbilical arterial pH <7.1 or base excess <-10, neonatal intensive care admission). Models were compared by test performance characteristics (ROC curve, sensitivity, specificity, positive/negative predictive value, positive/negative likelihood ratios) against baseline care (estimated fetal weight centile, amniotic fluid index and gestation at presentation).Results61 (20.6%) pregnancies ended in adverse outcome. Models incorporating PlGF/sFlt-1 ratio and umbilical artery free loop Doppler impedance demonstrated modest improvement in ROC area for adverse outcome (baseline care 0.69 vs. proposed models 0.73–0.76, p<0.05). However, there was little improvement in other test characteristics (baseline vs. best proposed model: sensitivity 21.7% [95% confidence interval 13.1–33.6] vs. 35.8%% [24.4–49.3], specificity 96.6% [93.4–98.3] vs. 94.7% [90.7–97.0], PPV 61.9% [40.9–79.3] vs. 63.3% [45.5–78.1], NPV 82.8% [77.9–86.8] vs. 85.2% [80.0–89.2], positive LR 6.3 [2.8–14.6] vs. 6.7 [3.4–3.3], negative LR 0.81 [0.71–0.93] vs. 0.68 [0.55–0.83]) and wide confidence intervals. Negative post-test probability remained high (16.7% vs. 14.0%).ConclusionAntenatal placental assessment may improve identification of RFM pregnancies at highest risk of adverse pregnancy outcome but further work is required to understand and refine currently available outcome definitions and diagnostic techniques to improve clinical utility.

Influencing factors of pregnancy loss and survival probability of clinical pregnancies conceived through assisted reproductive technology

BackgroundPregnancies following assisted reproductive technology (ART) may have elevated potential risk of pregnancy loss (PL) when compared to natural conception. However, rare studies comprehensively analyzed the IVF/ICSI cycle-dependent factors for loss of clinical pregnancy. Therefore, we aimed to determine the ART subgroup-specific risks of PL throughout pregnancy and explore different risk factors for early miscarriage and late miscarriage among pregnancies conceived through ART.MethodsA retrospective cohort study was launched in two infertility treatment centers in Nanjing and Changzhou including 5485 IVF/ICSI embryo transfer cycles with known outcomes after clinical pregnancy by the end of 2015. Cox proportional hazards regression analysis was performed to estimate the hazard ratios and their 95% confidence intervals. The associations between survival time during pregnancy and demographics and clinical characteristics of clinical pregnancies were estimated using the Kaplan-Meier method and the Log-rank test.ResultsThe overall PL rate in current ART population was 12.5%. Among the 685 pregnancy loss cycles, a total of 460 ended as early miscarriage, 191 as late miscarriage. We found couples in ART pregnancies demonstrated a significantly increased risk of PL as maternal age (HR = 1.31, Ptrend < 0.001) grows. Pregnancies received controlled ovarian hyperstimulation (COH) protocol like GnRH antagonist protocol (HR = 3.49, P < 0.001) and minimal stimulation protocol (HR = 1.83, P < 0.001) had higher risk of PL than GnRH-a long protocol. Notably, in contrast to fresh cycle, women who received frozen cycle embryo had a significant increased risk of early miscarriage (P < 0.001), while frozen cycle was linked with lower risk of late miscarriage (P = 0.045). In addition, four factors (maternal age, COH protocol, cycle type and serum hCG level 14 days after transfer) had independent impact on miscarriage mainly before 12 weeks of gestational age.ConclusionsWith these findings in this study, clinicians may make it better to evaluate a patient’s risk of PL based on the maternal age at the time of treatment, COH protocol, cycle type and serum hCG level 14 days after transfer and the gestational week of the fetus, and we hope that it contributes to future study on its etiology and guide the clinical prevention and treatment.

Maternal human chorionic gonadotrophin concentrations in very early pregnancy and risk of hyperemesis gravidarum: A retrospective cohort study of 4372 pregnancies after in vitro fertilization

ObjectiveWe investigated the association of human chorionic gonadotrophin (hCG) concentrations on a fixed day in very early pregnancy with development of hyperemesis gravidarum. Study designThis retrospective cohort study included 3107 singleton and 1265 twin pregnancies after in vitro fertilization treated at Department of Reproductive Medicine, Rikshospitalet, Oslo University Hospital, Norway in the period 1996–2013. Maternal serum hCG concentrations was measured on day 12 after embryo transfer. Information about development of hyperemesis gravidarum was obtained by individual linkage to the Medical Birth Registry of Norway. We studied hCG concentrations in very early pregnancy according to development of hyperemesis gravidarum, in singleton and twin pregnancies separately. We estimated the odds ratios for hyperemesis gravidarum with 95% confidence intervals according to quartiles of hCG concentrations. ResultsIn twin pregnancies as compared to singleton pregnancies, we found higher mean maternal hCG concentrations (219 IU/L versus 130 IU/L, p<0.001 Student’s t-test) and higher prevalence of hyperemesis gravidarum (2.7% versus 1.4%, p=0.002 chi-squared test). However, both in singleton and in twin pregnancies, we found no significant difference in mean hCG concentrations between women who developed hyperemesis gravidarum and women who did not (Singletons: 122 IU/L versus 130 IU/L, p=0.504. Twins: 234 IU/L versus 219 IU/L, p=0.417 Student’s t-test). We found no significant differences in odds ratios for developing hyperemesis gravidarum according to quartiles of hCG concentrations. ConclusionsWe found no association of maternal hCG concentrations on a fixed day in early pregnancy with development of hyperemesis gravidarum.

O21. First trimester serum placental growth factor and hyperglycosylated human chorionic gonadotropin are associated with later pre-eclampsia

Introduction First trimester serum placental growth factor (PlGF) predicts early-onset pre-eclampsia (diagnosis Objectives To study the accuracy of using combined maternal serum %hCG-h, PlGF, PAPP-A and maternal risk factors in prediction of pre-eclampsia. Methods We determined gestational-age-adjusted concentrations of PlGF, PAPP-A, hCG (Perkin Elmer Wallac Oy, Turku, Finland) and hCG-h (in-house immunofluorometric assay) in maternal serum at 8–13 weeks of gestation. The study consisted of 98 women who later developed pre-eclampsia and 177 pregnant controls. Of the cases, 24 developed preterm pre-eclampsia (diagnosis 160/110mmHg, proteinuria>5g/24h and/or hemolysis, elevated liver enzymes and low platelet count –syndrome). Results Serum PlGF, %hCG-h and PAPP-A were lower in women with later preterm or severe pre-eclampsia than in controls. In receiver-operating characteristics (ROC) curve analysis the area under the curve (AUC) was 0.680 for PlGF, 0.699 for %hCG-h and 0.714 for PAPP-A to predict preterm pre-eclampsia. AUC values for prediction of severe pre-eclampsia were 0.677, 0.702 and 0.677, respectively. When PlGF, %hCG-h and PAPP-A were combined by logistic regression analysis the AUC value was 0.830 for preterm pre-eclampsia and 0.824 for severe pre-eclampsia. Combination of PlGF, %hCG-h, PAPP-A and maternal risk factors including nulliparity and first-trimester mean arterial pressure (MAP) gave an AUC value of 0.805 for preterm pre-eclampsia and 0.882 for severe pre-eclampsia. When PlGF was removed from the analysis the AUC value was 0.803 for preterm pre-eclampsia and 0.878 for severe pre-eclampsia. When %hCG-h was removed the AUC values were 0.756 and 0.840, respectively. Conclusions Combining %hCG-h with PlGF, PAPP-A and maternal risk factors in first trimester improves prediction of later preterm or severe pre-eclampsia. %hCG-h tended to give better AUC values than PlGF when combined with PAPP-A and maternal risk factors. Thus, in first trimester %hCG-h might be superior to PlGF for prediction of preterm or severe pre-eclampsia and it should be further investigated in risk models of pre-eclampsia.

Mid-trimester maternal serum AFP and hCG as markers of preterm and term adverse pregnancy outcomes.

To evaluate the predictive values of mid-trimester serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) for preterm and term placenta-mediated adverse pregnancy outcomes (PMAPOs). We extracted data for nulliparous women with a singleton pregnancy without aneuploidy or lethal fetal anomalies from a prospective cohort study. Maternal serum AFP and hCG measured between 13 and 17 weeks of gestation and expressed as multiples of the median (MoM) for gestational age were compared between women who developed a PMAPO (preeclampsia, intrauterine growth restriction, fetal death) before term or at term and women who did not develop any of these complications. Among 3466 nulliparous women, maternal serum AFP and hCG levels were available in 2110 and 2125 cases, respectively. Women who developed a PMAPO before term had a higher median level of serum AFP (1.4 vs. 1.1 MoM; P < 0.01) and hCG (1.3 vs. 1.1 MoM; P < 0.01) than controls. A serum hCG > 2.0 MoM was associated with a higher risk of PMAPO before term (RR 4.6; CI 95% 2.3 to 9.1) but had no impact on the risk of PMAPO at term (RR 1.1; CI 95% 0.7 to 1.7). Maternal serum AFP > 2.0 MoM was also associated with a significant increase in the risk of preterm PMAPO (RR 3.9; CI 95% 1.6 to 9.8) but not term PMAPO (RR 1.2; CI 95% 0.6 to 2.3). Maternal serum AFP or hCG > 2.0 MoM increases the risk of preterm PMAPO but not term PMAPO in our population. We suggest that women with elevated serum AFP or hCG should receive standard pregnancy care once they have reached 37 weeks of gestation if fetal growth is in the normal range.

Change of maternal thyroid function in twin-twin transfusion syndrome.

Human chorionic gonadotropin (hCG) has weak thyroid-stimulating activity because of its homology with thyroid stimulating hormone (TSH). In twin-twin transfusion syndrome (TTTS), which is a severe complication of monochorionic twin pregnancies, a close association between maternal serum hCG concentration and TTTS has been reported. And, TTTS can be treated by fetoscopic laser coagulation of the communicating vessels. To clarify the relationship between maternal serum hCG and maternal thyroid function in TTTS, the present study investigated the change in thyroid hormone and hCG levels after laser therapy. The protocol included collection of serial maternal blood samples in TTTS before laser therapy, and at two and four weeks after laser therapy. For 131 cases of TTTS, the following parameters were determined at each point: hCG, TSH, free triiodothyronine (fT3), and free thyroxine (fT4). The multiple of the median (MoM) of pre-operative hCG concentration in TTTS was 5.39 MoM (interquartile range, 2.83 - 8.64). There was a moderate positive correlation between hCG and fT3 in TTTS pre-operatively (R = 0.22, P = 0.030). fT4 was also positively correlated with hCG (R = 0.33, P < 0.001). Some cases showed very high concentration in fT3. When laser therapy for TTTS was effective, the hCG concentration significantly decreased, and fT3 and fT4 decreased progressively in concert with the decrease in hCG. The relationship between hCG and thyroid function in TTTS supports the finding of TTTS as a novel etiology of hCG-mediated hyperthyroidism during pregnancy.

Early-onset severe preeclampsia by first trimester pregnancy-associated plasma protein A and total human chorionic gonadotropin.

This study aims to evaluate the relationship between early-onset severe preeclampsia and first trimester serum levels of pregnancy-associated plasma protein A (PAPP-A) and total human chorionic gonadotropin (hCG). The association between early-onset severe preeclampsia and abnormal levels of first trimester PAPP-A and total hCG in maternal serum were measured in a sample of singleton pregnancies without chromosomal defects that had integrated prenatal serum screening in 2009 and 2010 (n = 129,488). Logistic binomial regression was used to estimate the relative risk (RR) of early-onset severe preeclampsia in pregnancies with abnormal levels of first trimester PAPP-A or total hCG as compared with controls. Regardless of parity, women with low first trimester PAPP-A or high total hCG were at increased risk for early-onset severe preeclampsia. Women with low PAPP-A (multiple of the median [MoM] ≤ the 10th percentile in nulliparous or ≤ the 5th percentile in multiparous) or high total hCG (MoM ≥ the 90th percentile in nulliparous or ≥ the 95th percentile in multiparous) were at more than a threefold increased risk for early-onset severe preeclampsia (RR, 4.2; 95% confidence interval [CI], 3.0-5.9 and RR, 3.3; 95% CI, 2.1-5.2, respectively). Routinely collected first trimester measurements of PAPP-A and total hCG provide unique risk information for early-onset severe preeclampsia.

The role of unexplained high serum alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG) levels in the second trimester to determine poor obstetric outcomes.

Objective:To investigate the relationship between gestational complications and high levels of maternal serum alfa-fetoprotein (MSAFP) and/or beta human chorionic gonadotropin (hCG) and to determine whether these markers are effective predictors of poor pregnancy outcomes.Materials and Methods:In this study, we enrolled a total of 679 women at 15-20 gestational weeks with MSAFP and hCG below or above 2.0 multiples of the median (MoM); of those, 200 women with normal MSAFP and hCG MoM formed the control group. Pre-eclampsia, intrauterine growth retardation (IUGR), preterm labor, preterm delivery, placental abruption, placenta previa, placenta accreta, preterm premature rupture of the membranes (PPROM), intrauterine fetal death, as well as neonatal and perinatal morbidity rates were evaluated.Results:A significant relationship was found between adverse pregnancy outcomes and abnormal elevation of hCG and AFP levels in the second trimester. In cases of isolated elevation of hCG, preeclampsia and preterm labor/spontaneous preterm birth rate were slightly higher than in the control group (p=0.043, p=0.015), while IUGR, PPROM, placental abruption, and intrauterine fetal death rates were all similar (p=0.063, p=0.318, p=1.00, p=0.556).In case having an elevation in both markers, increased rate of obstetric complications have been observed. A significant relationship was found between the high levels of maternal serum AFP and hCG MoM and poor pregnancy outcomes like preeclampsia, IUGR, PPROM, intrauterine fetal death (p=0.003, p=0.001, p=0.040, p=0.006).Conclusion:To our knowledge, up to now, no definitive follow-up and treatment protocols have been established for patients at increased risk. In light of these findings, it is recommended to inform and educate patients about the most likely signs and symptoms of complications, to make more often antenatal visits, to perform more frequent ultrasound examination (fetal growth, AFI, etc.), NST, arterial/venous doppler, biophysical profile, and cervical length measurements in high-risk group.

Association between altered placental human chorionic gonadotrophin (hCG) production and the occurrence of cryptorchidism: a retrospective study.

BackgroundAn increase in cryptorchidism has been reported in many countries. One mechanism could be low fetal testosterone production possibly secondary to altered placental human chorionic gonadotrophin (hCG) release. Our Objective was to compare hCG values from maternal blood between boys with cryptorchidism and normal boys.MethodsTotal hCG and α-fetoprotein (AFP) values [12–16 weeks of gestation; from the double test for Down syndrome screening) were compared between cases of cryptorchidism and normal control boys who were matched for maternal age, maternal smoking, gestational age at time of hCG measurement (±1 day), birth weight and birth term. Measurements were performed in a single laboratory; values were expressed as absolute values (KU/L) and multiples of the median (MoM). Boys whose mothers had had a complicated pregnancy were excluded. Groups were compared using the Student’s t test. Log transformation was used to normalize hCG, MoM hCG, AFP and MoM AFP distribution, and values were expressed as geometric means (-1, + 1 tolerance factor).ResultsTotal hCG and MoM hCG levels were significantly lower in the 51 boys with cryptorchidism compared to 306 controls (21.4 (12.3; 37) KU/L vs 27.7 (15.9; 47.9) KU/L and 0.8 (0.5; 1.2) MoM vs 1.0 (0.6; 1.6) MoM, respectively, p < 0.01). By contrast, AFP and MoM AFP levels were similar between groups.ConclusionThis study showed a link between low maternal serum hCG levels and cryptorchidism in boys from uncomplicated pregnancy, while normal AFP levels indicated a normal fetoplacental unit. Whether these abnormalities were due to endogenous or exogenous factors remains to be determined.

PMM.88 Screening for Down’s Syndrome in Women with Renal Disease

IntroductionIn 2001, the UK National Screening Committee advised that all pregnant mothers should be offered a screening test for Down’s syndrome (DS). This is performed at first (biomarkers and ultrasound)...

Concentrations of human chorionic gonadotrophin in very early pregnancy and subsequent pre-eclampsia: a cohort study.

Are low serum concentrations of human chorionic gonadotrophin (hCG) in very early pregnancy associated with pre-eclampsia risk? Low hCG concentrations in very early pregnancy are associated with increased risk of severe pre-eclampsia. Low maternal serum concentrations of hCG early in pregnancy may indicate impaired proliferation or invasion of trophoblast cells, and thus low hCG concentrations may serve as a marker for impaired placental development. Impaired placental development is assumed to be a cause of pre-eclampsia, but there is little prospective evidence to support this hypothesis. We performed a prospective cohort study of pregnancies after IVF at Oslo University Hospital 1996-2010 with linkage to the Medical Birth Registry of Norway to obtain information on pre-eclampsia development. We included 2405 consecutive singleton pregnancies and examined the association of maternal serum hCG concentrations (measured using Elecsys, Roche) on Day 12 after embryo transfer with the risk of any pre-eclampsia and of mild and severe pre-eclampsia. HCG concentrations were inversely associated with pre-eclampsia risk in a dose-dependent manner (Ptrend 0.02). Compared with women with hCG ≥150 IU/l, women with hCG <50 IU/l were at 2-fold higher overall risk of pre-eclampsia [absolute risk 6.4 versus 2.8%; odds ratio (OR) 2.3, 95% confidence interval (CI) 1.2-4.7]. The inverse association was restricted to severe pre-eclampsia (Ptrend 0.01), thus, women with hCG <50 IU/l were at 4-fold higher risk of severe pre-eclampsia than women with hCG ≥150 IU/l (absolute risk 3.6 versus 0.9%; OR 4.2, 95% CI 1.4-12.2). For mild pre-eclampsia, there was no corresponding association (Ptrend 0.36). Results for IVF pregnancies may not be generalizable to spontaneously conceived pregnancies. Plausible causes of low maternal hCG concentrations very early in pregnancy include impaired placental development and delayed implantation. Thus, these results provide prospective evidence to support the hypothesis that impaired placental development may be associated with subsequent development of severe pre-eclampsia. The study was financially supported by the Research Council of Norway. None of the authors has any conflict of interest to declare.

HCG in screening for aneuploidy: A possible role for its glycoforms?

Fetal trisomy 21 is associated with elevated maternal serum hCG and its free beta-subunit (hCG-beta) in vivo, and abnormal placental hCG production and glycosylation in vitro. Other maternal serum markers may also be disrupted in major aneuploidies (T21, T18, T13). We evaluated our aneuploidy screening practices, focusing on hCG-beta and hCG glycoforms, and retrospectively analyzed 55 aneuploidy cases diagnosed over a 2 year period, determining maternal serum hCG glycoforms profiles using 2D-electrophoresis. Screening efficiency reached 96.7%. T21 was associated with elevated hCG-beta while T18 presented with diminished serum markers. hCG glycoforms tended to be basic in aneuploidy (mainly T13).