A pilot longitudinal study of anti‐Müllerian hormone levels throughout gestation in low risk pregnancy

Abstract

Background: Anti-Mϋllerian hormone (AMH) plays an important role regulating ovarian sensitivity to follicle-stimulating hormone and luteinizing hormone in folliculogenesis. Anti-Mϋllerian hormone is well established as a biomarker of ovarian reserve but may also have utility in predicting pregnancy outcomes. Few studies have described AMH levels in pregnancy and, among those that have, most have used cross-sectional study designs and are limited to participants seeking fertility treatment. Our aim was to analyze AMH longitudinally in low-risk pregnancies. Methods:We conducted a prospective cohort study at Baystate Medical Center, a large tertiary care hospital in Springfield, MA, USA. We recruited women (n = 30) with low risk, singleton pregnancies, aged 18 to 35 years, with BMI between 18 and 40 kg/ m 2 , and without preexisting disease. Anti-Mϋllerian hormone (pmol/L) was measured in plasma samples collected at 5 prenatal care visits throughout gestation.Results: Anti-Mϋllerian hormone levels varied significantly over gestation (Friedman's analysis of variance, P value < .0001). At gestational weeks 7 to 10, average AMH was 36.7 pmol/L (standard error = 8.1) and at weeks 34 to 37 was 9.5 pmol/L (standard error = 1.9). Initial AMH varied between women, and an overall significant log-linear decline was observed.Conclusions: Anti-Mϋllerian hormone varies between women and declines exponentially during pregnancy. The biological mechanism of the heterogeneity of AMH decline over gestation is unclear. Future studies evaluating AMH throughout pregnancy that also assess gravid health and pregnancy outcomes are warranted. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Serum anti-Müllerian hormone (AMH) concentration during pregnancy: a longitudinal study

“…The present study represents the 2 nd largest study available exploring this question by employing a longitudinal design. The kinetics of AMH between the 1 st and 2 nd trimesters of pregnancy have been evaluated by four other longitudinal studies, which also found a decrease in AMH during pregnancy (Freeman et al, 2018, Koninger et al, 2013, Nelson et al, 2010, Pankhurst et al, 2016. The median AMH percentage decrease in these studies varied from 13.5% to 35.9% from the 1 st to the 2 nd trimester, consistent with our finding of a median 39.8% decrease during this period.…”

“…The median AMH percentage decrease in these studies varied from 13.5% to 35.9% from the 1 st to the 2 nd trimester, consistent with our finding of a median 39.8% decrease during this period. One longitudinal study of 30 women took serial AMH measurements at five time points throughout pregnancy demonstrating decreasing AMH with increasing gestation, with the largest decline in the 1st trimester between 7-and 14-weeks gestation (Freeman et al, 2018). This finding may suggest that the initial steep decline in AMH levels had already begun for women in our cohort whose 1st AMH measurement was taken at 10-13 weeks gestation.…”

“…A recent systematic review demonstrated an association between reduced serum AMH concentration and advancing gestational age, with a post-partum return to pre-pregnancy AMH levels (McCredie et al, 2017). However, the majority of evidence regarding AMH in pregnancy is based on cross-sectional studies (La Marca et al, 2005, Plante et al, 2010, Li et al, 2010, Stegmann et al, 2015, Santillan et al, 2012, with only a few studies longitudinally examining serum AMH fluctuations in early pregnancy (Koninger et al, 2013, Nelson et al, 2010, Pankhurst et al, 2016, Freeman et al, 2018, eliminating the problems of significant inter-individual variability in serum AMH seen in cross-sectional studies (Overbeek et al, 2012, La Marca et al, 2013. As such, the objective of this study is to describe the…”

Reference ranges of anti‐Müllerian hormone and interaction with placental biomarkers in early pregnancy: the Generation R Study, a population-based prospective cohort study

“…Most studies reported a decline in AMH levels from the late first trimester of pregnancy onwards ( 20 , 41 , 42 ). Others observed a decline earlier in pregnancy, between 7 and 14 weeks of gestation ( 43 ). The analyzed AMH levels in those studies were not adjusted for maternal age, smoking, BMI, education level, maternal ethnicity, parity, or fetal sex.…”