Changes in antimüllerian hormone levels in early pregnancy are associated with preterm birth

Abstract

Objective To determine the association of preterm birth with anti-Mullerian hormone (AMH) levels, both in isolation and in combination with other markers of feto-placental health commonly measured during Integrated Prenatal Screening (IPS) for aneuploidy. Design Retrospective case-control study Setting State of Iowa Patients All pregnant women in Iowa who elected to undergo IPS and who subsequently delivered in Iowa were eligible for inclusion. Cases included women giving birth at <37 weeks gestation, controls included those who delivered at ≥37 weeks gestation. Interventions none Main outcome measure(s) Probability of a preterm birth Results 2nd trimester AMH levels were not associated with preterm birth, either independently or after controlling for other markers of feto-placental health. AMH difference was not associated with preterm birth when modeled alone, but a statistically significant association was found after adjusting for maternal serum alpha-fetoprotein (MSAFP) and maternal weight change between the 1st and 2nd trimester. After stratifying the model by MSAFP level, most of the risk for preterm birth was identified in women with an MSAFP >1 Multiple of the Median (MoM) and who had a stable or rising AMH level in early pregnancy. Conclusions A lack of decline in the AMH level in early pregnancy can be used to identify women with a high probability for preterm birth, especially when MSAFP levels are >1 MoM. Monitoring changes in the AMH level between the 1st and 2nd trimesters of pregnancy may help identify women who would benefit from interventional therapies such as supplemental progesterone.

Anti-Müllerian hormone kinetics in pregnancy and post-partum: a systematic review

“…There were four case-control studies (Gerli et al, 2015;Li et al, 2010;Plante et al, 2010;Stegmann et al, 2015), one of which was longitudinal in design (Gerli et al, 2015), one longitudinal cohort study (Nelson et al, 2010), two cross-sectional studies (La Marca et al, 2005;Santillan et al, 2012) and one study with a combination of crosssectional and longitudinal components (Köninger et al, 2013). Three studies were designed prospectively (Gerli et al, 2015;La Marca et al, 2005;Nelson et al, 2010), four studies were retrospective (Li et al, 2010;Plante et al, 2010;Santillan et al, 2012;Stegmann et al, 2015), and one was a combination of prospective and retrospective components (Köninger et al, 2013) (Table 2). Gestational age at measurement varied across the studies, in accordance with their design.…”

“…Two of the studies were primarily aiming to determine the fluctuations of AMH in pregnancy (Köninger et al, 2013;La Marca et al, 2005), whilst the others were determining the association of AMH in pregnancy with pre-term birth (Stegmann et al, 2015), fetal sex (Santillan et al, 2012), gestational diabetes mellitus (Gerli et al, 2015), maternal adiposity (Nelson et al, 2010) or fetal aneuploidy (Li et al, 2010;Plante et al, 2010).…”

“…The DSL assay was used in one study (Nelson et al, 2010), the Immunotech Beckman-Coulter assay was used in one study (La Marca et al, 2005), and one study used both assays on their samples (AMHbc and AMHdsl) (Plante et al, 2010). One study used their own laboratorydeveloped assay (Stegmann et al, 2015). A further four studies used the most recently available AMH Gen II assay by Beckman-Coulter (Gerli et al, 2015; Köninger et al, 2013; Li et al, 2010; Santillan et al, 2012).…”

“…In two out of eight studies the association between AMH and gestational age was specifically evaluated (Köninger et al, 2013;La Marca et al, 2005). In the remaining six studies the association of AMH with fetal aneuploidy (n = 2) (Li et al, 2010;Plante et al, 2010), gestational diabetes mellitus (n = 1) (Gerli et al, 2015), fetal sex (n = 1) (Santillan et al, 2012), pre-term birth (n = 1) (Stegmann et al, 2015) and maternal adiposity (n = 1) (Nelson et al, 2010) was examined. Some of these studies reported AMH data separately for case and control groups and these data have also been extracted separately, where available.…”

“…Some of these studies reported AMH data separately for case and control groups and these data have also been extracted separately, where available. More specifically, in the study by Stegmann et al (2015) the cases group included women of white race who delivered Figure 1 -Flow chart of study selection.…”