Maternal serum inhibin A levels are a marker of a viable trophoblast in incomplete and complete miscarriage

Abstract

Objective: From early gestation the human trophoblast secretes large amounts of inhibin A and activin A, and their measurement provides a value for predicting the outcome in women who become pregnant after assisted reproductive techniques. The aim of the study was to investigate the putative role of maternal serum inhibin A and activin A levels as markers of a viable trophoblast in women who miscarry. Design: Controlled cross-sectional study. Methods: One group consisted of 65 healthy pregnant women (controls), progressing to deliver a healthy singleton baby and another group consisted of 54 miscarriages (38 incomplete (27 nonviable, 11 anembryonic pregnancies) and 16 complete). Maternal blood samples were collected between 5 and 12 weeks of gestation. Results: Serum human chorionic gonadotrophin concentrations in women with incomplete or complete miscarriages were significantly (both P , 0:001) lower than in controls; activin A levels being lowest only in women with a complete miscarriage ðP , 0:001Þ: On the other hand, inhibin A levels were significantly lower in incomplete or complete miscarriage than in controls (both P , 0:0001). Conclusions: Maternal serum inhibin A, but not activin A, determination reflects the lack of a viable trophoblast in complete miscarriage.

Activin A and Follistatin as Biomarkers for Ectopic Pregnancy and Missed Abortion

“…Activin A levels are reduced in the presence of nonviable trophoblast [17–19], and single and serial measurements have been used to predict miscarriage [8]. Furthermore, it has been suggested that lower activin A in EP compared with those other failed pregnancies may be due to the difficulty of the ectopic trophoblast to correctly implant, compromising the decidualization process, and that some EPs could have more active trophoblasts and behave more like IUPs, whilst others will be failing and behave like failing MAs [12].…”

“…Both factors are involved in the complex mechanisms allowing the establishment and the maintenance of pregnancy. Their serum concentrations rise throughout viable pregnancy [5, 6] and decline in a state of nonviable trophoblasts [17–20]. Furthermore, their serum concentrations are significantly lower in serial measurements in women who subsequently miscarried when compared with live births [11, 19–21].…”

Serum activin A levels are lower in tubal than intrauterine spontaneously conceived pregnancies

“…Indeed, the human placenta is a relevant source of activin A since early pregnancy [25] and, variations in maternal activin A levels are common in trophoblast diseases as in the case of complete miscarriage [26][27][28]. Nevertheless, these evidences together would suggest that a reduction of activin A secretion may signal the difficulty of the trophoblast to correctly implant.…”

The Accuracy of Single Progesterone, Single β-hCG, and Their Combination Measurement in Predicting Early Miscarriage: A Prospective Study in Outpatient Setting

“…Another potential maternal serum markers currently highlighted was inhibin A. Johns et al found that after controlling for serum -hCG level, inhibin A was the only predictor for miscarriage [15]. Inhibin A and -hCG are two substances produced by the growing trophoblast and lower level of these two hormones was associated with miscarriage [16].…”