Serum chorionic gonadotrophin (hCG), schwangerschaftsprotein 1(SP1), progesterone and oestradiol levels in patients with nausea and vomiting in early pregnancy

Abstract

S e r u m concentrations of h u m a n chorionii gonadotrophin (hCG). schwangerschaftsprotein l(SPl), progesterone and oestradiol were measured in 1 16 pregnant w o m e n experiencing varying degrees o f nausea and vomiting or no nausea at all a t between 9 and 16 wceks gestation. 'Thc patients w e r e categorized into four groups, namcly asymptomatic. nausea alone, nausea a n d vomiting a n d hyperemesis gravidarum. T h e distribution of levels for each g r o u p were examined in relation t o t h e calculated normal ranges. Statistically higher hCG levels were f o u n d in out-patients with nausea alone or nausea and vomiting than in t h e asymptomatic women. No significant differences were found between t h e groups for any of t h e o t h c r measured variables, including t h e progesterone/oestradiol concentration ratio.Approximately one in two women will cxperience some nausea and vomiting in the early stages of pregnancy. commonly in the form of 'morning sickness' (Fairweather 1968). In a small proportion when the vomiting becomes more serious and persistent the term 'hyperemesis gravidarum' is applied.The aetiology of nausea and vomiting in pregnancy still remains obscure but endocrine, allergic and psychosomatic factors have all been suggested as responsible. This study was designed to consider four possible endocrine factors, two placental proteins, human chorionic gonadotrophin (hCG) and schwangerschaftsprotein 1 (SPl), and two steroid hormones, progesterone and oestradiol. although SPI and hCG might also be considered as possible allergens.Since its discovery hCG has been considered a likely candidate for causing nausea and vomiting in pregnancy becausc of the early and rapid rise in placental output, and Schoeneck (1942) found higher concentrations of hCG in the urinc of pregnant women who suffered from nausea and vomiting than in those who were asymptomatic. In a clinical study of patients with hyperemesis gravidarum Fairweather (1968) reported that the first trimester peak of hCG in urine and blood coincided with the most common gestation at admission, although Fairweather Rr Loraine (1962) had found that hCG excretion was significantly lower in patients with hyperemesis than in normal pregnant wornen. More recently, Soules ef crl. (1980) found no relation between absolute levels of hCG or 17-hydroxyprogesterone and the incidence or severity of naubea and vomiting in women with either normal or molar pregnancies.Maternal blood levels of SP1 have been shown to rise throughout pregnancy (Klopper 1979). but they have not been related to nausea and vomiting in early pregnancy.It has been suggestcd that nausea and vomiting are caused by progesterone deficiency, but 21 1

Rates of nausea and vomiting in pregnancy and dietary characteristics across populations

“…Symptoms range from mild nausea (often accompanied by aversions to certain foods) to frequent vomiting and hyperemesis (Furneaux et al 2001). Until recently, NVP was thought to be simply an unfortunate by-product of dramatic hormonal changes during early pregnancy (Masson et al 1985;Lagiou et al 2003), with potentially negative consequences on offspring intrauterine growth and health in later life through resulting undernutrition (e.g. Godfrey et al 1996;Fall et al 2003).…”

Vasospasms of Cerebral Arteries in Hyperemesis gravidarum

“…The association between high circulating human chorionic gonadotropin (hCG) levels and emesis or hyperemesis has been described [5]. hCG has a biological action similar to that of thyroid-stimulating hormone and interacts with the thyroid-stimulating hormone receptor.…”

“…Elevated levels of human chorionic gonadotropin [1] and thyroid-stimulating hormone [2,3] and physiological factors have been implicated [4,5].…”

Nausea and Vomiting in Pregnancy: An Association between Symptoms and Maternal Prostaglandin E2

“…These syncytiotrophoblast and cytotrophoblast cells secrete a number of hormones, cytokines and prostaglandins, including HCG [10], IL-1ß [11], TNF· [12] and PGE2 [13]. HCG has been related to the symptoms of NVP [6][7][8][9], but HCG itself cannot be the cause of NVP, as very raised serum and cerebrospinal fluid levels of HCG occur in choriocarcinoma in the absence of nausea and vomiting, provided there are no gastrointestinal or cerebral secondaries [Bagshawe KD, private communication]. HCG can therefore be regarded as a marker for NVP, although not its cause.…”

“…Some have reported a negative correlation [4], no correlation [5] or a positive correlation [6][7][8][9]. Our hypothesis is that substances arising from the chorionic villi which are involved in the synthesis or effects of HCG are implicated in the aetiology of NVP.…”