Serum progesterone distribution in normal pregnancies compared to pregnancies complicated by threatened miscarriage from 5 to 13 weeks gestation: a prospective cohort study

Abstract

BackgroundProgesterone is a critical hormone in early pregnancy. A low level of serum progesterone is associated with threatened miscarriage. We aim to establish the distribution of maternal serum progesterone in normal pregnancies compared to pregnancies complicated by threatened miscarriage from 5 to 13 weeks gestation.MethodsThis is a single centre, prospective cohort study of 929 patients. Women from the Normal Pregnancy [NP] cohort were recruited from antenatal clinics, and those in the Threatened Miscarriage [TM] cohort were recruited from emergency walk-in clinics. Women with multiple gestations, missed, incomplete or inevitable miscarriage were excluded from the study. Quantile regression was used to characterize serum progesterone levels in the NP and TM cohorts by estimating the 10th, 50th and 90th percentiles from 5 to 13 weeks gestation. Pregnancy outcome was determined at 16 weeks of gestation. Subgroup analysis within the TM group compared progesterone levels of women who subsequently miscarried with those who had ongoing pregnancies at 16 weeks of gestation.ResultsMedian serum progesterone concentration demonstrated a linearly increasing trend from 57.5 nmol/L to 80.8 nmol/L from 5 to 13 weeks gestation in the NP cohort. In the TM cohort, median serum progesterone concentration increased from 41.7 nmol/L to 78.1 nmol/L. However, median progesterone levels were uniformly lower in the TM cohort by approximately 10 nmol/L at every gestation week. In the subgroup analysis, median serum progesterone concentration in women with ongoing pregnancy at 16 weeks gestation demonstrated a linearly increasing trend from 5 to 13 weeks gestation. There was a marginal and non-significant increase in serum progesterone from 19.0 to 30.3 nmol/L from 5 to 13 weeks gestation in women who eventually had a spontaneous miscarriage.ConclusionsSerum progesterone concentration increased linearly with gestational age from 5 to 13 weeks in women with normal pregnancies. Women with spontaneous miscarriage showed a marginal and non-significant increase in serum progesterone. This study highlights the pivotal role of progesterone in supporting an early pregnancy, with lower serum progesterone associated with threatened miscarriage and a subsequent complete miscarriage at 16 weeks gestation.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-2002-z) contains supplementary material, which is available to authorized users.

Baseline Levels of Serum Progesterone and the First Trimester Pregnancy Outcome in Women with Threatened Abortion: A Retrospective Cohort Study

“…As far as we know, most studies suggested that serum progesterone levels were associated with pregnancy outcome, especially in the first trimester. Serum progesterone in abortion patients was generally lower than that in continuing pregnancy [10][11][12][13][14]. In our study, a negative correlation between serum progesterone and early pregnancy failure was further described.…”

“…Covariates. The selection of covariates in this study was mainly based on previous studies which researched the relationship between progesterone and pregnancy outcome [10][11][12][13][14][17][18][19][20][21][22]. Therefore, patients' basic demographics (age, height, weight, smoking history, drinking history, and marital status), obstetric history (times of gestity, parity, and abortion), and clinical information (gestational week, progesterone, β-HCG, medical history, and use of progesterone) were collected.…”

“…To ensure the robustness of data analysis, we made a sensitivity analysis. (1) Serum progesterone changed over time [11] and had two-way causality with progesterone therapy. Therefore, we used marginal structural model for sensitivity analysis.…”

“…Several studies showed that low serum progesterone was associated with abortion [10][11][12][13][14]. Hence, exogenous progesterone supplements were often used to treat threatened abortion, especially in China [15].…”

Effects of Pregnancy and Hormones on T cell Immune Regulation in Multiple Sclerosis

“…P4 is essential for the establishment and maintenance of pregnancy as evident by the fact that administration of the P4-receptor antagonist Mifepristone (RU486) results in cessation of pregnancy (Couzinet et al 1986). Furthermore, lowered circulating levels of P4 have been associated with several pregnancy complications (Arck et al 2008, Okabe et al 2014, Ku et al 2018, and therapeutic use of P4 in pregnancy has been shown to reduce the risk of preterm birth in certain risk groups (Jarde et al 2019). In general, pregnancy hormones are believed to suppress maternal alloresponses while promoting fetal tolerance (Schumacher et al 2014).…”