Validity in Nulliparas of Increased b-Human Chorionic Gonadotrophin at Mid-Term for Predicting Pregnancy-Induced Hypertension Complicated with Proteinuria and Intrauterine Growth Retardation

Abstract

The objective of the present study was to investigate whether increased β-human chorionic gonadotrophin (βHCG) plasma concentrations in an unselected population of nulliparas could predict the occurrence of complicated pregnancy-induced hypertension (PIH). The design was that of a prospective population study. It was conducted at the obstetric departments of Amiens University Hospital and Creil General Hospital on 434 consecutive nulliparas with singleton pregnancies after natural fertilization who accepted the systematic offer of trisomy 21 screening but for whom this disorder was finally eliminated. Measurement of plasma concentration of βHCG (ELISA method) was carried out between 14 and 20 weeks (mean: 17 weeks) of amenorrhea, and measurement of blood pressure and proteinuria ( > 300 mg/24 h or Albustix ++) during the first, second and third term and 2-3 months after the delivery, as well as measurement of birth weight for determination of small for gestational age (SGA) babies. 37 women developed PIH, 10 without other complication, 16 with proteinuria (5 of which with SGA babies) and 11 with SGA babies. Furthermore 2 patients presented abruptio placentae without PIH. 395 women did not develop PIH including 389 normotensive women and 6 chronic hypertensive patients without superimposed toxemia. Only 1 was diabetic. None had chronic renal disease. Mean ( ± SD) levels of βHCG were higher in PIH than in controls: 46,805 ± 19,068 versus 23,479 ± 13,463 IU. A pathological threshold was chosen as the mean for the whole population + 1 SD: 25,613 + 15,479 = 41,082 IU. Elevated levels (above this value) were significantly associated with isolated PIH or PIH complicated with proteinuria and/or with SGA babies. The positive predictive value of this criterion was respectively 11, 15 and 12% for each of these complications. The relative risk (and 95% confidence limit) of women with elevated βHCG for each of these complications was 20 (6-79), 11 (4-43) and 22 (7-93). Elevated plasma βHCG found around 17 weeks of amenorrhea predicts PIH complicated with either proteinuria or SGA babies with a positive predictive value comparable to that of the best and earliest test proposed up to now to select nulliparas at high risk of preeclampsia, namely the abnormalities of the Doppler waveforms of the uterine arteries. Since this test is simpler to perform, it represents the most convenient method to screen a population of nulliparas for evaluation of the benefits of low-dose aspirin.

Correlation between second trimester beta human chorionic gonadotropin levels and pregnancy outcome in high risk group

“…The study of Valliant P et al was a random retrospective study and our study was a prospective study hence there were the differences in the incidence of prim gravida and multigravida. 3 In the present study group, cases who developed any complications, 100% had high and 45.8% had low values of  hCG which was statistically significant (p< 0.001), thereby concluding that raised  hCG levels were significant in predicting pregnancy complication. This similar observation was made by Benn AP et al in which 26% had high and 9.9% had low values of  hCG which was statistically significant (p<0.001) confirming that elevated maternal  hCG levels have association with adverse pregnancy outcome.…”

Prediction of Preeclampsia or Intrauterine Growth Restriction by Second Trimester Serum Screening and Uterine Doppler Velocimetry

“…Many studies have examined a possible correlation between the hCG level and the occurrence of pregnancy complications, since the introduction of serum screening for Down's syndrome [5,6,[23][24][25][26][27][28][29]. Most of these articles are case-control studies.…”

“…Most of these articles are case-control studies. The sensitivity and PPVs for preeclampsia reported in these studies for an hCG level 12 MoM are highly variable, ranging from 20 to 69% and 3 to 15% respectively [23][24][25][26][27]29]. In a large retrospective study, Walton et al [9] have examined the association between hCG levels and pregnancy outcome in 28,743 women.…”

Elevated Second-Trimester Free β-hCG as an Isolated Finding and Pregnancy Outcomes

“…In this view, it is possible that some of the very young primigravidas develop an accentuated immunologic response that is reflected through a high level of free ß-hCG. On the other hand, young age and nulliparity are the most consistently reported risk factors for preeclampsia [23,24]. Data concerning the genetic etiology of preeclampsia generally agree that the condition may be the result of a maternalfetal genotype by genotype interaction analogous to rhesus disease [25].…”