The association between unexplained second-trimester maternal serum hCG elevation and pregnancy complications

Area of Science:

• Maternal-Fetal Medicine
• Reproductive Endocrinology
• Perinatal Outcomes Research

Background:

• Maternal serum screening plays a crucial role in identifying pregnancies at risk for adverse outcomes.
• Human chorionic gonadotropin (hCG) is a key biomarker in prenatal screening.
• Unexplained elevations in hCG may indicate underlying placental or fetal issues.

Purpose of the Study:

• To investigate the association between unexplained elevated maternal serum hCG levels and pregnancy complications.
• To determine the risk of adverse perinatal outcomes in pregnancies with high hCG levels.
• To inform clinical management strategies for pregnancies with elevated hCG.

Main Methods:

• Cohort analytic study design.
• Inclusion criteria: singleton gestation, confirmed gestational age, hCG > 2.5 multiples of the median (MOM).
• Exclusion criteria: fetal anomalies, abnormal karyotype, maternal serum alpha-fetoprotein (MSAFP) > 2.5 MOM. Control group with normal hCG and MSAFP.

Main Results:

• 4.7% of screened women (284/6011) had unexplained elevated hCG.
• Elevated hCG significantly increased risk for hypertension (OR 4.4) and fetal growth restriction (OR 2.8).
• hCG levels > 4 MOM correlated with increased risk of preterm delivery (OR 3.3).

Conclusions:

• Unexplained elevated maternal serum hCG levels identify high-risk pregnancies.
• These pregnancies warrant heightened surveillance and appropriate clinical management.
• Early identification can potentially mitigate adverse perinatal outcomes.