Early serum estradiol decline as a predictive biomarker of spontaneous abortion without fetal chromosomal
Yu-Han Shen1, Sui Peng1, Jiayi Li1
1Department of Gynecology, Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Introduction:
Identifying reliable biomarkers to predict spontaneous abortion (SA), particularly in pregnancies without fetal chromosomal abnormalities, remains a critical objective in obstetric care. This retrospective cohort study assessed the predictive utility of serum β-human chorionic gonadotropin (β-hCG), estradiol, and progesterone concentrations in patients experiencing SA with confirmed chromosomally normal chorionic villi.
Material And Methods:
A retrospective analysis was conducted on clinical and laboratory data from 76 patients who experienced SA between 5 and 10 weeks of gestation and received care at the Department of Obstetrics and Gynecology of our hospital between 2019 and 2024. All patients underwent uterine evacuation, and chorionic villus specimens were assessed for chromosomal abnormalities using next-generation sequencing (NGS). Based on NGS findings, two groups were defined: patients without fetal chromosomal abnormalities [n = 36; defined as no structural variants > 0.1 megabase pairs (Mb)] and patients with fetal chromosomal abnormalities (n = 40; variants > 1 Mb). An additional control group (n = 100) with uncomplicated, ongoing pregnancies was included for comparison. Serum concentrations of βhCG, estradiol, and progesterone were measured and compared across groups in the pregnant women.
Results:
Peak serum β-hCG concentrations were significantly lower in the SA group without chromosomal abnormalities compared to both the chromosomally abnormal SA group and the control group. Similarly, peak progesterone and estradiol concentrations were lowest in the SA group without chromosomal abnormalities (p < 0.05). Among the three biomarkers, estradiol demonstrated the highest discriminatory capacity. A significantly higher rate of early serum estradiol decline was observed in the SA group without chromosomal abnormalities compared to the group with abnormalities (p = 0.027). In contrast, no significant differences were found in the rate of progesterone decline across the groups. The median estradiol concentration at the time of initial decline was also significantly lower in the SA group without chromosomal abnormalities than in the other two groups.
Conclusion:
Early decline in serum estradiol levels may serve as a superior biomarker for predicting SA not associated with fetal chromosomal abnormalities. In contrast, serum β-hCG and progesterone concentrations exhibited limited predictive value in this context. These findings support consideration of serum estradiol monitoring to facilitate timely clinical intervention in pregnancies at increased risk for non-chromosomal miscarriage.
