DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20220013
Published: 2022-01-28

β-hCG levels in second trimester as a predictor of gestational hypertension and preeclampsia

Neha Rathore, Reema Khajuria, Rohini Jaggi

Abstract


Background: Hypertensive disorders of pregnancy complicate up to 10% of pregnancies worldwide, and remain amongst the most significant and intriguing unsolved problems in obstetrics. The goal of this study is to test the hypothesis that women with high serum β-hCG levels in early pregnancy are at higher risk of developing gestational hypertension and preeclampsia.

Methods: This is a prospective study done in 200 women between 13 and 20 weeks of gestation, selected randomly for this study. Serum β-hCG estimation was done by Sandwich chemiluminescence immunoassay method and calculated in multiple of median (MOM).  They were followed till delivery for development of gestational hypertension and preeclampsia. Results were analysed statistically.

Results: Out of 200 cases, 43 (21.5%) cases developed PIH. β-hCG levels were considered raised if the levels were >2 MOM.  Out of 39 cases with beta HCG levels >2 MOM, 32 (82.1%) developed PIH whereas 7 (17.9%) remain normotensives against. Also, higher levels of beta HCG are associated with increased severity of PIH (p<0.000). The sensitivity was 82%, specificity was 93.2% and positive predictive value was 74.3%.

Conclusions: The study conclude that elevated serum β-hCG levels in women with second trimester pregnancy indicates increased risk of gestational hypertension and preeclampsia and raised β-hCG levels are associated with severity of disease


Keywords


Human chorionic gonadotrophin, Placenta, Gestational hypertension and preeclampsia, Second trimester pregnancy, Sensitivity and specificity

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References


Cunningham LB, Spong DH, Casey. Hypertensive disorders chapter 40, William’s obstetrics 24th edition, Mc Graw Hill Education, New York. 2014;728-9.

Rajesh A, Vandana M. Serum beta hCG in early second trimester as a predictor of gestational hypertension. Int J Reprod Contracept Obstet Gynecol. 2018;7(6):2355-9.

Daskalakis G, Papapanagiotou A. Serum Markers for the Prediction of Preeclampsia. J Neurol Neurophysiol. 2015;6:264.

Yu CK, Smith GC, Papageorghiou AT. An integrated model for the prediction of pre-eclampsia using mater¬nal factors and uterine artery Doppler velocimetry in unselected low-risk women. Am J Obstet Gynecol. 2006;195(1):330.

Khan K, Say L, Gulmezoglu AM. WHO analysis of causes of maternal death: A systematic review. Lancet. 2006;367:1066-74.

Kulkarni N, Bansal R, Pawar P. Serum Beta HCG and uterine artery Doppler studies in second trimester to predict preeclampsia and eclampsia. Int J Reprod Contracept Obstet Gynecol. 2018;7(5):1924-8.

Kharfi A, Giguere Y, Sapin V. Trophoblastic remodeling in normal and preeclamptic pregnancies: implication of cytokines. Clin Biochem. 2003;36:323-31.

Hsu CD, Chan DW, Iriye B. Elevated serum human chorionic gonadotropin as evidence of secretory response in severe preeclampsia. Am J Obstet Gynecol. 1994;170:1135-8.

Brodszki J, Lanne T, Laurini R. Vascular mechanical properties and endothelial function in pre-eclampsia with special reference to bilateral uterine artery notch. Acta Obstet Gynecol Scand. 2008;87:154-62.

Chavarria ME, Lara-Gonzalez L. Prostacycline thromboxane, early changes in pregnancies that are complicated by preeclampsia. Am J Obstet Gynecol. 2003;88:986-92.

Adnan MN, Ashour MB, Ellice S. The value of elevated second trimester beta HCG in predicting development of preeclampsia. Am J Obstet Gynecol. 1997;176(2):438-42.

Anneli MP, Anna LH, Olli JV. Midtrimester N-terminal proatrial. Natriuretic peptide, free beta hCG, and alpha-fetoprotein in predicting Preeclampsia. Obstet Gynecol. 1998;91:940-4.

Muller F, Savey L, Fiblec LB. Maternal serum HCG Levels at fifteen weeks is a predictor of preeclampsia. Am J Obstet Gynecol. 1996;175:37-40

Onderoglu LS, Kabukçu A. Elevated second trimester human chorionic gonadotropin level associated with adverse pregnancy outcome. Int J Obstet Gynecol. 1997;56:245-9.

Hermsteiner M, Zoltan DR, Kunzel W. Human chorionic gonadotropin attenuates the vascular response to angiotensin II. Eur J Obstet Gynecol Reprod Biol. 2002;102:148-54.

Sharma P, Maheshwari S, Barala S. Correlation between second trimester beta human chorionic gonadotropin levels and pregnancy outcome in high risk group. Int J Reprod Contracept Obstet Gynecol. 2016;5(7):2358-61.

Vidyabati RK, Davina H, Singh NK, Gynaehswar SW. Serum β hCG and lipid profile in second trimester as predictors of pregnancy induced hypertension. J Obstet Gynecol India. 2010;60(1):44-50.

Satyanarayan K, Sawhney H, Vasishta K. Association between second trimester maternal serum hCG levels and PIH. J Obst Gyn India. 2001;51:85-8.

Gokdeniz R, Perez R, David M. Elevated serum HCG levels in severe preeclampsia. Turk J Med Sci. 2000;30:43-5.

Yadav S, Gupta S, Chandra. Correlation of elevated levels of maternal serum beta HCG in pregnancy induced hypertension and pregnancy outcomes in these petients. Indian J Pathol Microbiol. 1997;40(3):345-9.

Kaur G, Jain V, Mehta S. Prediction of PIH by Maternal Serum Beta HCG Levels in the Second Trimester (13-20 weeks) of Pregnancy. J Obstet Gynecol India. 2012;62:32-4.

Roiz-Hernandez J, de Cabello-Martinez J, Fernandez Mejia M. Human chorionic gonadotropin levels between 16 and 21 weeks of pregnancy and prediction of pre-eclampsia. Int J Gynaecol Obstet. 2006;92:101-5.

Sorensen TK, Williams MA, Zingheim RW. Elevated second trimester HCG and subsequent pregnancy induced hypertension. Am J Obstet Gynecol. 1993;169:834-8.

Asvold BO, Vatten LJ, Tanbo TG, Eskild A. Concentrations of human chorionic gonadotrophin in very early pregnancy and subsequent pre-eclampsia. Human Reprod. 2014;29(6):1153-60.

Keikkala E, Vuorela P, Laivuori H, Romppanen J, Heinonen S, Stenman UH. First trimester hyperglycosylated human chorionic gonadotrophin in serum-A marker of early-onset preeclampsia. Placenta. 2013;34:1059-65.

Balwinder K, Chittranjan V, Manjit M. Serum human chorionic gonadotropin level in preeclamptic and normotensive pregnant women: a prospective study. Int J Contemporary Med Res. 2017;4(8):1811-4.

Begum Z, Ara I, Tanira S, Keya Ka. The association between serum beta human chorionic gonadotropin and preeclampsia. J Dhaka Med Coll. 2014;23(1):89-93

Aquilina J, Thompson O. Improved early prediction of preeclampsia by combining second trimester serum inhibin A and uterine artery Doppler. Ultrasound Obstet Gynecol. 2001;17:477-84.

Crosignani PG, Trojsi L, Attanasio AE, Finzi GC. Value of HCG and HCS measurement in clinical practice. Obstet Gynecol. 1974;44:673-81.

Levine RJ, Lam C, Qian C, Yu KF, Maynard SE, Sachs BP et al. Soluble endoglin and other circulating antiangiogenic factors in preeclampsia. N Engl J Med. 2006;355:992-1005.

Maynard S, Epstein FH, Karumanchi SA. Preeclampsia and angiogenic imbalance. Annu Rev Med. 2008;59:61-78.