The role of serum beta-human chorionic gonadotropin as a predictor for pregnancy induced hypertension in 12-20 weeks of pregnancy
Keywords:Beta hCG, Preeclampsia, Hypertensitive disorder of pregnancy
Background: Pregnancy-induced hypertension occurs in approximately 3 to 5% of pregnancies and is still a major cause of both fetal and maternal morbidity and mortality worldwide. Pre-eclampsia is risk factor for stillbirth, intrauterine growth restriction (IUGR), low birth weight (LBW), preterm delivery, respiratory distress syndrome, and admission to neonatal intensive care unit. Overall, the incidence of preeclampsia ranges from 5 to 15% in India. This study conducted to assess the predictive value of raised beta-human chorionic gonadotropin (β-hCG) levels in development of pregnancy-induced hypertension in antenatal women and follow up the risk patients and reduce both maternal and perinatal morbidity and mortality.
Methods: The present study was conducted in the department of obstetrics and gynaecology, L.L.R.M Medical College and associated SVBP Hospital, Meerut during the period of January 2021 to December 2021 on 400 antenatal women with 12 to 20 weeks of gestation. Estimation of serum beta hCG level was done by enzyme linked fluorescence immunoassay. The cases were followed up in antenatal clinics, 4 weekly till 28 weeks, fortnightly up to 34 weeks and thereafter weekly till delivery for the development of PIH.
Results: From the study it was found that women with elevated beta hCG values in 12-20 weeks were at increased risk of developing PIH. The sensitivity of β-hCG for development of PIH was found to be 90%. It was found that specificity, positive predictive value (PPV), negative predictive value (NPV) of β-hCG for development of PIH was 82%, 41.7%, 98.3% respectively. However, p value of β-hCG for development of PIH is 0.001 which is highly significant.
Conclusions: From this study we found that that measuring second trimester serum beta-hCG levels is a good predictor of pregnancy induced hypertension and showed association with elevated levels of beta hCG with development and severity of PIH, but sensitivity and positive predictive value of beta hCG are low in this study to be useful for mass screening marker on its own.
Duley L. The global impact of preeclampsia and eclampsia. Semin Perinatol. 2016;33(3):130-7.
Sibai BM. Diagnosis and management of gestational hypertension and preeclampsia. Am J Obstet Gynecol. 2014;102(1):181-92.
Brazy JE, Grimm JK, Little VA. Neonatal manifestations of severe maternal hypertension occurring before the thirty-sixth week of pregnancy. J Pediatr. 1982;100(2):265-71.
Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122:1122-31.
Chowdhary H, Khurshid R, Parveen S, Yousuf S, Tali SH, Shah ZA. Utility of second trimester beta HCG levels in prediction of gestational hypertension: a prospective cohort study. Int J Reprod Contracept Obstet Gynecol. 2017;6(3):1040-4.
Kaur G, Jain V, Mehta S, Himani S. Prediction of PIH by Maternal Serum Beta HCG Levels in the Second Trimester (13-20 Weeks) of Pregnancy. J Obstet Gynaecol India. 2012;62(1):32-4.
Sharma V, Sharma P, Firdous N. BETA HCG in Mid Trimester as a Predictor of Pregnancy Induced Hypertension. Int J Sci Res. 2016;5(9):303-5.
Roiz-Hernandez J, 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.