DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20203052

Association between maternal serum beta human chorionic gonadotropin levels and hypertensive disorders of pregnancy

Archana Kumari, Vahini M.

Abstract


Background: A major challenge in obstetrics is early identification of hypertensive disorders of pregnancy (HDP). This study was performed to determine the association between elevated maternal serum β-hCG levels and HDP, the correlation between serum β-hCG level and severity of preeclampsia and to determine the value of serum β-hCG level as a diagnostic marker for early diagnosis of HDP.

Methods: This was a hospital based observational study conducted in the department of obstetrics and gynecology, Rajendra Institute of Medical Sciences, Ranchi on 375 pregnant women with period of gestation more than 20 weeks, including 250 pregnant women with HDP as study group and 125 normotensive pregnant women as controls. Serum β-hCG concentration was measured and its level was compared between two groups.

Results: The maternal mean serum β-hCG levels (51161.08±30038.21 IU/L) of study group of HDP were higher than the normotensive control group (17603.23±16748.21 IU/L). In non-severe preeclampsia, the mean serum levels were 36417.32±23876.74 IU/L while in severe preeclampsia, 60030.34±28771.31 IU/L. There was statistically significant difference (p<0.001) with higher levels in early onset preeclamptic mothers than late onset preeclampsia. The cut-off point of β-hCG for predicting HDP was 32077 IU/L with sensitivity of 65% and specificity of 86%.

Conclusions: Serum β-hCG level is higher in HDP when compared to normotensive women. Higher levels of β-hCG are associated with increasing severity of hypertensive disorders of pregnancy. The utility of serum β-hCG as a diagnostic test is limited because of low sensitivity and difficulty in deciding the cut-off value.


Keywords


Eclampsia, Hypertensive disorders of pregnancy, Preeclampsia, Serum β-hCG

Full Text:

PDF

References


Sajith M, Nimbargi V, Modi A, Sumariya R, Pawar A. Incidence of pregnancy induced hypertension and prescription pattern of antihypertensive drugs in pregnancy. Int J Pharma Sci Res. 2014;23:4.

Misra R, Donald’s I. Practical Obstetrics problems; 6th edition; Oracle BI publisher. 2006;14:300-1.

Chua S, Arulkumaran S, Eclampsia-no room for complacency. Singapore Med J. 1995;36:470-1.

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

Redman CWG. Platelets and the beginning of preeclampsia. N Eng J Med. 1990;323:478-80.

Long PA, Oat JN. Preeclampsia in twin pregnancy: severity and pathogenesis. Aust NZ J Obstet Gynecol. 1987;27:1-5.

Curry SL, Hammond CB, Tyrey L, Creasman WT, Parker RT. Hydatidiform mole: diagnosis, management and long term follow up of 374 patients. Obstet Gynecol. 1975;45:1-8.

Kumari A. Retrospective analysis of maternal mortality in a referral medical college, Jharkhand. Indian Med J. 2016;110:74(A)-77(A).

Berg CJ, Harper MA, Arkinson SM, Bell EA, Brown HL, Hage ML, et al. Preventability of pregnancy-related deaths. Obstet Gynecol. 2005;106:1228-34.

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

Basirat Z, Barat S, Hajiahmadi M. Serum beta human chorionic gonadotropin levels and pre-eclampsia. Saudi Med J. 2006;27(7):1001-4.

Choudhury KM, Das M, Ghosh S, Bhattacharya D, Ghosh TK. Value of serum β-hCG in pathogenesis of pre-eclampsia. J Clin Gynecol Obstet. 2012;1(4-5):71-5.

Mujawar SA, Patil VW, Daver RG. Serum human chorionic gonadotropin as a biochemical marker of adverse pregnancy outcome in severe preeclampsia. Am J Biochem. 2018;8(1):13-7.

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. The J Obstet Gynecol India. 2012;62(1):32-4.

Al-bayati MM, Hammod NJ. Elevated serum β-hCG levels in severe pre-eclampsia. Iraqi J Med Sci. 2009;7(1):96-101.

Jaiswar SP, Nisha, Mamta R. Maternal human chorionic gonadotrophin as a predictor for pregnancy induced hypertension. J Obstet Gynecol Ind. 2003;53(6):543-5.

Mooney RA, Arvan DA, Saller DN, French CA, Peterson CJ. Decreased maternal serum hCG levels with increasing gravidity and parity. Obstet Gynecol. 1995;86:900-5.

Shenhav S, Gemer O, Sassoon E, Volodarsky M, Peled R, Segal S. Mid-trimester triple test levels in early and late onset sever pre-eclampsia. Prenat Diagnos. 2002;22:579-82.

Moodley D, Moodley J, Buck R, Haneet R, Payne A. Free alpha subunit of human chorionic gonadotropin in pre-eclampsia. Int J Gynecol Obstet. 1995;49:283-7.

Yousefnejad K, Moslemizadeh N. Serum β-hCG levels in diagnosis and management of pre-eclampsia. J Med Sci. 2008;8(8):722-7.

Huppertz B. Placental origins of pre-eclampsia; challenging the current hypothesis. Hypert. 2008;51:970-5.

Dutta DC. Text book of obstetrics. 8th edition, Chapter 17; Hypertensive disorders in pregnancy. Central Publishers; 2016:221-242.

Levine RJ, Hauth JC, Curet LB, Sibai BM, Catalano PM, Morris CD,et al. Trial of calcium to prevent preeclampsia. N Engl J Med. 1997;337:69-76.

Hofmeyr GJ, Lawrie TA, Atallah AN, Dubey L. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev. 2010;8:CD001059.

Barros JS, Baptista MG, Bairos VA. Human chorionic gonadotrophin in human placentas from normal and preeclamptic pregnancies. Arch Gynecol Obstet. 2002;266(2):67-71.

Vaillant P, David E, Constant I, Athmani B, Devulder G, Fievet P, et al. Validity in nulliparas of increased beta-human chorionic gonadotropin at mid-term for predicting pregnancy-induced hypertension complicated with proteinuria and intrauterine growth retardation. Nephron. 1996;72:557-63

Sahar MY, El-Baradie, Mahmoud M, Makhlouf HH. Elevated serum levels of interleukin-15, interleukin-16, and human chorionic gonadotropin in women with pre-eclampsia. J Obstet Gynaecol Can. 2009;31(2):142-8.