BibTex RIS Kaynak Göster

First and second trimester hCG levels have no value in predicting small for gestational age infants

Yıl 2013, Cilt: 35 Sayı: 2, 215 - 220, 31.01.2013

Nilgün Güdücü , Gökçenur Gönenç , Herman İşçi Alin Başgül Yiğiter İlkkan Dünder

Öz

Abstract

Aim. The aim of this study was to compare high hCG levels in the first and second trimester in predicting small-for-gestational age (SGA) infants. This is the first study that compares hCG levels of first and second trimesters. Methods. Patients with both first and second trimester Down syndrome screening tests were investigated retrospectively and human chorionic gonadotropin (hCG) values were recorded. Patients were divided into groups as SGA and non-SGA. High hCG values (≥2 MoM) were compared with low hCG values (<2MoM). Results. There was no significant difference in the hCG levels in women delivering SGA and non-SGA infants. Sensitivity and specificity of both tests were the same (9.09 and 89.95 respectively). Conclusions. Neither first nor second trimester hCG values were predictive in detection of SGA infants

Keywords: Small-for-gestational-age, hCG, Down syndrome screening tests

 

Özet

Amaç. Bu çalışmada amaç birinci ve ikinci trimester human chorionic gonadotropin (hCG) değerlerinin gebelik yaşına göre küçük bebekleri tahmin etmede faydalı olup olmadığını araştırmaktı. Yöntem. Hem birinci, hem de ikinci trimester Down sendromu tarama testi yaptırmış olan hastaların sonuçları retrospektif olarak tarandı ve hCG MoM değerleri tespit edildi. Hastalar gebelik yaşına göre küçük ve gebelik yaşına göre küçük (GYK) olan ve olmayan bebek doğuranlar olarak iki gruba ayrıldı. Yüksek hCG değerleri (≥2MoM) ile düşük hCG değerleri (<2MoM) karşılaştırıldı. Bulgular. GYK olan ve olmayan bebek doğuranların hCG değerleri arasında istatiksel olarak anlamlı bir fark görülmedi. Sensitivite ve spesifisite her iki grupta da aynı bulundu (sırasıyla 9.09 ve 89.95). Sonuç. Birinci ve ikinci trimester hCG değerlerinin GYK bebekleri tahmin etmede yeri yoktur.

Anahtar sözcükler: Gebelik yaşına göre küçük, hCG, Down sendromu tarama testleri

Anahtar Kelimeler

Small-for-gestational-age hCG Down syndrome screening tests

Kaynakça

  • Kok JH, den Ouden AL, Verloove-Vanhorick SP, Brand R. Outcome of very preterm small for gestational age infants: the first nine years of life. BJOG 1998; 105: 162-8.
  • Lindqvist PG, Molin J. Does antenatal identification of small-for-gestational age fetuses significantly improve their outcome? Ultrasound Obstet Gynecol 2005; 25: 258-64.
  • Bogart MH, Pandian MR, Jones OW. Abnormal maternal serum chorionic gonadotropin levels in pregnancies with fetal chromosome abnormalities. Prenat Diagn 1987; 7: 623-30.
  • Smith GC, Stenhouse EJ, Crossley JA, Aitken DA, Cameron AD, Connor JM. Early pregnancy levels of pregnancy-associated plasma protein a and the risk of intrauterine growth restriction, premature birth, preeclampsia, and stillbirth. J Clin Endocrinol Metab 2002; 87: 1762-7.
  • Krantz D, Goetzl L, Simpson JL, Thom E, Zachary J, Hallahan TW, Silver R, Pergament E, Platt LD, Filkins K, Johnson A, Mahoney M, Hogge WA, Wilson RD, Mohide P, Hershey D, Wapner R; First Trimester Maternal Serum Biochemistry and Fetal Nuchal Translucency Screening (BUN) Study Group. Association of extreme first-trimester free human chorionic gonadotropin-beta, pregnancy-associated plasma protein A, and nuchal translucency with intrauterine growth restriction and other adverse pregnancy outcomes. Am J Obstet Gynecol 2004; 191: 1452-8.
  • Ong CY, Liao AW, Spencer K, Munim S, Nicolaides KH. First trimester maternal serum free beta human chorionic gonadotrophin and pregnancy associated plasma protein A as predictors of pregnancy complications. BJOG 2000; 107: 1265-70.
  • Tul N, Pusenjak S, Osredkar J, Spencer K, Novak-Antolic Z. Predicting complications of pregnancy with first-trimester maternal serum free-betahCG, PAPP-A and inhibin-A. Prenat Diagn 2003; 23: 990-6.
  • Morssink LP, Kornman LH, Hallahan TW, Kloosterman MD, Beekhuis JR, de Wolf BT, Mantingh A. Maternal serum levels of free beta-hCG and PAPP-A in the first trimester of pregnancy are not associated with subsequent fetal growth retardation or preterm delivery. Prenat Diagn 1998; 18: 147-52.
  • Kavak ZN, Basgul A, Elter K, Uygur M, Gokaslan H. The efficacy of firsttrimester PAPP-A and free beta hCG levels for predicting adverse pregnancy outcome. J Perinat Med 2006; 34: 145-8.
  • Spencer K, Cowans NJ, Avgidou K, Molina F, Nicolaides KH. First-trimester biochemical markers of aneuploidy and the prediction of small-for-gestational age fetuses. Ultrasound Obstet Gynecol 2008; 31: 15-9.
  • Goetzinger KR, Singla A, Gerkowicz S, Dicke JM, Gray DL, Odibo AO. The efficiency of first-trimester serum analytes and maternal characteristics in predicting fetal growth disorders. Am J Obstet Gynecol 2009; 201: 412.e1-6. Tao YX, Lei ZM, Hofmann GE, Rao CV. Human intermediate trophoblasts express chorionic gonadotropin/luteinizing hormone receptor gene. Biol Reprod 1995; 53: 899-904.
  • Lei ZM, Reshef E, Rao V. The expression of human chorionic gonadotropin/luteinizing hormone receptors in human endometrial and myometrial blood vessels. J Clin Endocrinol Metab 1992; 75: 651-9.
  • Zygmunt M, Herr F, Keller-Schoenwetter S, Kunzi-Rapp K, Münstedt K, Rao CV, Lang U, Preissner KT. Characterization of human chorionic gonadotropin as a novel angiogenic factor. J Clin Endocrinol Metab 2002; 87: 5290-6.
  • Rodway MR, Rao CV. A novel perspective on the role of human chorionic gonadotropin during pregnancy and in gestational trophoblastic disease. Early Pregnancy 1995; 1: 176-87.
  • Fitzgerald B, Levytska K, Kingdom J, Walker M, Baczyk D, Keating S. Villous trophoblast abnormalities in extremely preterm deliveries with elevated second trimester maternal serum hCG or inhibin-A. Placenta 2011; 32: 339-45.
  • Hsu CD, Chan DW, Iriye B, Johnson TR, Hong SF, Repke JT. Elevated serum human chorionic gonadotropin as evidence of secretory response in severe preeclampsia. Am J Obstet Gynecol 1994; 170: 1135-8.
  • Canini S, Prefumo F, Pastorino D, Crocetti L, Afflitto CG, Venturini PL, De Biasio P. Association between birth weight and first-trimester free beta-human chorionic gonadotropin and pregnancy-associated plasma protein A. Fertil Steril 2008; 89: 174-8.
  • Morris RK, Cnossen JS, Langejans M, Robson SC, Kleijnen J, Ter Riet G, Mol BW, van der Post JA, Khan KS. Serum screening with Down's syndrome markers to predict pre-eclampsia and small for gestational age: systematic review and meta-analysis. BMC Pregnancy and Childbirth 2008; 8: 33.
  • Spencer K. Second-trimester prenatal screening for Down syndrome and the relationship of maternal serum biochemical markers to pregnancy complications with adverse outcome. Prenat Diagn 2000; 20: 652-6.
  • Sayin NC, Canda MT, Ahmet N, Arda S, Süt N, Varol FG. The association of triple-marker test results with adverse pregnancy outcomes in low-risk pregnancies with healthy newborns. Arch Gynecol Obstet 2008; 277: 47-53. Toal M, Chaddha V, Windrim R, Kingdom J. Ultrasound detection of placental insufficiency in women with elevated second trimester serum alpha-fetoprotein or human chorionic gonadotropin. J Obstet Gynaecol Can 2008; 30: 198-206.
  • Odibo AO, Sehdev HM, Stamilio DM, Macones GA. Evaluating the thresholds of abnormal second trimester multiple marker screening tests associated with intrauterine growth restriction. Am J Perinatol 2006; 23: 363-7.
  • Karsidag AY, Buyukbayrak EE, Kars B, Suyugul U, Unal O, Turan MC. The relationship between unexplained elevated serum markers in triple test, uterine artery Doppler measurements and adverse pregnancy outcome. J Pak Med Assoc 2010; 60: 181-6.
  • Gagnon A, Wilson RD, Audibert F, Allen VM, Blight C, Brock JA, Désilets VA, Johnson JA, Langlois S, Summers A, Wyatt P; Society of Obstetricians and Gynaecologists of Canada Genetics Committee. Obstetrical complications associated with abnormal maternal serum markers analytes. J Obstet Gynaecol Can 2008; 30: 918-49.
  • Luckas MJ, Sandland R, Hawe J, Neilson JP, McFadyen IR, Meekins JW. Fetal growth retardation and second trimester maternal serum human chorionic gonadotrophin levels. Placenta 1998; 19: 143-7.
  • Brosens I, Dixon HG, Robertson WB. Fetal growth retardation and the arteries of the placental bed. Br J Obstet Gynaecol 1977; 84: 656-63.
  • Romero R, Kusanovic JP, Kim CJ. Placental disorders in the genesis of the great obstetrical disorders. In: Pijnenborg R, Brosens I, Romero R, eds. Placental bed disorders. Cambridge University Press; 2010: 271-89.
  • Ganapathy R, Lamont RF, Bassett P. Unexplained elevated maternal serum betaHCG concentration and adverse pregnancy outcome. Prenat Diagn 2007; 27: 995
  • Tavor O, Shohat M, Lipitz S. The relationship between perinatal outcome of singleton pregnancies and isolated highly elevated levels of maternal serum human chorionic gonadotropin at mid-gestation. Isr Med Assoc J 2007; 9: 509
  • Caniggia I, Winter J, Lye SJ, Post M. Oxygen and placental development during the first trimester: implications for the pathophysiology of pre-eclampsia. Placenta 2000; 21 Suppl A: S25-30.

Original research-Orijinal araştırma

Yıl 2013, Cilt: 35 Sayı: 2, 215 - 220, 31.01.2013

Nilgün Güdücü , Gökçenur Gönenç , Herman İşçi Alin Başgül Yiğiter İlkkan Dünder

Öz

Amaç. Bu çalışmada amaç birinci ve ikinci trimester human chorionic gonadotropin (hCG) değerlerinin gebelik yaşına göre küçük bebekleri tahmin etmede faydalı olup olmadığını araştırmaktı. Yöntem. Hem birinci, hem de ikinci trimester Down sendromu tarama testi yaptırmış olan hastaların sonuçları retrospektif olarak tarandı ve hCG MoM değerleri tespit edildi. Hastalar gebelik yaşına göre küçük ve gebelik yaşına göre küçük (GYK) olan ve olmayan bebek doğuranlar olarak iki gruba ayrıldı. Yüksek hCG değerleri (≥2MoM) ile düşük hCG değerleri (<2MoM) karşılaştırıldı. Bulgular. GYK olan ve olmayan bebek doğuranların hCG değerleri arasında istatiksel olarak anlamlı bir fark görülmedi. Sensitivite ve spesifisite her iki grupta da aynı bulundu (sırasıyla 9.09 ve 89.95). Sonuç. Birinci ve ikinci trimester hCG değerlerinin GYK bebekleri tahmin etmede yeri yoktur.

Anahtar Kelimeler

Gebelik yaşına göre küçük hCG Down sendromu tarama testleri

Kaynakça

  • Kok JH, den Ouden AL, Verloove-Vanhorick SP, Brand R. Outcome of very preterm small for gestational age infants: the first nine years of life. BJOG 1998; 105: 162-8.
  • Lindqvist PG, Molin J. Does antenatal identification of small-for-gestational age fetuses significantly improve their outcome? Ultrasound Obstet Gynecol 2005; 25: 258-64.
  • Bogart MH, Pandian MR, Jones OW. Abnormal maternal serum chorionic gonadotropin levels in pregnancies with fetal chromosome abnormalities. Prenat Diagn 1987; 7: 623-30.
  • Smith GC, Stenhouse EJ, Crossley JA, Aitken DA, Cameron AD, Connor JM. Early pregnancy levels of pregnancy-associated plasma protein a and the risk of intrauterine growth restriction, premature birth, preeclampsia, and stillbirth. J Clin Endocrinol Metab 2002; 87: 1762-7.
  • Krantz D, Goetzl L, Simpson JL, Thom E, Zachary J, Hallahan TW, Silver R, Pergament E, Platt LD, Filkins K, Johnson A, Mahoney M, Hogge WA, Wilson RD, Mohide P, Hershey D, Wapner R; First Trimester Maternal Serum Biochemistry and Fetal Nuchal Translucency Screening (BUN) Study Group. Association of extreme first-trimester free human chorionic gonadotropin-beta, pregnancy-associated plasma protein A, and nuchal translucency with intrauterine growth restriction and other adverse pregnancy outcomes. Am J Obstet Gynecol 2004; 191: 1452-8.
  • Ong CY, Liao AW, Spencer K, Munim S, Nicolaides KH. First trimester maternal serum free beta human chorionic gonadotrophin and pregnancy associated plasma protein A as predictors of pregnancy complications. BJOG 2000; 107: 1265-70.
  • Tul N, Pusenjak S, Osredkar J, Spencer K, Novak-Antolic Z. Predicting complications of pregnancy with first-trimester maternal serum free-betahCG, PAPP-A and inhibin-A. Prenat Diagn 2003; 23: 990-6.
  • Morssink LP, Kornman LH, Hallahan TW, Kloosterman MD, Beekhuis JR, de Wolf BT, Mantingh A. Maternal serum levels of free beta-hCG and PAPP-A in the first trimester of pregnancy are not associated with subsequent fetal growth retardation or preterm delivery. Prenat Diagn 1998; 18: 147-52.
  • Kavak ZN, Basgul A, Elter K, Uygur M, Gokaslan H. The efficacy of firsttrimester PAPP-A and free beta hCG levels for predicting adverse pregnancy outcome. J Perinat Med 2006; 34: 145-8.
  • Spencer K, Cowans NJ, Avgidou K, Molina F, Nicolaides KH. First-trimester biochemical markers of aneuploidy and the prediction of small-for-gestational age fetuses. Ultrasound Obstet Gynecol 2008; 31: 15-9.
  • Goetzinger KR, Singla A, Gerkowicz S, Dicke JM, Gray DL, Odibo AO. The efficiency of first-trimester serum analytes and maternal characteristics in predicting fetal growth disorders. Am J Obstet Gynecol 2009; 201: 412.e1-6. Tao YX, Lei ZM, Hofmann GE, Rao CV. Human intermediate trophoblasts express chorionic gonadotropin/luteinizing hormone receptor gene. Biol Reprod 1995; 53: 899-904.
  • Lei ZM, Reshef E, Rao V. The expression of human chorionic gonadotropin/luteinizing hormone receptors in human endometrial and myometrial blood vessels. J Clin Endocrinol Metab 1992; 75: 651-9.
  • Zygmunt M, Herr F, Keller-Schoenwetter S, Kunzi-Rapp K, Münstedt K, Rao CV, Lang U, Preissner KT. Characterization of human chorionic gonadotropin as a novel angiogenic factor. J Clin Endocrinol Metab 2002; 87: 5290-6.
  • Rodway MR, Rao CV. A novel perspective on the role of human chorionic gonadotropin during pregnancy and in gestational trophoblastic disease. Early Pregnancy 1995; 1: 176-87.
  • Fitzgerald B, Levytska K, Kingdom J, Walker M, Baczyk D, Keating S. Villous trophoblast abnormalities in extremely preterm deliveries with elevated second trimester maternal serum hCG or inhibin-A. Placenta 2011; 32: 339-45.
  • Hsu CD, Chan DW, Iriye B, Johnson TR, Hong SF, Repke JT. Elevated serum human chorionic gonadotropin as evidence of secretory response in severe preeclampsia. Am J Obstet Gynecol 1994; 170: 1135-8.
  • Canini S, Prefumo F, Pastorino D, Crocetti L, Afflitto CG, Venturini PL, De Biasio P. Association between birth weight and first-trimester free beta-human chorionic gonadotropin and pregnancy-associated plasma protein A. Fertil Steril 2008; 89: 174-8.
  • Morris RK, Cnossen JS, Langejans M, Robson SC, Kleijnen J, Ter Riet G, Mol BW, van der Post JA, Khan KS. Serum screening with Down's syndrome markers to predict pre-eclampsia and small for gestational age: systematic review and meta-analysis. BMC Pregnancy and Childbirth 2008; 8: 33.
  • Spencer K. Second-trimester prenatal screening for Down syndrome and the relationship of maternal serum biochemical markers to pregnancy complications with adverse outcome. Prenat Diagn 2000; 20: 652-6.
  • Sayin NC, Canda MT, Ahmet N, Arda S, Süt N, Varol FG. The association of triple-marker test results with adverse pregnancy outcomes in low-risk pregnancies with healthy newborns. Arch Gynecol Obstet 2008; 277: 47-53. Toal M, Chaddha V, Windrim R, Kingdom J. Ultrasound detection of placental insufficiency in women with elevated second trimester serum alpha-fetoprotein or human chorionic gonadotropin. J Obstet Gynaecol Can 2008; 30: 198-206.
  • Odibo AO, Sehdev HM, Stamilio DM, Macones GA. Evaluating the thresholds of abnormal second trimester multiple marker screening tests associated with intrauterine growth restriction. Am J Perinatol 2006; 23: 363-7.
  • Karsidag AY, Buyukbayrak EE, Kars B, Suyugul U, Unal O, Turan MC. The relationship between unexplained elevated serum markers in triple test, uterine artery Doppler measurements and adverse pregnancy outcome. J Pak Med Assoc 2010; 60: 181-6.
  • Gagnon A, Wilson RD, Audibert F, Allen VM, Blight C, Brock JA, Désilets VA, Johnson JA, Langlois S, Summers A, Wyatt P; Society of Obstetricians and Gynaecologists of Canada Genetics Committee. Obstetrical complications associated with abnormal maternal serum markers analytes. J Obstet Gynaecol Can 2008; 30: 918-49.
  • Luckas MJ, Sandland R, Hawe J, Neilson JP, McFadyen IR, Meekins JW. Fetal growth retardation and second trimester maternal serum human chorionic gonadotrophin levels. Placenta 1998; 19: 143-7.
  • Brosens I, Dixon HG, Robertson WB. Fetal growth retardation and the arteries of the placental bed. Br J Obstet Gynaecol 1977; 84: 656-63.
  • Romero R, Kusanovic JP, Kim CJ. Placental disorders in the genesis of the great obstetrical disorders. In: Pijnenborg R, Brosens I, Romero R, eds. Placental bed disorders. Cambridge University Press; 2010: 271-89.
  • Ganapathy R, Lamont RF, Bassett P. Unexplained elevated maternal serum betaHCG concentration and adverse pregnancy outcome. Prenat Diagn 2007; 27: 995
  • Tavor O, Shohat M, Lipitz S. The relationship between perinatal outcome of singleton pregnancies and isolated highly elevated levels of maternal serum human chorionic gonadotropin at mid-gestation. Isr Med Assoc J 2007; 9: 509
  • Caniggia I, Winter J, Lye SJ, Post M. Oxygen and placental development during the first trimester: implications for the pathophysiology of pre-eclampsia. Placenta 2000; 21 Suppl A: S25-30.
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Bölüm Dahili Tıp Bilimleri Araştırma Yazıları
Yazarlar

Nilgün Güdücü

Gökçenur Gönenç

Herman İşçi

Alin Başgül Yiğiter

İlkkan Dünder

Yayımlanma Tarihi 31 Ocak 2013
Yayımlandığı Sayı Yıl 2013Cilt: 35 Sayı: 2

Kaynak Göster

AMA Güdücü N, Gönenç G, İşçi H, Başgül Yiğiter A, Dünder İ. First and second trimester hCG levels have no value in predicting small for gestational age infants. CMJ. Haziran 2013;35(2):215-220.