title: The association between unexplained second-trimester maternal serum hCG elevation and pregnancy complications.
abstract: OBJECTIVE
  We conducted this cohort analytic study to determine whether women with unexplained elevations of maternal serum hCG at 16-20 weeks' gestation are at increased risk for pregnancy complications and adverse perinatal outcomes.
  
  
  METHODS
  The inclusion criteria were a singleton gestation, a confirmed gestational age, and an hCG level greater than 2.5 multiples of the median (MOM). The exclusion criteria were fetal anomalies, an abnormal karyotype, and a maternal serum alpha-fetoprotein (MSAFP) level greater than 2.5 MOM. A group of randomly selected women with normal hCG and MSAFP levels served as controls.
  
  
  RESULTS
  Of the 6011 women screened, 284 (4.7%) had an unexplained elevated hCG level. Patients with elevated levels of hCG had a significantly higher risk for hypertension (odds ratio 4.4; 95% confidence interval [CI] 1.9-10) and fetal growth restriction (odds ratio 2.8; 95% CI 1-7). Women with hCG levels greater than 4 MOM also had an increased risk of preterm delivery (odds ratio 3.3; 95% CI 1.3-8.2).
  
  
  CONCLUSIONS
  Pregnancies with unexplained elevated hCG levels should be regarded as high-risk pregnancies and managed accordingly.
authors.affiliation: Department of Obstetrics and Gynecology, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Gonen
authors.forename: R
authors.initials: R
authors.lastname: Perez
authors.forename: M
authors.initials: M
authors.lastname: David
authors.forename: H
authors.initials: H
authors.lastname: Dar
authors.forename: R
authors.initials: R
authors.lastname: Merksamer
authors.forename: M
authors.initials: M
authors.lastname: Sharf
mesh_terms: D006063:Chorionic Gonadotropin / Q000097:blood*; D005260:Female; D006801:Humans; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood* / Q000453:epidemiology; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D012044:Regression Analysis; D012307:Risk Factors
chemical_list: D006063:Chorionic Gonadotropin