Correlations between serum assays of human chorionic gonadotrophin (hCG) and human placental lactogen (hPL) and pre-eclampsia or intrauterine growth restriction (IUGR) among nulliparas younger than 38 years.
OBJECTIVE
To study the relation between serum human chorionic gonadotrophin (hCG) levels measured at 15-18 weeks and gestational disorders, assess their correlation with the artery uteroplacental Doppler (AUD) at 24 weeks among nulliparas, and assess the predictivity of the hCG/hPL (human placental lactogen) ratio for pre-eclampsia.


METHODS
Retrospective study of two groups of women younger than 38 years old: one with an elevated serum hCG level (2 MoM (multiples of the median) or more) and a normal fetal karyotype (group A), and the other with a lower hCG level (group B). Within each group, we studied the nulliparas separately (respectively groups AO and BO). We analyzed the double screening, elevated hCG levels with abnormal AUD, for the predicting of hypertensive disorders.


RESULTS
Elevated hCG levels were significantly (p<0.05) more prevalent among women who developed gestational diabetes (groups A and AO) and among nulliparas with pregnancy-induced hypertension and pre-eclampsia (AO). Among nulliparas, the combination of the hCG assay and a subsequent Doppler increased the positive predictive value (PPV) of the assay from 19 to 75%, without reducing its negative predictive value (NPV) for gestational vascular disorders. The hCG/hPL ratio did not improve the predictivity of the hCG assay alone for pre-eclampsia.


CONCLUSIONS
An hCG level of 2 MoM or more at 15-18 weeks identifies a group of women at risk of gestational vascular disorders; it therefore ought to lead to an AUD at 24 weeks. This double screening should be able to define a population of women at risk of developing a hypertensive disorder, who could thus benefit from a preventive treatment, as aspirin.
Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France. philippe.merviel@tnn.ap-hop-paris.fr
P
P
Merviel
F
F
Müller
J
J
Guibourdenche
N
N
Berkane
R
R
Gaudet
G
G
Bréart
S
S
Uzan
D000328:Adult; D001724:Birth Weight; D044383:Black People; D016022:Case-Control Studies; D006063:Chorionic Gonadotropin / Q000097:blood*; D016640:Diabetes, Gestational / Q000097:blood; D005260:Female; D005317:Fetal Growth Retardation / Q000097:blood* / Q000175:diagnosis; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008423:Maternal Age; D010298:Parity; D010928:Placental Lactogen / Q000097:blood*; D011225:Pre-Eclampsia / Q000097:blood* / Q000175:diagnosis; D011237:Predictive Value of Tests; D011247:Pregnancy; D012744:Sex Ratio; D018615:Ultrasonography, Doppler, Color; D016216:Ultrasonography, Prenatal; D044465:White People
D006063:Chorionic Gonadotropin; D010928:Placental Lactogen