title: Circulating levels of inhibin A, activin A and follistatin in missed and recurrent miscarriages.
abstract: BACKGROUND
  The aim of this study was to investigate the changes in circulating levels and the clinical use of inhibin A, activin A and follistatin as endocrine markers of early pregnancy loss.
  
  
  METHODS
  Blood samples were collected from women presenting with a sporadic missed miscarriage (n = 10), and controls having pregnancy termination at 8-12 weeks (n = 15) and from women with a history of unexplained recurrent miscarriages (n = 12) at 6-12 weeks gestation. All samples were assayed for inhibin A, inhibin B, activin A, follistatin, hCG, estradiol and progesterone.
  
  
  RESULTS
  Serum inhibin A, hCG, estradiol and progesterone levels were significantly ( approximately 2-3 fold) decreased in sporadic miscarriages compared with controls. In the recurrent miscarriage group, time dependent changes in plasma inhibin A and hCG levels were significantly (P < 0.05) altered in the group that had a subsequent miscarriage compared with those who had a live birth. At 6-7 weeks gestation, plasma inhibin A ( approximately 4 fold, P < 0.01), hCG ( approximately 4 fold, P < 0.01) and estradiol ( approximately 2 fold, P < 0.001) levels were significantly lower in women who went on to have another miscarriage than those with a live birth. Inhibin B levels were near the detection limit of the assay.
  
  
  CONCLUSIONS
  Our findings suggest that inhibin A is a specific marker of early pregnancy loss before the onset of the clinical symptoms of recurrent miscarriage. There is a high degree of association between levels of inhibin A and hCG in cases of miscarriage, indicating that these two proteins could be used in combination to predict future pregnancy outcome.
authors.affiliation: Department of Obstetrics and Gynaecology, Royal Free-UCL Medical School, 86-96 Chenies Mews, London WC1E 6HX, UK. s.muttukrishna@ucl.ac.uk
authors.forename: S
authors.initials: S
authors.lastname: Muttukrishna
authors.forename: E
authors.initials: E
authors.lastname: Jauniaux
authors.forename: N
authors.initials: N
authors.lastname: Greenwold
authors.forename: H
authors.initials: H
authors.lastname: McGarrigle
authors.forename: S
authors.initials: S
authors.lastname: Jivraj
authors.forename: S
authors.initials: S
authors.lastname: Carter
authors.forename: S
authors.initials: S
authors.lastname: Elgaddal
authors.forename: N
authors.initials: N
authors.lastname: Groome
authors.forename: L
authors.initials: L
authors.lastname: Regan
mesh_terms: D000026:Abortion, Habitual / Q000097:blood*; D000030:Abortion, Missed / Q000097:blood*; D028341:Activins / Q000097:blood*; D000328:Adult; D015415:Biomarkers / Q000097:blood; D006063:Chorionic Gonadotropin / Q000097:blood; D004958:Estradiol / Q000097:blood; D005260:Female; D038681:Follistatin / Q000097:blood*; D005865:Gestational Age; D006801:Humans; D028322:Inhibin-beta Subunits / Q000097:blood*; D007265:Inhibins / Q000097:blood*; D008137:Longitudinal Studies; D011247:Pregnancy; D011374:Progesterone / Q000097:blood
chemical_list: D015415:Biomarkers; D006063:Chorionic Gonadotropin; D038681:Follistatin; C422405:activin A; C422362:inhibin A; D028341:Activins; D011374:Progesterone; D004958:Estradiol; D007265:Inhibins; D028322:Inhibin-beta Subunits