title: Reduced levels of plasma kisspeptin during the antenatal booking visit are associated with increased risk of miscarriage.
abstract: BACKGROUND
  Kisspeptin is a recently identified hormone encoded by the KISS1 gene, playing a critical role in human reproduction. Plasma kisspeptin levels rise dramatically during normal pregnancy due to placental synthesis, which implicates it as a potential tool for assessing risks of pregnancy complications. No previous prospective study has investigated the association between plasma kisspeptin and risk of miscarriage.
  
  
  OBJECTIVE
  The objective of the study was to determine whether a single plasma kisspeptin or serum human chorionic gonadotropin (hCG) measurement in asymptomatic women attending their booking antenatal visit is associated with miscarriage.
  
  
  METHODS
  This was a prospective cohort study.
  
  
  METHODS
  The study was conducted at a tertiary obstetric center.
  
  
  METHODS
  A total of 993 asymptomatic pregnant women with a gestation of 6 weeks or longer attending routine antenatal booking visit were recruited between January 2010 and December 2012.
  
  
  METHODS
  Plasma kisspeptin and serum hCG were measured during the antenatal booking visit. Pregnancy outcome was recorded prospectively.
  
  
  RESULTS
  Plasma kisspeptin correlated with gestation (r(2) = 0.57; P < .0001). Gestational age-corrected (multiples of median) plasma kisspeptin was 60.4% lower (P < .001), and multiples of median-hCG was 36.1% lower (P < .001) in women later diagnosed with miscarriage compared with women without miscarriage. Increased plasma kisspeptin was associated with reduced miscarriage risk, even after adjusting for age, body mass index, gestational age, smoking, and blood pressure [odds ratio 0.13 (95% confidence interval 0.08-0.22), P = .0001]. Kisspeptin had a higher diagnostic performance for miscarriage than hCG (receiver-operator characteristic-area under the curve 0.899 ± 0.025 plasma kisspeptin; 0.775 ± 0.040, serum hCG, P < .01 vs plasma kisspeptin).
  
  
  CONCLUSIONS
  Our data suggest for the first time that a single plasma kisspeptin measurement taken during the antenatal booking visit provides a potential novel marker for identifying asymptomatic pregnant women at a gestation of 6 weeks or greater at increased risk of miscarriage.
authors.affiliation: Section of Investigative Medicine (C.N.J., A.A., A.I.-E., A.N.C., Z.S., Z.G.-D., M.A.G., S.R.B., W.S.D.) and Imperial Clinical Trials Unit (H.G.M.), Imperial College London, London W12 ONN, United Kingdom; Medical Oncology Laboratory (R.A.H., A.I.P.), Charing Cross Hospital Campus, Imperial College National Health Service Healthcare Trust, London W6 8RF, United Kingdom; Department of Obstetrics and Gynaecology (M.D.), Queen Charlotte's Hospital, Imperial College National Health Service Healthcare Trust, London W12 0HS, United Kingdom; Department Obstetrics and Gynaecology (C.W.), King's College London, London SE5 9PJ, United Kingdom; and Department of Obstetrics and Gynaecology (L.R.), St Mary's Hospital, Imperial College National Health Service Healthcare Trust, London W2 1NY, United Kingdom.
authors.forename: C N
authors.initials: CN
authors.lastname: Jayasena
authors.forename: A
authors.initials: A
authors.lastname: Abbara
authors.forename: C
authors.initials: C
authors.lastname: Izzi-Engbeaya
authors.forename: A N
authors.initials: AN
authors.lastname: Comninos
authors.forename: R A
authors.initials: RA
authors.lastname: Harvey
authors.forename: J
authors.initials: J
authors.lastname: Gonzalez Maffe
authors.forename: Z
authors.initials: Z
authors.lastname: Sarang
authors.forename: Z
authors.initials: Z
authors.lastname: Ganiyu-Dada
authors.forename: A I
authors.initials: AI
authors.lastname: Padilha
authors.forename: M
authors.initials: M
authors.lastname: Dhanjal
authors.forename: C
authors.initials: C
authors.lastname: Williamson
authors.forename: L
authors.initials: L
authors.lastname: Regan
authors.forename: M A
authors.initials: MA
authors.lastname: Ghatei
authors.forename: S R
authors.initials: SR
authors.lastname: Bloom
authors.forename: W S
authors.initials: WS
authors.lastname: Dhillo
mesh_terms: D000022:Abortion, Spontaneous / Q000097:blood* / Q000453:epidemiology; D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D059648:Kisspeptins / Q000097:blood*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011295:Prenatal Care; D011446:Prospective Studies; D012306:Risk
chemical_list: D006063:Chorionic Gonadotropin; D059648:Kisspeptins