Concentrations of human chorionic gonadotrophin in very early pregnancy and subsequent pre-eclampsia: a cohort study
Concentrations of human chorionic gonadotrophin in very early pregnancy and subsequent pre-eclampsia: a cohort study
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DOI：
10.1093/humrep/deu068
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发表时间：
2014-06-01
影响因子：
6.1
通讯作者：
Eskild, A.
中科院分区：
文献类型：
--
作者：
Asvold, B. O.;Vatten, L. J.;Eskild, A.
极早期妊娠血清人绒毛膜促性腺激素（hCG）浓度低与先兆子痫风险相关吗？早孕期低hCG浓度与重度先兆子痫风险增加相关，妊娠早期低hCG母体血清浓度可能表明滋养层细胞增殖或侵袭受损，因此低hCG浓度可能作为胎盘发育受损的标志。胎盘发育受损被认为是先兆子痫的原因，我们对1996-2010年在奥斯陆大学医院进行的IVF后妊娠进行了一项前瞻性队列研究，并与挪威医学出生登记处联系，以获得关于IVF前我们纳入了2405例连续的单胎妊娠，并研究了母体血清hCG浓度与妊娠结局的关系。在胚胎移植后第12天，HCG浓度与任何先兆子痫以及轻度和重度先兆子痫的风险呈负相关（使用Elecsys，Roche测量）XCG浓度以剂量依赖性方式与先兆子痫风险呈负相关（P趋势0.02）。与hCG <50 IU/l的妇女相比，hCG <150 IU/l的妇女发生先兆子痫的总风险高2倍[绝对风险6.4 vs 2.8%;比值比（OR）2.3，95%置信区间（CI）1.2-4.7]。这种负相关仅限于重度先兆子痫（P趋势0.01），因此，hCG < 50 IU/l的女性患重度先兆子痫的风险是hCG <150 IU/l的女性的4倍（绝对风险3.6 vs 0.9%; OR 4.2，95% CI 1.4-12.2）。对于轻度先兆子痫，没有相应的关联（P趋势0.36）。IVF妊娠的结果可能无法推广到自然受孕的妊娠。妊娠早期母体hCG浓度低的合理原因包括胎盘发育受损和着床延迟。因此，这些结果提供了前瞻性的证据，以支持这一假设，受损的胎盘发育可能与随后的严重先兆子痫的发展。
Are low serum concentrations of human chorionic gonadotrophin (hCG) in very early pregnancy associated with pre-eclampsia risk?Low hCG concentrations in very early pregnancy are associated with increased risk of severe pre-eclampsia.Low maternal serum concentrations of hCG early in pregnancy may indicate impaired proliferation or invasion of trophoblast cells, and thus low hCG concentrations may serve as a marker for impaired placental development. Impaired placental development is assumed to be a cause of pre-eclampsia, but there is little prospective evidence to support this hypothesis.We performed a prospective cohort study of pregnancies after IVF at Oslo University Hospital 1996-2010 with linkage to the Medical Birth Registry of Norway to obtain information on pre-eclampsia development.We included 2405 consecutive singleton pregnancies and examined the association of maternal serum hCG concentrations (measured using Elecsys, Roche) on Day 12 after embryo transfer with the risk of any pre-eclampsia and of mild and severe pre-eclampsia.HCG concentrations were inversely associated with pre-eclampsia risk in a dose-dependent manner (P-trend 0.02). Compared with women with hCG a parts per thousand yen150 IU/l, women with hCG < 50 IU/l were at 2-fold higher overall risk of pre-eclampsia [absolute risk 6.4 versus 2.8%; odds ratio (OR) 2.3, 95% confidence interval (CI) 1.2-4.7]. The inverse association was restricted to severe pre-eclampsia (P-trend 0.01), thus, women with hCG < 50 IU/l were at 4-fold higher risk of severe pre-eclampsia than women with hCG a parts per thousand yen150 IU/l (absolute risk 3.6 versus 0.9%; OR 4.2, 95% CI 1.4-12.2). For mild pre-eclampsia, there was no corresponding association (P-trend 0.36).Results for IVF pregnancies may not be generalizable to spontaneously conceived pregnancies.Plausible causes of low maternal hCG concentrations very early in pregnancy include impaired placental development and delayed implantation. Thus, these results provide prospective evidence to support the hypothesis that impaired placental development may be associated with subsequent development of severe pre-eclampsia.