Predictive value of hyperglycosylated human chorionic gonadotropin for pregnancy outcomes in threatened abortion in first-trimester viable pregnancies

Egileak

  • A. Salas Departamento de Obstetricia y Ginecología. Clínica Universidad de Navarra. Pamplona. España
  • B. Gastón Departamento de Obstetricia y Ginecología. Complejo Hospitalario de Navarra. Pamplona. España.
  • J. Barrenetxea Departamento de Obstetricia y Ginecología. Complejo Hospitalario de Navarra. Pamplona. España.
  • T. Sendino Laboratorio de Bioquímica. Clínica Universidad de Navarra. Pamplona. España.
  • M. Jurado Departamento de Obstetricia y Ginecología. Clínica Universidad de Navarra. Pamplona. España
  • J.L. Alcázar Departamento de Obstetricia y Ginecología. Clínica Universidad de Navarra. Pamplona. España

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https://doi.org/10.23938/ASSN.0933

Gako-hitzak:

hCG, Early pregnancy, First trimester bleeding, Threatened abortion, Miscarriage

Laburpena

Background. To investigate the value of a single determination of hyperglycosylated hCG (hCG-H) for predicting the clinical outcome of patients with threatened abortion in the first trimester of pregnancy.

Methods. Prospective study performed on 86 consecutively selected women with a diagnosis of threatened abortion and viable intrauterine pregnancy in the first trimester of pregnancy, conducted in two tertiary care hospitals. All patients underwent a single blood sample to determine hCG-H and total hCG serum levels and a transvaginal ultrasound 12-24 hours after diagnosis. Patients were monitored to determine whether the outcome was a miscarriage before the 20th week of pregnancy.

Results. Forty-three women (50%) had a miscarriage during the follow-up. We observed a very high correlation between hCG-H and total hCG (r = 0.91, p < 0.001). Median hCG-H and total hCG from pregnancies with normal outcome was significantly higher than those ending in abortion. hCG-H and total hCG were very similar predictors of pregnancy outcomes (AUC: 0.90 and 0.89, respectively). The ratio hCG-H / total hCG was a poor predictor (AUC: 0.64).

Conclusion. A single hCG-H assay is helpful for predicting pregnancy outcomes in women with first trimester threatened abortion and viable or potentially viable pregnancy at the time of presentation. However, hCG-H is not a better predictor than total hCG.

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Erreferentziak

REGAN L, RAI R. Epidemiology and the medical causes of miscarriage. Bailliere’s Best Pract Res Clin Obstet Gynaecol 2000; 14: 839-854. https://doi.org/10.1053/beog.2000.0123

Sociedad Española de Ginecología y Obstetricia. Aborto espontáneo. Madrid: SEGo, 2010. https://blog.utp.edu.co/maternoinfantil/files/2012/04/Aborto-espontaneo-1-trimestre.pdf

DOUBILET PM, BENSON CB, BOURNE T, BLAIVAS M. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med 2013; 369: 1443-1451. https://doi.org/10.1056/nejmra1302417

KRISHNAMOORTHY K, MOUHAYAR Y. Diagnosis and management of pregnancy loss. Handb Gynecol 2017; 1: 305-313. https://doi.org/10.1007/978-3-319-17798-4_31

NORWITZ ER, SCHUST DJ, FISHER SJ. Implantation and the survival of early pregnancy. N Engl J Med 2001; 345: 1400-1408. https://doi.org/10.1056/nejmra000763

PINAR MH, GIBBINS K, HE M, KOSTADINOV S, SILVER R. Early pregnancy losses: review of nomenclature, histopathology, and possible etiologies. Fetal Pediatr Pathol 2018; 37: 191-209. https://doi.org/10.1080/15513815.2018.1455775

HASAN R, BAIRD DD, HERRING AH, OLSHAN AF, JONSSON FUNK ML, HARTMANN KE. Patterns and predictors of vaginal bleeding in the first trimester of pregnancy. Ann Epidemiol 2010.; 20: 524-531. https://doi.org/10.1016/j.annepidem.2010.02.006

MOL F, ANKUM WM, HAJENIUS PJ, OPMEER BC, VAN MELLO NM, COOMARASAMY A et al. Diagnostic value of serum hCG on the outcome of pregnancy of unknown location: a systematic review and meta-analysis. Hum Reprod Update 2012; 18: 603-617. https://doi.org/10.1093/humupd/dms035

FARANESH R, BEN-DAVID Y. [Persistent low levels of human chorionic gonadotropin in the serum: investigation and management]. Harefuah 2009; 148: 101-103.

SUTTON-RILEY JM, KHANLIAN SA, BYRN FW, COLE LA. A single serum test for measuring early pregnancy outcome with high predictive value. Clin Biochem 2006; 39: 682-687. https://doi.org/10.1016/j.clinbiochem.2006.03.020

CHUNG K, ALLEN R. The Use of serial human chorionic gonadotropin levels to establish a viable or a nonviable pregnancy. Semin Reprod Med 2008; 26: 383-390. https://doi.org/10.1055/s-0028-1087104

COLE LA. Hyperglycosylated hCG and pregnancy failures. J Reprod Immunol 2012; 93: 119-122.

COLE LA. Hyperglycosylated hCG, a review. Placenta 2010; 31: 653-164. 14.

COLE LA, Khanlian SA. Hyperglycosylated hCG: A variant with separate biological functions to regular hCG. Mol Cell Endocrinol 2007; 260-262: 228-236. https://doi.org/10.1016/j.mce.2006.03.047

COLE LA. The O-linked oligosaccharide structures are striking different on pregnancy and choriocarcinoma HCG. J Clin Endocrinol Metab 1987; 65: 811-813. https://doi.org/10.1210/jcem-65-4-811

COLE LA, BUTLER SA. B152 anti-hyperglycosylated human chorionic gonadotropin free β-Subunit. A new, possible treatment for cancer. J Reprod Med 2015; 60: 13-20. J Reprod Med;60:13–20.

KOVALEVSKAYA G, KAKUMA T, SCHLATTERER J, O’CONNOR JF. Hyperglycosylated HCG expression in pregnancy: Cellular origin and clinical applications. Mol Cell Endocrinol 2007; 260-262: 237-243. https://doi.org/10.1016/j.mce.2006.02.021

KO G, GENBACE O, FISHER SJ, CACERES E. Trophoblast origin of hCG isoforms : cytotrophoblasts are the primary source of choriocarcinoma-like hCG. Mol Cell Endocrinol 2002; 194: 147-155. https://doi.org/10.1016/s0303-7207(02)00135-1

HANDSCHUH K, GUIBOURDENCHE J, TSATSARIS V, GUESNON M, LAURENDEAU I, EVAIN-BRION D et al. Human chorionic gonadotropin produced by the invasive trophoblast but not the villous trophoblast promotes cell invasion and is down-regulated by peroxisome proliferator-activated receptor-γ. Endocrinology 2007; 148: 5011-5019. . https://doi.org/10.1210/en.2007-0286

EVANS J. Hyperglycosylated hCG: a unique human implantation and invasion factor. Am J Reprod Immunol 2016; 75: 333-340. https://doi.org/10.1111/aji.12459

SZCZERBA A, BIAŁAS P, PIȨTA PP, JANKOWSKA A. hCG - related molecules and their measurement. Ginekol Pol 2016; 87: 65-70. . https://doi.org/10.17772/gp/60981

SASAKI Y, LADNER DG, COLE LA. Hyperglycosylated human chorionic gonadotropin and the source of pregnancy failures. Fertil Steril 2008; 89: 1781-1786. https://doi.org/10.1016/j.fertnstert.2007.03.010

BRADY PC, FARLAND L V., RACOWSKY C, GINSBURG ES. Hyperglycosylated human chorionic gonadotropin as a predictor of ongoing pregnancy. Am J Obstet Gynecol 2019;222: 68.e1-68.e12. https://doi.org/10.1016/j.ajog.2019.08.004

KOVALEVSKAYA G, BIRKEN S, KAKUMA T, O’CONNOR JF. Early pregnancy human chorionic gonadotropin (hCG) isoforms measured by an immunometric assay for choriocarcinoma-like hCG. J Endocrino 1999; 161: 99-106. https://doi.org/10.1677/joe.0.1610099

EVANS J, SALAMONSEN LA, MENKHORST E, DIMITRIADIS E. Dynamic changes in hyperglycosylated human chorionic gonadotrophin throughout the first trimester of pregnancy and its role in early placentation. Hum Reprod 2015; 30: 1029-1038. https://doi.org/10.1093/humrep/dev016

GUIBOURDENCHE J, HANDSCHUH K, TSATSARIS V, GERBAUD P, LEGUY MC, MULLER F et al. Hyperglycosylated hCG is a marker of early human trophoblast invasion. J Clin Endocrinol Metab 2010; 95: 240-244. ttps://doi.org/10.1210/jc.2010-0138

BERNDT S, BLACHER S, MUNAUT C, DETILLEUX J, D’HAUTERIVE SP, HUHTANIEMI I et al. Hyperglycosylated human chorionic gonadotropin stimulates angiogenesis through TGF-β receptor activation. FASEB J. 2013; 27: 1309-1321. https://doi.org/10.1096/fj.12-213686

KOVALEVSKAYA G, BIRKEN S, KAKUMA T, OZAKI N, SAUER M, LINDHEIM S et al. Differential expression of human chorionic gonadotropin (hCG) glycosylation isoforms in failing and continuing pregnancies: Preliminary characterization of the hyperglycosylated hCG epitope. J Endocrinol 2002; 172: 497-506. https://doi.org/10.1677/joe.0.1720497

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Argitaratuta

2021-04-28

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Salas, A., Gastón, B., Barrenetxea, J., Sendino, T., Jurado, M., & Alcázar, J. (2021). Predictive value of hyperglycosylated human chorionic gonadotropin for pregnancy outcomes in threatened abortion in first-trimester viable pregnancies. Anales Del Sistema Sanitario De Navarra, 44(1), 23–31. https://doi.org/10.23938/ASSN.0933

Zenbakia

bol: 44 zk: 1 (2021): enero - abril 2021

Atala

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