Low hCG in early pregnancy associated with preeclampsia

Image: PD 

1. Human chorionic gonadotropin (hCG) levels in very early pregnancy were inversely associated with preeclampsia risk. 

2. The inverse association observed between hCG levels and preeclampsia incidence was isolated to term pregnancies and severe preeclampsia. 

Evidence Rating Level: 2 (Good) 

Study Rundown: This study found that hCG level in early pregnancy was inversely associated with risk of preeclampsia. Findings of previous investigations suggest that low hCG levels in the 1^st trimester and high levels in the 2^nd and 3^rd trimesters are associated with increased risk of preeclampsia. The present work is the first study to evaluate hCG levels during the initial phase of placental development, thereby allowing insight into how impaired placental development may be the pathogenesis of preeclampsia.

Findings are limited by inclusion of only women undergoing in vitro fertilization (IVF), as IVF is an independent risk factor for preeclampsia. Prospective cohort studies among women not undergoing assisted reproductive technologies treatments are merited to determine whether the observed relationship between hCG and preeclampsia applies more broadly.

Click to read the study in Human Reproduction

Relevant Reading: Preeclampsia: the role of angiogenic factors in its pathogenesis

In-Depth [prospective cohort]: This study evaluated the relationship between hCG levels on day 12 after embryo transfer and preeclampsia risk in 2405 women undergoing IVF in Norway. Preeclampsia was defined as blood pressure (BP) ≥ 140/90mm Hg and proteinuria with dipstick ≥ 1+ or ≥ 0.3g/24h, with severe defined as BP ≥ 160/110mm Hg and proteinuria with dipstick ≥2+; preterm delivery; or delivery of a small for gestational age (SGA) infant. Incidences of preeclampsia, preterm delivery, gestational hypertension and SGA status were assessed.

Serum hCG was inversely associated with preeclampsia (p=0.02) and severe preeclampsia (p=0.01) in a dose dependent manner. Women with hCG <50 IU/L were more likely to develop preeclampsia (OR 2.3, CI 1.2-4.7) and severe preeclampsia (OR 4.2, CI 1.4-12.2) respectively, when compared to women with hCG ≥ 150 IU/L. Women with hCG <50 IU/L were also more likely to experience term preeclampsia (OR 1.9, CI 0.8-4.5).

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