Prospective evaluation of maternal serum human chorionic gonadotropin levels in 3428 pregnancies

Article Abstract:

Pregnant women who are 35 years old or older are normally screened for fetal Down syndrome and other aneuploidy (chromosomal abnormalities). More recently, maternal blood levels of alpha-fetoprotein (AFP) have been considered, as well as age, as a risk factor for chromosomal disorders; however, these factors yield a detection rate of under 40 percent. Other studies have found an association between high levels of human chorionic gonadotropin (hCG), a hormone made by the implanted embryo and detected by pregnancy tests, and Down syndrome. Because this association has not been rigorously studied, data on these and other factors were collected from 3,428 pregnancies that were being screened for other defects. Of these, 255 pregnancies did not have normal outcomes, ranging from fetal death or distress to prematurity, twins, aneuploidy, and other abnormal outcomes. Of these 255 cases, 58 women did not have elevated hCG levels and 26 women did not have elevated AFP levels. Elevations in hCG levels, determined as multiples of the average level, when adjusted for weight, were higher in blacks and Orientals than in whites. Weight-adjusted average hCG levels for twin pregnancies with normal outcomes were also higher. Six of 11 pregnancies with aneuploidy had higher hCG levels, including four of six with Down syndrome. Of white women with normal outcomes, 10 percent had hCG levels more than double the average. Levels of hCG did not correlate with maternal age. The study indicates that adjustment of hCG levels for race and weight is important before they can be used to assess risk of Down syndrome. Further study to establish baseline levels is needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Risk factors, Fetus, Alpha fetoproteins, Human chromosome abnormalities

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The influence of maternal weight on human chorionic gonadotropin in the multiple-marker screening test for fetal Down syndrome

Article Abstract:

Blood levels of human chorionic gonadotropin (hCG) in pregnant women may vary according to women's weight and volume of distribution. An abnormally high level of hCG may indicate a fetus with Down syndrome. Researchers reviewed two genetics databases for cases of women with high hCG levels. Women who weighed over 180 pounds and who were 30 years or older were more likely to have falsely low screen positive rates for hCG levels as compared to women of the same age range weighing less than 180. A weight correction formula effectively distributed the positive screening findings more evenly by age and weight group. The weight correction formula did not change the detection rate of Down syndrome but may prevent underestimation of Down syndrome risk in older pregnant women.

Body weight

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Free alpha-subunit of human chorionic gonadotropin in Down syndrome

Article Abstract:

Measuring the concentration of free alpha-subunit of human chorionic gonadotropin (hCG) in the mother's blood does not appear to be useful in the prenatal diagnosis of Down syndrome. Free beta-subunit hCG concentrations are significantly elevated in Down syndrome pregnancies but findings on free alpha-hCG are inconclusive. Levels of free alpha-hCG were measured in 36 pregnant women whose fetuses were previously diagnosed with Down syndrome and in 180 women with normal pregnancies. Maternal concentrations of free alpha-hCG measured in the second trimester did not vary significantly with gestational age. However, free alpha-hCG concentrations were only slightly higher among women with Down syndrome pregnancies than among women with normal pregnancies.

Methods, Prenatal diagnosis

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