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International Journal of Endocrinology and Metabolism

Research Institute for Endocrine Sciences

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https://doi.org/10.5812/ijem.5014

Mid-Trimester Maternal Serum hCG and Alpha Fetal Protein Levels: Clinical Significance and Prediction of Adverse Pregnancy Outcome

Author(s):
Georgios AndroutsopoulosGeorgios Androutsopoulos1,*, Panagiotis GkogkosPanagiotis Gkogkos1, Georgios DecavalasGeorgios Decavalas1
1Department of Obstetrics and Gynaecology, University of Patras, Medical School, Rion, Greece
International Journal of Endocrinology and Metabolism:Vol. 11, issue 2; 102-6
Published online:Mar 31, 2013
Article type:Review Article
Received:Apr 02, 2012
Accepted:Oct 07, 2012
How to Cite:Androutsopoulos G, Gkogkos P, Decavalas G. Mid-Trimester Maternal Serum hCG and Alpha Fetal Protein Levels: Clinical Significance and Prediction of Adverse Pregnancy Outcome. Int J Endocrinol Metab. 2013;11(2):. doi: https://doi.org/10.5812/ijem.5014

Abstract

Context:

Maternal serum human Chorionic Gonadotropin (hCG) and Alpha Fetal Protein (AFP) were originally introduced to detect trisomy 21 and neural tube defects. However, in the absence of aneuploidy or neural tube defects, mid-trimester maternal serum hCG and/or maternal serum AFP associated with adverse pregnancy outcomes. Pregnancies with unexplained mid-trimester elevation in maternal serum hCG and/or maternal serum AFP, are at increased risk for pregnancy complications resulting from placental insufficiency.

Evidence Acquisition:

Mid-trimester maternal serum hCG>2.5 MoM associated with an increased risk for pregnancy complications including: late fetal loss, gestational hypertension, preeclampsia, intrauterine growth restriction (IUGR), preterm delivery and intrauterine fetal death(IUFD). Mid-trimester maternal serum AFP levels >2.5 MoM are thought to reflect a defect in placentation and associated with an increased risk for pregnancy complications including: late fetal loss, gestational hypertension, preeclampsia, IUGR, preterm delivery and IUFD.

Results:

Combined mid-trimester elevation in maternal serum hCG and AFP levels suggest a more complex type of placental pathology. They have stronger association with pregnancy complications including: late fetal loss, gestational hypertension, preeclampsia, IUGR, preterm delivery and IUFD.

Conclusions:

Mid-trimester maternal serum hCG or AFP levels alone cannot detect all pregnant women with increased risk to develop pregnancy complications. Multiparameter testing of placental function in mid-trimester (maternal serum hCG and AFP screening, uterine artery Doppler and placental morphology) may allow us to identify women with increased risk to develop severe placental insufficiency and pregnancy complications. However, future prospective studies are needed to confirm the prognostic significance of multiparameter testing of placental function in mid-trimester.

Keywords
Maternal Serum Screening Tests
Chorionic Gonadotropin
AFP
Adverse Pregnancy Outcome

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