Department of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore, 100 Bukit Timah Road, Singapore, 229899, Singapore.
Duke-National University of Singapore Graduate Medical School, Singapore, Singapore.
BMC Pregnancy Childbirth. 2018 Sep 5;18(1):360. doi: 10.1186/s12884-018-2002-z.
Progesterone is a critical hormone in early pregnancy. A low level of serum progesterone is associated with threatened miscarriage. We aim to establish the distribution of maternal serum progesterone in normal pregnancies compared to pregnancies complicated by threatened miscarriage from 5 to 13 weeks gestation.
This is a single centre, prospective cohort study of 929 patients. Women from the Normal Pregnancy [NP] cohort were recruited from antenatal clinics, and those in the Threatened Miscarriage [TM] cohort were recruited from emergency walk-in clinics. Women with multiple gestations, missed, incomplete or inevitable miscarriage were excluded from the study. Quantile regression was used to characterize serum progesterone levels in the NP and TM cohorts by estimating the 10th, 50th and 90th percentiles from 5 to 13 weeks gestation. Pregnancy outcome was determined at 16 weeks of gestation. Subgroup analysis within the TM group compared progesterone levels of women who subsequently miscarried with those who had ongoing pregnancies at 16 weeks of gestation.
Median serum progesterone concentration demonstrated a linearly increasing trend from 57.5 nmol/L to 80.8 nmol/L from 5 to 13 weeks gestation in the NP cohort. In the TM cohort, median serum progesterone concentration increased from 41.7 nmol/L to 78.1 nmol/L. However, median progesterone levels were uniformly lower in the TM cohort by approximately 10 nmol/L at every gestation week. In the subgroup analysis, median serum progesterone concentration in women with ongoing pregnancy at 16 weeks gestation demonstrated a linearly increasing trend from 5 to 13 weeks gestation. There was a marginal and non-significant increase in serum progesterone from 19.0 to 30.3 nmol/L from 5 to 13 weeks gestation in women who eventually had a spontaneous miscarriage.
Serum progesterone concentration increased linearly with gestational age from 5 to 13 weeks in women with normal pregnancies. Women with spontaneous miscarriage showed a marginal and non-significant increase in serum progesterone. This study highlights the pivotal role of progesterone in supporting an early pregnancy, with lower serum progesterone associated with threatened miscarriage and a subsequent complete miscarriage at 16 weeks gestation.
孕激素是妊娠早期的关键激素。血清孕激素水平低与先兆流产有关。我们旨在确定 5 至 13 周妊娠正常妊娠与先兆流产妊娠的母体血清孕激素分布。
这是一项单中心前瞻性队列研究，共纳入 929 例患者。正常妊娠[NP]队列的女性从产前门诊招募，先兆流产[TM]队列的女性从急诊门诊招募。多胎妊娠、漏产、不完全流产或难免流产的患者被排除在研究之外。采用分位数回归法，通过估计 5 至 13 周妊娠时 NP 组和 TM 组的第 10、50 和 90 百分位数，来描述血清孕激素水平。妊娠结局在 16 周时确定。在 TM 组内进行亚组分析，比较 16 周时继续妊娠和流产的女性的孕激素水平。
NP 组血清孕激素浓度中位数从 5 周到 13 周呈线性增加趋势，从 57.5 nmol/L 增加到 80.8 nmol/L。TM 组血清孕激素浓度中位数从 41.7 nmol/L 增加到 78.1 nmol/L。然而，在每个妊娠周，TM 组的中位数孕激素水平都低约 10 nmol/L。在亚组分析中，16 周时继续妊娠的女性的血清孕激素浓度中位数从 5 周到 13 周呈线性增加趋势。16 周时自然流产的女性的血清孕激素从 5 周到 13 周有轻微且无统计学意义的增加，从 19.0 nmol/L 增加到 30.3 nmol/L。
正常妊娠妇女的血清孕激素浓度从 5 周到 13 周呈线性增加。自然流产的女性血清孕激素有轻微但无统计学意义的增加。本研究强调了孕激素在支持早期妊娠中的关键作用，血清孕激素水平较低与先兆流产有关，随后在 16 周时完全流产。
