Lieppman R E, Williams M A, Cheng E Y, Resta R, Zingheim R, Hickok D E, Luthy D A
Center for Perinatal Studies Swedish Medical Center.
Am J Obstet Gynecol. 1993 Jun;168(6 Pt 1):1852-6; discussion 1856-7. doi: 10.1016/0002-9378(93)90701-j.
Unexplained elevations in maternal serum alpha-fetoprotein in the midtrimester are associated with adverse pregnancy outcome. Recently it has also been suggested that elevations of maternal serum human chorionic gonadotropin in the second trimester may be associated with adverse pregnancy outcome.
We conducted a cohort study of 460 women at Swedish Medical Center, Seattle, Washington, between Jan. 1, 1990, and Aug. 15, 1991, inclusive. Entry criteria for the cohort included (1) triple screen analysis (maternal serum alpha-fetoprotein, human chorionic gonadotropin, unconjugated estriol) between 15 and 18 weeks' gestation, (2) a risk for Down syndrome of more than one in 195 on the basis of triple screen analysis, (3) study group human chorionic gonadotropin > or = 2 multiples of the median and referent group < or = 2 multiples of the median, alpha-fetoprotein < or = 2 multiples of the median, unconjugated estriol > or = 0.5 multiples of the median, and (4) chromosomally normal single gestation without anomalies. Cumulative incidence risk ratios were estimated for each pregnancy outcome as a measure of the relative association with elevated human chorionic gonadotropin (> or = 2.0 multiples of the median) and adverse pregnancy outcome: low birth weight, < or = 2500 gm; preterm delivery, < 37 weeks' gestation; and small for gestational age, < or = 10th percentile. The Mantel extension test was used to evaluate any apparent linear trend in risk between level of human chorionic gonadotropin and adverse pregnancy outcome.
Elevated human chorionic gonadotropin levels were associated with an increased risk for low birth weight (relative risk = 4.0), preterm delivery (relative risk = 2.8), and small for gestational age (relative risk = 1.8). The risk for each adverse outcome increased with increasing levels of human chorionic gonadotropin.
Elevations of human chorionic gonadotropin in the midtrimester appear to be associated with adverse pregnancy outcome. The magnitude of the risk correlates with the level of human chorionic gonadotropin. This risk appears to be independent of the risk for adverse pregnancy outcome associated with unexplained elevations of maternal serum alpha-fetoprotein.
孕中期母体血清甲胎蛋白不明原因升高与不良妊娠结局相关。最近也有人提出，孕中期母体血清人绒毛膜促性腺激素升高可能与不良妊娠结局有关。
我们对华盛顿州西雅图市瑞典医疗中心的460名女性进行了一项队列研究，时间从1990年1月1日至1991年8月15日（含）。该队列的纳入标准包括：（1）妊娠15至18周期间进行三联筛查分析（母体血清甲胎蛋白、人绒毛膜促性腺激素、未结合雌三醇）；（2）基于三联筛查分析，唐氏综合征风险高于1/195；（3）研究组人绒毛膜促性腺激素≥中位数的2倍，参照组≤中位数的2倍，甲胎蛋白≤中位数的2倍，未结合雌三醇≥中位数的0.5倍；（4）染色体正常的单胎妊娠且无异常。估计每种妊娠结局的累积发病风险比，作为人绒毛膜促性腺激素升高（≥中位数的2.0倍）与不良妊娠结局相对关联的一种衡量指标：低出生体重，≤2500克；早产，妊娠<37周；小于胎龄儿，≤第10百分位数。使用Mantel扩展检验来评估人绒毛膜促性腺激素水平与不良妊娠结局之间风险的任何明显线性趋势。
人绒毛膜促性腺激素水平升高与低出生体重风险增加（相对风险=4.0）、早产风险增加（相对风险=2.8）和小于胎龄儿风险增加（相对风险=1.8）相关。每种不良结局的风险随人绒毛膜促性腺激素水平升高而增加。
孕中期人绒毛膜促性腺激素升高似乎与不良妊娠结局相关。风险程度与人绒毛膜促性腺激素水平相关。这种风险似乎独立于与母体血清甲胎蛋白不明原因升高相关的不良妊娠结局风险。
