First-trimester hyperglycosylated human chorionic gonadotropin and development of hypertension

ABSTRACT Objective This study aimed to determine whether urine levels of hyperglycosylated human chorionic gonadotropin (HhCG) in the first trimester are predictive of subsequent development of hypertension during pregnancy Method This prospective cohort study consisted of women seeking care before 12 weeks gestation. A clean catch urine was obtained at the first prenatal visit and tested for HhCG and creatinine levels. The median HhCG levels and multiples of the median (MoM) by gestational age were compared between the groups that either developed hypertension or did not. Results Urine HhCG were determined for 204 women between 4 weeks 4 days to 11 weeks 6 days. The median HhCG of those who developed gestational hypertension (n = 7) or preeclampsia (n = 15) did not differ from the group that did not (median: 284 ng/mg creatinine vs 365 ng/mg; p = 0.55). If the MoM of HhCG for the no hypertension group was 1.00, the MoM of HhCG for the hypertension group was 0.93 (p = 0.93). A possible association was observed after 10 weeks between low HhCG levels and the development of late‐onset hypertension (≥34 weeks). Conclusions Prenatal screening for subsequent hypertension is unreliable with a single measurement of maternal urine HhCG at 10 weeks or less. © 2013 John Wiley & Sons, Ltd. What's already known about this topic? Hyperglycosylated hCG can be detected in maternal urine as early as 4 weeks gestational age. Levels of HhCG in the first trimester are critical to normal cytotrophoblast development, and inadequate levels early in gestation have been associated with subsequent pregnancy failure. Low urinary levels of HhCG in the early second trimester were reported to predict the subsequent development of preeclampsia in otherwise asymptomatic women. What does this study add? We observed that low levels of HhCG at 10 weeks or less did not predict subsequent late‐onset preeclampsia or gestational hypertension requiring intervention. Five of the 22 women who developed hypertension had lower levels of HhCG at 10–12 weeks, which may be critical as a window for early screening. Further studies should focus on evaluating serial samples during this critical period, which could also be incorporated with biomarker screens for Down syndrome.