Elevated maternal serum hCG in the second trimester increases prematurity rate and need for neonatal intensive care in primiparous preeclamptic pregnancies

Objective. This study was designed to investigate the association between t he serum concentrations of maternal second trimester human chorionic gonado tropin (hCG) and the severity of preeclampsia. Methods. At Kuopio University Hospital. a total of 487 preeclamptic primipa ras had undergone maternal serum screening for Down's syndrome between Janu ary 1993 and December 1998. Of these, 37 women had unexplained elevated ser um hCG concentrations [>2.5 multiples of the median (MoM)], whereas the rem aining 450 preeclamptic women had normal hCG results. Pregnancy characteris tics and outcome measures in these groups were evaluated using logistic reg ression. Results. Elevated midtrimester hCG concentrations were associated with high er rates of low-birth-weight infants, preterm delivery, and need for neonat al intensive care. The adjusted odds ratios was 2.11 [95% confidence interv al (CI): 1.03-4.32], 2.08 (95% CI: 1.10-4.30), and 2.27 (95% CI: 1.14-4.51) , respectively. Conclusions. In primiparous preeclamptic pregnancies, an elevated maternal serum hCG concentration is a marker of early-onset and severe disease with significant maternal and perinatal morbidity. This finding, in turn, reinfo rces the association between elevated hCG concentrations and placental dama ge in early pregnancy. Elevated maternal serum hCG levels identify a subgro up of preeclamptic patients who deserve more intensive observation.