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. 2017 Feb;32(2):135-144.
doi: 10.1007/s10654-016-0201-3. Epub 2016 Oct 5.

Human chorionic gonadotropin (hCG) concentrations during the late first trimester are associated with fetal growth in a fetal sex-specific manner

Mirjana Barjaktarovic  1   2   3 , Tim I M Korevaar  1   2   3 , Vincent W V Jaddoe  1   4   5 , Yolanda B de Rijke  6 , Theo J Visser  2   3 , Robin P Peeters  2   3 , Eric A P Steegers  7
Affiliations

Human chorionic gonadotropin (hCG) concentrations during the late first trimester are associated with fetal growth in a fetal sex-specific manner

Mirjana Barjaktarovic et al. Eur J Epidemiol. 2017 Feb.

Abstract

Human chorionic gonadotropin (hCG) is a pregnancy-specific hormone that regulates placental development. hCG concentrations vary widely throughout gestation and differ based on fetal sex. Abnormal hCG concentrations are associated with adverse pregnancy outcomes including fetal growth restriction. We studied the association of hCG concentrations with fetal growth and birth weight. In addition, we investigated effect modification by gestational age of hCG measurement and fetal sex. Total serum hCG (median 14.4 weeks, 95 % range 10.1-26.2), estimated fetal weight (measured by ultrasound during 18-25th weeks and >25th weeks) and birth weight were measured in 7987 mother-child pairs from the Generation R cohort and used to establish fetal growth. Small for gestational age (SGA) was defined as a standardized birth weight lower than the 10th percentile of the study population. There was a non-linear association of hCG with birth weight (P = 0.009). However, only low hCG concentrations measured during the late first trimester (11th and 12th week) were associated with birth weight and SGA. Low hCG concentrations measured in the late first trimester were also associated with decreased fetal growth (P = 0.0002). This was the case for both male and female fetuses. In contrast, high hCG concentrations during the late first trimester were associated with increased fetal growth amongst female, but not male fetuses. Low hCG in the late first trimester is associated with lower birth weight due to a decrease in fetal growth. Fetal sex differences exist in the association of hCG concentrations with fetal growth.

Keywords: Birth weight; Fetal growth; Fetal sex; Trophoblast; hCG.

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Conflict of interest statement

Conflict of interest

The authors have nothing to disclose.

Ethics approval

The general design, all research aims and the specific measurements in the Generation R study have been approved by the Medical Ethical Committee of the Erasmus Medical Center, Rotterdam. Written informed consent was obtained from all participants.

Figures

Fig. 1
Fig. 1
Flowchart showing selection procedure of study population
Fig. 2
Fig. 2
Plots show the linear regression models for total hCG (standardized according to gestational age at measurement; SD) and birth weight (standardized according to gestational age at birth; SD), as well as the logistic regression model for hCG and birth weight small for gestational age (defined as birth weight below 10th percentile for gestational age) as predicted mean with 95 percent confidence interval. Analyses were performed after exclusion of women with IVF treatment (N = 38), twin pregnancy (N = 90) and were adjusted for maternal age, smoking, BMI, parity, placental weight at birth, education level, ethnicity, gestational weight gain and fetal sex
Fig. 3
Fig. 3
Graph depicts the beta estimates from a repeated measurement model of the association of total hCG (standardized according to gestational age at measurement; SD) with fetal growth (standardized estimated fetal weight measured using ultrasound in mid pregnancy (18–25 weeks), late pregnancy (> 25 weeks) and birth weight). Analyses were performed after exclusion of women with IVF treatment (N = 38), twin pregnancy (N = 90) and were adjusted for maternal age, smoking, BMI, parity, education level, ethnicity, gestational weight gain, placental weight at birth and fetal sex
Fig. 4
Fig. 4
The association of maternal hCG in 11th or 12th week with fetal growth stratified by fetal sex
See this image and copyright information in PMC

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