Cigarette smoking in pregnancy results in marked decrease in maternal hCG and oestradiol levels

We have examined serum levels of oestradiol (E2), sex-hormone binding globulin (SHBG) and human chorionic gonadotrophin (hCG) during early pregnancy in relation to smoking status at the time of sampling in a series of 147 women. Smoking was associated with significantly depressed serum levels of E2, SHBG and hCG: in smokers, E2 levels were on average 17.6% lower (P = 0.037), SHBG levels were 12.4% lower (P = 0.15), and hCG levels were 21.5% lower (P = 0.044). There appeared to be a steady decline in these values with increasing cigarette consumption. These lower hormone levels in smokers may explain certain adverse effects of smoking in pregnancy.     

The influence of smoking on maternal serum PAPP-A and free beta hCG levels in the first trimester of pregnancy

In an analysis of 3111 singleton pregnancies routinely screened in the first trimester with nuchal translucency, free beta hCG and pregnancy associated plasma protein A (PAPP-A) smoking has been found to occur in 20.8 per cent of pregnant women. When the individual marker levels were assessed in smokers and non-smokers, levels of PAPP-A were reduced in smokers by some 15 per cent. Despite free beta hCG levels being reduced by 10-14 per cent in the second trimester of smoking women, in the first trimester period this is not evident. Simulation studies would suggest that in smokers the detection of trisomy 21 using free beta hCG, PAPP-A and maternal age will be reduced by some 5 to 6 per cent compared with that of the general population.     

Influences of maternal smoking and fetal sex on maternal serum oestriol,prolactin, hCG,and hPl levels

Summary A total of 222 pregnant women had repeated hormone assays between 20 weeks and delivery; 86 of the women were smokers. The maternal hormone balance appeared to be affected by smoking. Smoking affected maternal serum levels of hPL and hCG in pregnancies with a female fetus whereas maternal serum concentrations of oestriol and prolactin were affected in pregnancies with a male fetus. Significantly higher hCG levels were found in mothers who smoked and had a girl than in those who smoked and had a boy. On the basis of our results we feel that smoking mainly affects the placenta.     

Fluctuations of maternal smoking during pregnancy

To examine fluctuations in women's cigarette smoking during pregnancy and implications for the design of clinical interventions for pregnant smokers and research on the effects of fetal exposure to cigarettes.We examined changes in absolute smoking status in 1426 women who reportedly smoked during their last pregnancy in the National Health Interview Survey 1991 Pregnancy and Smoking Supplement and fluctuations in amount smoked in 60 pregnant smokers in the Family Health and Development Project.In the National Health Interview Survey 1991 Pregnancy and Smoking Supplement, a substantial proportion of women exhibited a pattern of repeated cessation and relapse. In multivariable logistic regression models, having more than a high school education was significantly associated with being an intermittent versus a continuous smoker (odds ratio = 1.55, P <.01) and with successful quitting versus continuously smoking or relapsing (odds ratio = 1.74, P <.01). Fluctuations in smoking intensity in the Family Health and Development Project were also substantial and, although 48% quit or reduced their smoking upon learning of their pregnancy, over half changed smoking intensity multiple times.We conclude that smoking during pregnancy is a complex and variable behavior for many women. Simple measures of smoking may lead to under-estimation of the impact of smoking on the fetus, and brief smoking cessation interventions early in pregnancy are likely to be inadequate for many smokers during pregnancy.     

Cigarette smoking and pregnancy II: vascular effects.

The act of smoking introduces a complex set of chemicals that have a broad range of effects, both complementary and antagonistic, at various levels within the vascular tree. A general review of these systemic effects is followed by a summary of documented effects of smoking on the uterine vasculature and of relationships of smoking to pregnancy outcomes known to be associated with vascular pathology. Last, we offer a potential resolution for the apparent paradox of the seemingly 'protective' effect of smoking to reduce the incidence of pre-eclampsia, one of the most serious vascular complications of pregnancy.     

The effect of smoking during pregnancy on cord blood and maternal serum immunoglobulin levels

The effect of smoking on the fetal and maternal humoral immune parameters was evaluated in cord and maternal blood, collected at delivery from 163 mothers who smoked and 130 mothers who did not smoke, and their offspring. There was no difference in time of gestation between the two groups, but the mean birth weight of the offspring of mothers who smoked was decreased, as previously observed. There were higher levels of IgA (p less than 0.01), IgM (p less than 0.001), and IgG (p less than 0.001) in cord sera of children of mothers who smoked than in the offspring of mothers who did not smoke. Mothers themselves who smoked had higher levels of IgM (p less than 0.001) and IgG (p less than 0.001), but not IgA, as compared to control mothers who did not smoke. Since cord IgA and IgM are produced by the fetus, these results could be interpreted as being due to either a higher incidence of infection in utero or metabolic differences in the children of mothers who smoke. Either of these possibilities may explain the increased frequency of postpartum endometritis, increased incidence of fetal distress, and the characteristic of meconium-stained amniotic fluid in mothers who smoke.     

Cigarette smoking during pregnancy in relation to placenta previa.

To evaluate the relationship between cigarette smoking and the occurrence of placenta previa, we used interview and medical record data to conduct a case-control analysis of 69 placenta previa cases and 12,351 controls. The unadjusted relative risk estimate of placenta previa for women reported to have "ever smoked" during pregnancy relative to nonsmoking mothers was 1.9 (95% confidence interval, 1.2 to 3.0). The risk rose after adjusting for potential confounders (odds ratio, 2.6; 95% confidence interval, 1.3 to 5.5). In contrast to a previous report, the duration of smoking was not an independent risk factor for placenta previa. These results suggest that cigarette smoking during pregnancy is a determinant of placenta previa. Carbon monoxide hypoxemia, which is one possible mechanism for this association, may result in compensatory placental hypertrophy. Placentas with increased surface areas are more likely to cover the cervical os, causing placenta previa.     

Serum hCG levels measured by time-resolved fluoroimmunoassay in first-trimester pregnancy and after pregnancy termination

Time-resolved fluoroimmunoassay (TR-FIA) reliably shows the concentrations of serum hCG during the first trimester of normal pregnancy. After first-trimester induced abortion the mean disappearance of hCG in serum (under 10 IU/l) takes place in three weeks. TR-FIA is a convenient and ultrarapid method for diagnosing pregnancy-related disorders.     

Serum chorionic gonadotrophin (hCG), schwangerschaftsprotein 1(SP1), progesterone and oestradiol levels in patients with nausea and vomiting in early pregnancy

Summary. Serum concentrations of human chorioni gonadotrophin (hCG). schwangerschaftsprotein l(SPl), progesterone and oestradiol were measured in 116 pregnant women experiencing varying degrees of nausea and vomiting or no nausea at all at between 9 and 16 weeks gestation. The patients were categorized into four groups, namely asymptomatic, nausea alone, nausea and vomiting and hyperemesis gravidarum. The distribution of levels for each group were examined in relation to the calculated normal ranges. Statistically higher hCG levels were found in out-patients with nausea alone or nausea and vomiting than in the asymptomatic women. No significant differences were found between the groups for any of the other measured variables, including the progesterone/oestradiol concentration ratio.     

Serum chorionic gonadotrophin (hCG), schwangerschaftsprotein 1 (SP1), progesterone and oestradiol levels in patients with nausea and vomiting in early pregnancy

Serum concentrations of human chorionic gonadotrophin (hCG), schwangerschaftsprotein 1(SP1), progesterone and oestradiol were measured in 116 pregnant women experiencing varying degrees of nausea and vomiting or no nausea at all at between 9 and 16 weeks gestation. The patients were categorized into four groups, namely asymptomatic, nausea alone, nausea and vomiting and hyperemesis gravidarum. The distribution of levels for each group were examined in relation to the calculated normal ranges. Statistically higher hCG levels were found in out-patients with nausea alone or nausea and vomiting than in the asymptomatic women. No significant differences were found between the groups for any of the other measured variables, including the progesterone/oestradiol concentration ratio.     

提高妊娠合并心脏病的诊疗水平降低孕产妇病死率

妊娠合并心脏病涉及到妇产科及交叉学科,渗透着多学科知识。因此,妇产科医师除必须精通或熟悉本专业外,还应了解内、外、儿等学科的知识。长期以来妊娠中出现心脏方面的疾病,一直是妇产科和内科医师感到棘手的问题。尤其近20年来,随着心脏外科手术的大量开展,先天性心脏病(先心     

The association between unexplained second-trimester maternal serum hCG elevation and pregnancy complications.

OBJECTIVE: We conducted this cohort analytic study to determine whether women with unexplained elevations of maternal serum hCG at 16-20 weeks' gestation are at increased risk for pregnancy complications and adverse perinatal outcomes. METHODS: The inclusion criteria were a singleton gestation, a confirmed gestational age, and an hCG level greater than 2.5 multiples of the median (MOM). The exclusion criteria were fetal anomalies, an abnormal karyotype, and a maternal serum alpha-fetoprotein (MSAFP) level greater than 2.5 MOM. A group of randomly selected women with normal hCG and MSAFP levels served as controls. RESULTS: Of the 6011 women screened, 284 (4.7%) had an unexplained elevated hCG level. Patients with elevated levels of hCG had a significantly higher risk for hypertension (odds ratio 4.4; 95% confidence interval [CI] 1.9-10) and fetal growth restriction (odds ratio 2.8; 95% CI 1-7). Women with hCG levels greater than 4 MOM also had an increased risk of preterm delivery (odds ratio 3.3; 95% CI 1.3-8.2). CONCLUSION: Pregnancies with unexplained elevated hCG levels should be regarded as high-risk pregnancies and managed accordingly.     

Normal early pregnancy: serum hCG levels and vaginal ultrasonography findings

Vaginal sonography and determination of serum hCG levels were carried out in 22 healthy pregnant women every 2 to 4 days after the first positive pregnancy test until a living fetus was observed. Gestational age was calculated from the day of ovulation, assessed by LH surge or hCG administration, plus 14 days. A gestational sac of 1-3 mm was detected at a mean (SEM) of 31.2 (0.2) days of gestation (range 30-33 days). The corresponding mean hCG level was 730 iu/l (30) and the range 467-935 iu/l (International Reference Preparation). The yolk sac was detected at a mean of 36.0 (0.2) days, range 34-38 days, at a mean hCG level of 4130 iu/l (370), range 1120-7280 iu/l. Fetal heart motion was visible at a mean of 41.1 (0.3) days, range 39-43 days and the corresponding mean hCG level was 12,050 iu/l (1240), range 5280-22,950, iu/l. The yolk sac and the fetal heart motion were always seen when the sac exceeded 10 and 18 mm in mean diameter, respectively.     

hCG in ectopic pregnancy

Ectopic pregnancies remain an important cause of morbidity and mortality in women of reproductive age. Management of these pregnancies has changed dramatically over the years. Human chorionic gonadotropin (hCG) is a glycoprotein hormone composed of 2 dissimilar subunits, alpha and beta, joined non-covalently. The free beta-subunit is the principal immuno-reactive agent in pregnancy serum samples. Improved diagnostic methods using hCG levels in combination with transvaginal ultrasound have lead to earlier detection rates, subsequent treatment and a reduction in mortality resulting from ectopic pregnancies. This chapter will describe current trends in ectopic pregnancy diagnosis based on hCG levels.