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Peri-implantation urinary hormone monitoring distinguishes between types of first-trimester spontaneous pregnancy loss

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Title: Peri-implantation urinary hormone monitoring distinguishes between types of first-trimester spontaneous pregnancy loss
Authors: Foo, L
Johnson, S
Marriott, L
Bourne, T
Bennett, P
Lees, C
Item Type: Journal Article
Abstract: Background Lutenising hormone (LH) and human chorionic gonadotropin (hCG) hormone are useful biochemical markers to indicate ovulation and embryonic implantation, respectively. We explored “point‐of‐care” LH and hCG testing using a digital home‐testing device in a cohort trying to conceive. Objective To determine conception and spontaneous pregnancy loss rates, and to assess whether trends in LH‐hCG interval which are known to be associated with pregnancy viability could be identified with point‐of‐care testing. Methods We recruited healthy women aged 18‐44 planning a pregnancy. Participants used a home monitor to track LH and hCG levels for 12 menstrual cycles or until pregnancy was conceived. Pregnancy outcomes (viable, clinical miscarriage, or biochemical pregnancy loss) were recorded. Monitor data were analysed by a statistician blinded to pregnancy outcome. Results From 387 recruits, there were 290 pregnancies with known outcomes within study timeline. Adequate monitor data for analysis were available for 150 conceptive cycles. Overall spontaneous first‐trimester pregnancy loss rate was 30% with clinically recognised miscarriage rate of 17%. The difference to LH‐hCG interval median had wider spread for biochemical losses (0.5‐8.5 days) compared with clinical miscarriage (0‐5 days) and viable pregnancies (0‐6 days). Fixed effect hCG profile change distinguished between pregnancy outcomes from as early as day‐2 post‐hCG rise from baseline. Conclusion The risk of first‐trimester spontaneous pregnancy loss in our prospective cohort is comparable to studies utilising daily urinary hCG collection and laboratory assays. A wider LH‐hCG interval range is associated with biochemical pregnancy loss and may relate to late or early implantation. Although early hCG changes discriminate between pregnancies that will miscarry from viable pregnancies, this point‐of‐care testing model is not sufficiently developed to be predictive.
Issue Date: 1-Sep-2020
Date of Acceptance: 27-Oct-2019
URI: http://hdl.handle.net/10044/1/76990
DOI: 10.1111/ppe.12613
ISSN: 0269-5022
Publisher: Wiley
Start Page: 495
End Page: 503
Journal / Book Title: Paediatric and Perinatal Epidemiology
Volume: 34
Issue: 5
Copyright Statement: © 2020 The Authors. Paediatric and Perinatal Epidemiology published by John Wiley & Sons Ltd This is an open access article under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Keywords: Science & Technology
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
Obstetrics & Gynecology
Pediatrics
biochemical pregnancy
hCG
miscarriage
ovulation
HUMAN CHORIONIC-GONADOTROPIN
CROWN-RUMP LENGTH
IMPLANTATION
PREDICTION
CONCEPTION
OVULATION
COHORT
WOMEN
TIME
HCG
biochemical pregnancy
hCG
miscarriage
ovulation
Science & Technology
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
Obstetrics & Gynecology
Pediatrics
biochemical pregnancy
hCG
miscarriage
ovulation
HUMAN CHORIONIC-GONADOTROPIN
CROWN-RUMP LENGTH
IMPLANTATION
PREDICTION
CONCEPTION
OVULATION
COHORT
WOMEN
TIME
HCG
Epidemiology
1114 Paediatrics and Reproductive Medicine
1117 Public Health and Health Services
Publication Status: Published
Online Publication Date: 2020-02-13
Appears in Collections:Department of Metabolism, Digestion and Reproduction
Faculty of Medicine