Prediction of miscarriage in first trimester by serum estradiol, progesterone and β-human chorionic gonadotropin within 9 weeks of gestation

To predict miscarriage outcome within 12 weeks of gestational age by evaluating values of serum estradiol, progesterone and β-human chorionic gonadotropin (β-HCG) within 9 weeks of gestation.

One hundred sixty-five women with singleton pregnancies were retrospectively studied. Estradiol, progesterone and β-HCG levels were measured at 5-6 weeks of gestation and the measurements were repeated at 7-9 weeks. According to pregnancy outcome at 12 weeks of gestation, 71 cases were categorized into miscarriage group, and 94 cases into group of normal pregnancy. Each group was further divided into 5-6 and 7-9 weeks of gestation sub-group. Predictive values of estradiol, progesterone and β- HCG levels at 5-6 weeks and 7-9 weeks of gestation were analyzed with receiver operating characteristic (ROC) curves and logistic regression.

Serum levels of estradiol at 7-9 weeks identified miscarriage with an area under the ROC curve (AUC) of 0.866 (95% CI 0. 793 ~ 0.938, P = 0.000), diagnostic cutoff value of 576 pg/ml, sensitivity of 0.804, and specificity of 0.829 respectively at the optimal threshold, according to Youden index. Progesterone levels at 7-9 weeks were with AUC of 0.766 (95% CI 0. 672 ~ 0.861, P = 0.000), cutoff value of 15.27 ng/ml, sensitivity of 0.921, and specificity of 0.558, respectively; Estradiol at 5-6 weeks were with AUC of 0.709 (95% CI 0. 616 ~ 0.801, P < 0.001), the diagnostic cutoff value of 320 pg/ml, sensitivity of 0.800, and specificity of 0.574, respectively. The performance of the dual markers of estradiol and progesterone analysis (AUC 0.871, CI 0.793-0.950), three-markers analysis (AUC 0.869, CI 0.759-0.980)were slightly better than the single marker at 7-9 weeks. β-HCG or progesterone provide additional utility of estradiol prediction at 5-6 weeks with AUC 0.770 (0.672-0.869) for β-HCG and estradiol, AUC0.768(CI 0.670-0.866) for β-HCG, estradiol and progesterone and AUC 0.739 (CI 0.651-0.827) for progesterone and estradiol.

Low serum levels such as dual of estradiol and progesterone or estradiol alone at 7-9 weeks, β-HCG or progesterone combing estradiol at 5-6 weeks of gestation can be used better to predict miscarriage in first trimester.