Maternal serum activin, inhibin, human chorionic gonadotrophin and α-fetoprotein as second trimester predictors of pre-eclampsia

Objective To compare the serum levels of human chorionic gonadotrophin (hCG), alpha-fetoprotein, activin A, inhibin A and inhibin isoforms containing pro and alphaC in the second trimester serum of women who subsequently developed hypertensive disorders of pregnancy with those who remained normotensive throughout pregnancy. Design Retrospective case-control study of 15-20 week serum samples matched for duration of storage at -20degreesC. Setting Antenatal clinics at a teaching hospital in Scotland. Sample Second trimester serum samples of 39 women who subsequently developed pre-eclampsia, 31 who subsequently developed pregnancy-induced hypertension and 155 women who remained normotensive throughout pregnancy. Main outcome measures hCG, alpha-fetoprotein, activin A, inhibin A and inhibin pro-alphaC serum levels. Results Activin A levels in serum were significantly elevated in women who later developed pregnancy-induced hypertension (26% increase compared with controls) and hCG levels were significantly elevated in women who later developed pre-eclampsia (24% increase compared with controls). alpha-Fetoprotein, inhibin A and inhibin pro-alphaC levels were not significantly elevated in the patient groups compared with their controls. Conclusions A combination of analyses including second trimester serum activin A and hCG may yet prove to be helpful predictors of women at risk of hypertensive disorders of pregnancy. While the results proved significant, the effects reported in this study are too modest compared with natural variability to be useful as screening tools on their own.