Correlations between serum assays of human chorionic gonadotrophin (hCG) and human placental lactogen (hPL) and pre-eclampsia or intrauterine growth restriction (IUGR) among nulliparas younger than 38 years Philippe Merviel a,b,c,* , Franc Ëoise Mu Èller d , Jean Guibourdenche b,e , Nadia Berkane a , Rodolphe Gaudet a , Ge Ârard Bre Âart f , Serge Uzan a,c,f a Service de Gyne Âcologie-Obste Âtrique et Me Âdecine de la Reproduction, Ho Ãpital Tenon, 4 rue de la Chine, 75020 Paris, France b Faculte  des Sciences Pharmaceutiques et Biologiques, 4 avenue de l'Observatoire, INSERM U 427-Universite  Rene  Descartes-Paris V, 75270 Paris Cedex 06, France c UPRES Physiologie de l'Implantation et du De Âveloppement (EA. 2396), Ho Ãpital Tenon, 4 rue de la Chine, 75020 Paris, France d Service de Biochimie, Ho Ãpital Ambroise Pare Â, 9 avenue Charles de Gaulle, 92100 Boulogne, France e Service de Biochimie, Ho Ãpital Robert Debre Â, 48 boulevard Se Ârurier, 75019 Paris, France f INSERM U 149, Ho Ãpital Tenon, 4 rue de la Chine, 75020 Paris, France Received 20 October 1999; accepted 21 April 2000 Abstract Objective: To study the relation between serum human chorionic gonadotrophin (hCG) levels measured at 15±18 weeks and gestational disorders, assess their correlation with the artery uteroplacental Doppler (AUD) at 24 weeks among nulliparas, and assess the predictivity of the hCG/hPL (human placental lactogen) ratio for pre-eclampsia. Study Design: Retrospective study of two groups of women younger than 38 years old: one with an elevated serum hCG level (2 MoM (multiples of the median) or more) and a normal fetal karyotype (group A), and the other with a lower hCG level (group B). Within each group, we studied the nulliparas separately (respectively groups AO and BO). We analyzed the double screening, elevated hCG levels with abnormal AUD, for the predicting of hypertensive disorders. Results: Elevated hCG levels were signi®cantly (p<0.05) more prevalent among women who developed gestational diabetes (groups A and AO) and among nul- liparas with pregnancy-induced hypertension and pre-eclampsia (AO). Among nulliparas, the combination of the hCG assay and a subsequent Doppler increased the positive predictive value (PPV) of the assay from 19 to 75%, without reducing its negative predictive value (NPV) for gestational vascular disorders. The hCG/hPL ratio did not improve the predictivity of the hCG assay alone for pre-eclampsia. Conclusions: An hCG level of 2 MoM or more at 15±18 weeks identi®es a group of women at risk of gestational vascular disorders; it therefore ought to lead to an AUD at 24 weeks. This double screening should be able to de®ne a population of women at risk of developing a hypertensive disorder, who could thus bene®t from a preventive treatment, as aspirin. # 2001 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Human chorionic gonadotrophin (hCG); Human placental lactogenic hormone (hPL); Pre-eclampsia; Intrauterine growth retardation; Pregnancy- induced hypertension; Doppler 1. Introduction The onset of hypertension or pre-eclampsia during preg- nancy is a serious event that can lead to fetal and maternal complications: intrauterine growth restriction (IUGR), in utero fetal death, eclampsia, and abruptio placentae. Peri- natal mortality is increased 8±10-fold in these cases [1]. These complications occur most frequently among nulli- paras, i.e. women who have not previously had a pregnancy that went beyond 24 weeks' gestation (measured from the ®rst day of the last menstrual period). If treatment like aspirin [2±5] were available to prevent the onset of a pregnancy-related disorder, it would be useful to have a means of predicting which patients are most likely to develop this disorder. Serum levels of human chorionic gonadotrophin (hCG) between 15 and 18 weeks are assayed to screen for Down's European Journal of Obstetrics & Gynecology and Reproductive Biology 95 (2001) 59±67 * Corresponding author. Tel.: 33-1-56-01-6876; fax: 33-1-56-01-6062. E-mail address: philippe.merviel@tnn.ap-hop-paris.fr (P. Merviel). 0301-2115/01/$ ± see front matter # 2001 Elsevier Science Ireland Ltd. All rights reserved. PII:S0301-2115(00)00370-5