Research Article
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Can hyperemesis gravidarum influence the reliability of first trimester screening test?

Year 2026, Volume: 8 Issue: 1, 12 - 16, 06.01.2026
https://doi.org/10.38053/acmj.1803596

Abstract

Aims: The aim of our study was to explore the influence of the variation in plasma volume expansion due to hyperemesis gravidarum (HEG) on the biomarker concentrations and risk assessment in first trimester screening.
Methods: 144 pregnant women who were hospitalized due to HEG between 11 and 14 gestational ages were determined as the study group. 253 pregnant women at a similar gestational age were randomly selected and determined as a control group.
Results: The levels of Hgb, Htc, the MOM values of PAPP-A and β-HCG, the median risk of the double test were statistically higher in the study group when compared to the control group (p<0.05). Multivariate regression analysis for HEG revealed that the PAPP-A, β-HCG, and TSH variables were statistically significant when the six variables were controlled. There was no significant relationship between Hgb and Hct values and biochemical parameters of double test in the groups (p>0.05).
Conclusion: Even though it is not related to hemo-concentration, double test parameters and the combined results of the test changes in pregnant women with HEG. Therefore, we must be more careful when interpreting double test in women with HEG.

References

  • Boelig RC, Berghella V, Kelly AJ, et al. Interventions for treating hyperemesis gravidarum. Cochrane Database Syst Rev. 2013(6):1-10. doi: 10.1002/14651858.CD010607.pub2
  • Einarson TR, Piwko C, Koren G. Quantifying the global rates of nausea and vomiting of pregnancy: a meta analysis. J Popul Ther Clin Pharmacol. 2013;20(2):e171-e183.
  • Fejzo MS, Poursharif B, Korst LM, et al. Symptoms and pregnancy outcomes associated with extreme weight loss among women with hyperemesis gravidarum. J Womens Health (Larchmt). 2009;18(12):1981-1987. doi:10.1089/jwh.2009.1431
  • Sonkusare S. The clinical management of hyperemesis gravidarum. Arch Gynecol Obstet. 2011;283(6):1183-1192. doi:10.1007/s00404-011-1877-y
  • Jueckstock JK, Kaestner R, Mylonas I. Managing hyperemesis gravidarum: a multimodal challenge. BMC Med. 2010;8:46. doi:10.1186/ 1741-7015-8-46
  • Nicolaides KH, Wright D, Poon LC, et al. First-trimester contingent screening for trisomy 21 by biomarkers and maternal blood cell-free DNA testing. Ultrasound Obstet Gynecol. 2013;42(1):41-50 doi:10.1002/uog.12511
  • Wald NJ, Hackshaw AK. Combining ultrasound and biochemistry in first-trimester screening for Down's syndrome. Prenat Diagn. 1997;17(9): 821-829.
  • Lawrence JB, Oxvig C, Overgaard MT, et al. The insulin-like growth factor (IGF)-dependent IGF binding protein-4 protease secreted by human fibroblasts is pregnancy-associated plasma protein-A. Proc Natl Acad Sci U S A. 1999;96(6):3149-3153. doi:10.1073/pnas.96.6.3149
  • Blackburn ST, Loper DL. Maternal, fetal, and neonatal physiology. A clinical perspective. Philadelphia: W.B. Saunders Co. 1992.
  • Faupel-Badger JM, Hsieh CC, Troisi R, Lagiou P, Potischman N. Plasma volume expansion in pregnancy: implications for biomarkers in population studies. Cancer Epidemiol Biomarkers Prev. 2007;16(9):1720-1723. doi:10.1158/1055-9965.EPI-07-0311
  • Paller CJ, Shiels MS, Rohrmann S, et al. Association between sex steroid hormones and hematocrit in a nationally representative sample of men. J Androl. 2012;33(6):1332-1341. doi:10.2164/jandrol.111.015651
  • Troisi R, Potischman N, Roberts JM, et al. Maternal serum oestrogen and androgen concentrations in preeclamptic and uncomplicated pregnancies. Int J Epidemiol. 2003;32(3):455-460. doi:10.1093/ije/dyg094
  • Tamimi R, Lagiou P, Vatten LJ, et al. Pregnancy hormones, pre-eclampsia, and implications for breast cancer risk in the offspring. Cancer Epidemiol Biomarkers Prev. 2003;12(7):647-650.
  • Ravel R. Clinical laboratory medicine: clinical application of laboratory data. Clinical laboratory medicine: clinical application of laboratory data.1994;724-724
  • Carl AB, Edward RA. Tietz Textbook of clinical chemistry, W.B.Saunders company, Philadelphia, Pennsylvania. 1994.
  • Derbent AU, Yanik FF, Simavli S, et al. First trimester maternal serum PAPP-A and free β-HCG levels in hyperemesis gravidarum. Prenat Diagn. 2011;31(5):450-453. doi:10.1002/pd.2715
  • Unlu BS, Energin H, Yildiz Y, Unlu E, Yapar Eyi EG. Maternal serum pregnancy-associated plasma protein-A levels in hyperemesis gravidarum: a prospective case control study. Clin Exp Obstet Gynecol. 2014;41(5):534-536.
  • Vricella LK. Emerging understanding and measurement of plasma volume expansion in pregnancy. Am J Clin Nutr. 2017;106(6):1620-1625. doi:10.3945/ajcn.117.155903
  • Goodwin TM, Hershman JM, Cole L. Increased concentration of the free beta-subunit of human chorionic gonadotropin in hyperemesis gravidarum. Acta Obstet Gynecol Scand. 1994;73(10):770-772. doi:10. 3109/00016349409072502
  • Masson GM, Anthony F, Chau E. Serum chorionic gonadotrophin (hCG), schwangerschaftsprotein 1 (SP1), progesterone and oestradiol levels in patients with nausea and vomiting in early pregnancy. Br J Obstet Gynaecol. 1985;92(3):211-215. doi:10.1111/j.1471-0528.1985.tb 01084.x
  • Soto-Wright V, Bernstein M, Goldstein DP, Berkowitz RS. The changing clinical presentation of complete molar pregnancy. Obstet Gynecol. 1995;86(5):775-779. doi:10.1016/0029-7844(95)00268-V
  • Boldt HB, Conover CA. Pregnancy-associated plasma protein-A (PAPP-A): a local regulator of IGF bioavailability through cleavage of IGFBPs. Growth Horm IGF Res. 2007;17(1):10-18. doi:10.1016/j.ghir. 2006.11.003
  • Conover CA, Bale LK, Harrington SC, et al. Cytokine stimulation of pregnancy-associated plasma protein a expression in human coronary artery smooth muscle cells: inhibition by resveratrol. Am J Physiol Cell Physiol. 2006;290(1):C183-C188. doi:10.1152/ajpcell.00199.2005
  • Chen BK, Leiferman KM, Pittelkow MR, et al. Localization and regulation of pregnancy-associated plasma protein a expression in healing human skin. J Clin Endocrinol Metab. 2003;88(9):4465-4471. doi:10.1210/jc.2003-030193
  • Resch ZT, Chen BK, Bale LK, Oxvig C, Overgaard MT, Conover CA. Pregnancy-associated plasma protein a gene expression as a target of inflammatory cytokines. Endocrinology. 2004;145(3):1124-1129. doi:10. 1210/en.2003-1313
  • Laursen LS, Overgaard MT, Weyer K, et al. Cell surface targeting of pregnancy-associated plasma protein A proteolytic activity. Reversible adhesion is mediated by two neighboring short consensus repeats. J Biol Chem. 2002;277(49):47225-47234. doi:10.1074/jbc.M209155200
  • Ustün Y, Engin-Ustün Y, Dökmeci F, Söylemez F. Serum concentrations of lipids and apolipoproteins in normal and hyperemetic pregnancies. J Matern Fetal Neonatal Med. 2004;15(5):287-290. doi:10.1080/147670504 10001680028
  • Güney M, Oral B, Mungan T. Serum lipid peroxidation and antioxidant potential levels in hyperemesis gravidarum. Am J Perinatol. 2007;24(5): 283-289. doi:10.1055/s-2007-981429
  • Aksoy H, Aksoy AN, Ozkan A, Polat H. Serum lipid profile, oxidative status, and paraoxonase 1 activity in hyperemesis gravidarum. J Clin Lab Anal. 2009;23(2):105-109. doi:10.1002/jcla.20298

Hiperemezis gravidarum birinci trimester tarama testinin güvenilirliğini etkileyebilir mi?

Year 2026, Volume: 8 Issue: 1, 12 - 16, 06.01.2026
https://doi.org/10.38053/acmj.1803596

Abstract

Amaçlar: Çalışmamızın amacı, ilk trimester taramasında Hyperemezis gravidarum (HEG) nedeniyle plazma hacmi genişlemesindeki varyasyonun biyobelirteç konsantrasyonları ve risk değerlendirmesi üzerindeki etkisini araştırmaktı.

Yöntemler: Çalışma grubu olarak 11 ila 14 gebelik yaşları arasında hiperemezis gravidarum nedeniyle hastaneye kaldırılan 144 hamile kadın belirlendi. Benzer gebelik yaşındaki 253 hamile kadın rastgele seçildi ve kontrol grubu olarak belirlendi.

Sonuçlar: Hgb, Htc, PAPP-A ve β-HCG'nin MOM değerleri, çift testin medyan riski, çalışma grubunda kontrol grubuna kıyasla istatistiksel olarak daha yüksekti (p<0,05). HEG için çok değişkenli regresyon analizi, altı değişken kontrol edildiğinde PAPP-A, β-HCG ve TSH değişkenlerinin istatistiksel olarak anlamlı olduğunu ortaya koydu. Gruplarda Hgb ve Hct değerleri ile çift testin biyokimyasal parametreleri arasında anlamlı bir ilişki yoktu (p > 0,05).

Sonuç: Hemo-konsantrasyon ile ilişkili olmasa da, çift test parametreleri ve testin birleşik sonuçları HEG'li hamile kadınlarda değişir. Bu nedenle, HEG'li kadınlarda çift testi yorumlarken daha dikkatli olmalıyız.

References

  • Boelig RC, Berghella V, Kelly AJ, et al. Interventions for treating hyperemesis gravidarum. Cochrane Database Syst Rev. 2013(6):1-10. doi: 10.1002/14651858.CD010607.pub2
  • Einarson TR, Piwko C, Koren G. Quantifying the global rates of nausea and vomiting of pregnancy: a meta analysis. J Popul Ther Clin Pharmacol. 2013;20(2):e171-e183.
  • Fejzo MS, Poursharif B, Korst LM, et al. Symptoms and pregnancy outcomes associated with extreme weight loss among women with hyperemesis gravidarum. J Womens Health (Larchmt). 2009;18(12):1981-1987. doi:10.1089/jwh.2009.1431
  • Sonkusare S. The clinical management of hyperemesis gravidarum. Arch Gynecol Obstet. 2011;283(6):1183-1192. doi:10.1007/s00404-011-1877-y
  • Jueckstock JK, Kaestner R, Mylonas I. Managing hyperemesis gravidarum: a multimodal challenge. BMC Med. 2010;8:46. doi:10.1186/ 1741-7015-8-46
  • Nicolaides KH, Wright D, Poon LC, et al. First-trimester contingent screening for trisomy 21 by biomarkers and maternal blood cell-free DNA testing. Ultrasound Obstet Gynecol. 2013;42(1):41-50 doi:10.1002/uog.12511
  • Wald NJ, Hackshaw AK. Combining ultrasound and biochemistry in first-trimester screening for Down's syndrome. Prenat Diagn. 1997;17(9): 821-829.
  • Lawrence JB, Oxvig C, Overgaard MT, et al. The insulin-like growth factor (IGF)-dependent IGF binding protein-4 protease secreted by human fibroblasts is pregnancy-associated plasma protein-A. Proc Natl Acad Sci U S A. 1999;96(6):3149-3153. doi:10.1073/pnas.96.6.3149
  • Blackburn ST, Loper DL. Maternal, fetal, and neonatal physiology. A clinical perspective. Philadelphia: W.B. Saunders Co. 1992.
  • Faupel-Badger JM, Hsieh CC, Troisi R, Lagiou P, Potischman N. Plasma volume expansion in pregnancy: implications for biomarkers in population studies. Cancer Epidemiol Biomarkers Prev. 2007;16(9):1720-1723. doi:10.1158/1055-9965.EPI-07-0311
  • Paller CJ, Shiels MS, Rohrmann S, et al. Association between sex steroid hormones and hematocrit in a nationally representative sample of men. J Androl. 2012;33(6):1332-1341. doi:10.2164/jandrol.111.015651
  • Troisi R, Potischman N, Roberts JM, et al. Maternal serum oestrogen and androgen concentrations in preeclamptic and uncomplicated pregnancies. Int J Epidemiol. 2003;32(3):455-460. doi:10.1093/ije/dyg094
  • Tamimi R, Lagiou P, Vatten LJ, et al. Pregnancy hormones, pre-eclampsia, and implications for breast cancer risk in the offspring. Cancer Epidemiol Biomarkers Prev. 2003;12(7):647-650.
  • Ravel R. Clinical laboratory medicine: clinical application of laboratory data. Clinical laboratory medicine: clinical application of laboratory data.1994;724-724
  • Carl AB, Edward RA. Tietz Textbook of clinical chemistry, W.B.Saunders company, Philadelphia, Pennsylvania. 1994.
  • Derbent AU, Yanik FF, Simavli S, et al. First trimester maternal serum PAPP-A and free β-HCG levels in hyperemesis gravidarum. Prenat Diagn. 2011;31(5):450-453. doi:10.1002/pd.2715
  • Unlu BS, Energin H, Yildiz Y, Unlu E, Yapar Eyi EG. Maternal serum pregnancy-associated plasma protein-A levels in hyperemesis gravidarum: a prospective case control study. Clin Exp Obstet Gynecol. 2014;41(5):534-536.
  • Vricella LK. Emerging understanding and measurement of plasma volume expansion in pregnancy. Am J Clin Nutr. 2017;106(6):1620-1625. doi:10.3945/ajcn.117.155903
  • Goodwin TM, Hershman JM, Cole L. Increased concentration of the free beta-subunit of human chorionic gonadotropin in hyperemesis gravidarum. Acta Obstet Gynecol Scand. 1994;73(10):770-772. doi:10. 3109/00016349409072502
  • Masson GM, Anthony F, Chau E. Serum chorionic gonadotrophin (hCG), schwangerschaftsprotein 1 (SP1), progesterone and oestradiol levels in patients with nausea and vomiting in early pregnancy. Br J Obstet Gynaecol. 1985;92(3):211-215. doi:10.1111/j.1471-0528.1985.tb 01084.x
  • Soto-Wright V, Bernstein M, Goldstein DP, Berkowitz RS. The changing clinical presentation of complete molar pregnancy. Obstet Gynecol. 1995;86(5):775-779. doi:10.1016/0029-7844(95)00268-V
  • Boldt HB, Conover CA. Pregnancy-associated plasma protein-A (PAPP-A): a local regulator of IGF bioavailability through cleavage of IGFBPs. Growth Horm IGF Res. 2007;17(1):10-18. doi:10.1016/j.ghir. 2006.11.003
  • Conover CA, Bale LK, Harrington SC, et al. Cytokine stimulation of pregnancy-associated plasma protein a expression in human coronary artery smooth muscle cells: inhibition by resveratrol. Am J Physiol Cell Physiol. 2006;290(1):C183-C188. doi:10.1152/ajpcell.00199.2005
  • Chen BK, Leiferman KM, Pittelkow MR, et al. Localization and regulation of pregnancy-associated plasma protein a expression in healing human skin. J Clin Endocrinol Metab. 2003;88(9):4465-4471. doi:10.1210/jc.2003-030193
  • Resch ZT, Chen BK, Bale LK, Oxvig C, Overgaard MT, Conover CA. Pregnancy-associated plasma protein a gene expression as a target of inflammatory cytokines. Endocrinology. 2004;145(3):1124-1129. doi:10. 1210/en.2003-1313
  • Laursen LS, Overgaard MT, Weyer K, et al. Cell surface targeting of pregnancy-associated plasma protein A proteolytic activity. Reversible adhesion is mediated by two neighboring short consensus repeats. J Biol Chem. 2002;277(49):47225-47234. doi:10.1074/jbc.M209155200
  • Ustün Y, Engin-Ustün Y, Dökmeci F, Söylemez F. Serum concentrations of lipids and apolipoproteins in normal and hyperemetic pregnancies. J Matern Fetal Neonatal Med. 2004;15(5):287-290. doi:10.1080/147670504 10001680028
  • Güney M, Oral B, Mungan T. Serum lipid peroxidation and antioxidant potential levels in hyperemesis gravidarum. Am J Perinatol. 2007;24(5): 283-289. doi:10.1055/s-2007-981429
  • Aksoy H, Aksoy AN, Ozkan A, Polat H. Serum lipid profile, oxidative status, and paraoxonase 1 activity in hyperemesis gravidarum. J Clin Lab Anal. 2009;23(2):105-109. doi:10.1002/jcla.20298
There are 29 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Research Article
Authors

Bilal İçer 0000-0002-4602-0336

Fatma Doğa Öcal 0000-0003-4727-7982

Tuncay Küçüközkan 0000-0003-4280-3883

Submission Date October 14, 2025
Acceptance Date October 30, 2025
Publication Date January 6, 2026
Published in Issue Year 2026 Volume: 8 Issue: 1

Cite

AMA İçer B, Öcal FD, Küçüközkan T. Can hyperemesis gravidarum influence the reliability of first trimester screening test? Anatolian Curr Med J / ACMJ / acmj. January 2026;8(1):12-16. doi:10.38053/acmj.1803596

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