目的：评估hCG与不良妊娠结局之间的关系。
方法：Medline，Embase,2021年11月，使用医学主题词（MeSH）和相关关键词搜索了PubMed和Cochrane。
方法：发表了对妊娠8-28周的孕妇进行血清hCG检测的全文研究，以调查胎儿结局（子宫内胎儿死亡，小于胎龄，早产）或母体因素（妊娠期高血压：先兆子痫，妊娠高血压,胎盘早剥,HELLP综合征,妊娠期糖尿病）。
方法：使用RedCap软件提取研究。纽卡斯尔渥太华量表用于评估偏倚风险。最终的荟萃分析进行了进一步的质量评估，使用建议的分级，评估，发展,和评价(等级)方法。
结果：185项研究纳入最终审查，包括子宫内胎儿死亡的结局（45），小于胎龄（79），早产（61），妊娠期高血压（107），妊娠糖尿病（29），胎盘早剥（16），和溶血，肝酶升高和低血小板综合征（HELLP）（2）。根据hCG的分类测量和连续测量的hCG分别分析数据。符合条件的研究进行了荟萃分析，以生成结果组之间的汇总OR（分类hCG水平）或中位数差异（hCG连续量表）。孕早期低hCG水平与先兆子痫和子宫内胎儿死亡有关，而高hCG水平与先兆子痫有关。妊娠中期高hCG水平与子宫内胎儿死亡和先兆子痫有关。
结论：hCG水平与胎盘介导的不良妊娠结局相关。妊娠前三个月的高和低hCG水平都可以是不良结局的早期预警信号。需要进一步分析hCG亚型和妊娠结局，以参考特定的临界值来确定这些发现的诊断效用。
This study aimed to evaluate the association between human chorionic gonadotropin and adverse pregnancy outcomes.
Medline, Embase, PubMed, and Cochrane were searched in November 2021 using Medical Subject Headings (MeSH) and relevant key words.
This analysis included published full-text studies of pregnant women with serum human chorionic gonadotropin testing between 8 and 28 weeks of gestation, investigating fetal outcomes (fetal death in utero, small for gestational age, preterm birth) or maternal factors (hypertension in pregnancy: preeclampsia, pregnancy-induced hypertension, placental abruption, HELLP syndrome, gestational diabetes mellitus).
Studies were extracted using REDCap software. The Newcastle-Ottawa scale was used to assess for risk of bias. Final meta-analyses underwent further quality assessment using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) method.
A total of 185 studies were included in the final review, including the outcomes of fetal death in utero (45), small for gestational age (79), preterm delivery (62), hypertension in pregnancy (107), gestational diabetes mellitus (29), placental abruption (17), and HELLP syndrome (2). Data were analyzed separately on the basis of categorical measurement of human chorionic gonadotropin and human chorionic gonadotropin measured on a continuous scale. Eligible studies underwent meta-analysis to generate a pooled odds ratio (categorical human chorionic gonadotropin level) or difference in medians (human chorionic gonadotropin continuous scale) between outcome groups. First-trimester low human chorionic gonadotropin levels were associated with preeclampsia and fetal death in utero, whereas high human chorionic gonadotropin levels were associated with preeclampsia. Second-trimester high human chorionic gonadotropin levels were associated with fetal death in utero and preeclampsia.
Human chorionic gonadotropin levels are associated with placenta-mediated adverse pregnancy outcomes. Both high and low human chorionic gonadotropin levels in the first trimester of pregnancy can be early warning signs of adverse outcomes. Further analysis of human chorionic gonadotropin subtypes and pregnancy outcomes is required to determine the diagnostic utility of these findings in reference to specific cutoff values.
