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hCG Levels | The American Pregnancy Association

HCG (Human Chorionic Gonadotropin) is often called the pregnancy hormone because it is made by cells formed in the placenta, which nourishes the egg after it has been fertilized and becomes attached to the uterine wall. Levels can first be detected by a blood test about 11 days after conception and about 12-14 days after conception by a urine test.

Typically, the hCG levels will double every 72 hours. The level will reach its peak in the first 8-11 weeks of pregnancy and then will decline and level off for the remainder of the pregnancy.

1. As you get further along in pregnancy and the hCG level gets higher, the time it takes to double can increase to about every 96 hours.
2. Caution must be used in making too much of hCG numbers. A normal pregnancy may have low hCG levels and result in a perfectly healthy baby. The results from an ultrasound after 5 -6 weeks gestation are much more accurate than using hCG numbers.
3. An hCG level of less than 5 mIU/mL is considered negative for pregnancy, and anything above 25 mIU/mL is considered positive for pregnancy.
4. An hCG level between 6 and 24 mIU/mL is considered a grey area, and you’ll likely need to be retested to see if your levels rise to confirm a pregnancy.
5. The hCG hormone is measured in milli-international units per milliliter (mIU/mL).
6. A transvaginal ultrasound should be able to show at least a gestational sac once the hCG levels have reached between 1,000 – 2,000 mIU/mL. Because levels can differentiate so much and conception dating can be wrong, a diagnosis should not be made by ultrasound findings until the hCG level has reached at least 2,000 mIU/mL.
7. A single reading is not enough information for most diagnoses. When there is a question regarding the health of the pregnancy, multiple testings of hCG done a couple of days apart give a more accurate assessment of the situation.
8. The hCG levels should not be used to date a pregnancy since these numbers can vary so widely.
9. There are two common types of hCG tests. A qualitative test detects if hCG is present in the blood. A quantitative test (or beta) measures the amount of hCG actually present in the blood.

Guideline to hCG levels in weeks during pregnancy

* These numbers are just a guideline – every woman’s level of hCG can rise differently. It is not necessarily the level that matters, but rather the change in the level.

What Does a Low hCG Level Mean?

A low hCG level can mean any number of things and should be rechecked within 48-72 hours to see how the level is changing. A low level can indicate:

• Miscalculation of pregnancy dating
• Possible miscarriage or blighted ovum
• Ectopic pregnancy

Is a High hCG Level a Bad Thing?

A high level of hCG can also mean a number of things and should be rechecked within 48-72 hours to evaluate changes in the level. A high level can indicate:

• Miscalculation of pregnancy dating
• Molar pregnancy
• Multiple pregnancies

Should I Check My hCG level Regularly?

It’s not common for doctors to routinely check your hCG levels unless you are showing signs of a potential problem.
A health care provider may recheck your levels if you are bleeding, experiencing severe cramping, or have a history of miscarriage.

What Can I Expect After a Pregnancy Loss?

Most women can expect their levels to return to a non-pregnant range about 4 – 6 weeks after a pregnancy loss has occurred.
This can differentiate by how the loss occurred (spontaneous miscarriage, D & C procedure, abortion, natural delivery) and how high the levels were at the time of the loss.
Healthcare providers usually will continue to test hCG levels after a pregnancy loss to ensure they return back to <5.0.

What Can Interfere With My hCG Levels?

If you get a positive test result, you are most likely pregnant. False positives are extremely rare. However, there are some conditions that may cause a false positive, such as certain types of cancer and early miscarriage. Some antibodies may also interfere with test results.

Medications that contain hCG may interfere with hCG levels, as well.

These medications are often used infertility treatments, and your health care provider should advise you on how they may affect a test.

All other medications such as antibiotics, pain relievers, contraception or other hormone medications should not have any effect on a test that measures hCG.

Want to Know More?

• Pregnancy Calculator
• Calculating Gestation Age
• Concerns Regarding Early Fetal Development

Compiled using information from the following sources:

1. U.S. Food and Drug Administration

www.fda.gov

2. Bashir, I; Ihenetu, K; Miller, J.J.; Gim, M.; Lippmann, S. A Positive Pregnancy Test in the Post-Menopausal Psychiatric Patient — What to Think? Psychiatry (Edgemont). Feb. 2006.

Beta-subunit of human chorionic gonadotropin (beta-hCG)

Beta-subunit of human chorionic gonadotropin is one of the subunits of a specific hormone molecule - chorionic gonadotropin, which is formed in the shell of the human embryo. The analysis is carried out for the purpose of early diagnosis of pregnancy, detection of its complications and diagnosis of diseases associated with impaired hCG secretion.

Synonyms Russian

Beta subunit of hCG.

Synonyms English

Human Chorionic Gonadotropin, hCG, b-HCG, Quantitative hCG; Beta hCG, Total hCG, Total beta hCG.

Test method

Electrochemiluminescent immunoassay (ECLIA).

Detection range: 0.1 - 1,000,000 IU/l.

Units

IU/l (international unit per litre).

What biomaterial can be used for research?

Venous blood.

How to properly prepare for an examination?

• Do not smoke for 30 minutes before the test.

Study Overview

Human chorionic gonadotropin (hCG) is a hormone produced in the fetal membrane of the human embryo. It is an important indicator of the development of pregnancy and its deviations. It is produced by the cells of the chorion (the shell of the embryo) immediately after it is attached to the wall of the uterus (this happens only a few days after fertilization). The embryo at this stage of pregnancy is a microscopic vesicle filled with fluid, the walls of which are made up of rapidly multiplying cells. From one part of these cells, the unborn child (embryoblast) develops, while from the cells outside the embryo, a trophoblast is formed - that part of the fetal egg, with which it is attached to the wall of the uterus. Later, the chorion is formed from the trophoblast.

Chorion performs the function of nourishing the embryo, being an intermediary between the body of the mother and the child. In addition, it produces chorionic gonadotropin, which, on the one hand, affects the formation of the child, on the other hand, it specifically affects the mother's body, ensuring a successful pregnancy. The appearance of this hormone in the body of a future mother at the initial stage of pregnancy explains the importance of the test for early diagnosis of pregnancy.

Chorionic gonadotropin stimulates the secretory function of the corpus luteum of the ovaries, which should produce the hormone progesterone, which maintains the normal state of the inner lining of the uterine wall - the endometrium. The endometrium provides reliable attachment of the fetal egg to the mother's body and its nutrition with all the necessary substances.

Due to a sufficient amount of human chorionic gonadotropin, the corpus luteum, which normally exists for only about 2 weeks during each menstrual cycle, does not undergo resorption after successful conception and remains functionally active throughout the entire period of pregnancy. Moreover, it is in pregnant women under the influence of chorionic gonadotropin that it produces very large amounts of progesterone. In addition, CG stimulates the production of estrogens and weak androgens by ovarian cells and promotes the development of the functional activity of the chorion itself, and later the placenta, which is formed as a result of the maturation and growth of the chorionic tissue, improving its own nutrition and increasing the number of chorionic villi.

Thus, the role of human chorionic gonadotropin lies in the specific and multifaceted effect on the body of a woman and the fetus in order to ensure a successful pregnancy. Based on the analysis for chorionic gonadotropin, the presence of chorionic tissue in the woman's body is determined, and hence pregnancy.

According to its chemical structure, chorionic gonadotropin is a combination of protein and complex carbohydrates, consisting of two parts (subunits): alpha and beta. The alpha subunit of chorionic gonadotropin is completely identical to the alpha subunits of the luteinizing, follicle-stimulating and thyroid-stimulating hormones of the pituitary gland, which perform functions that are largely similar to the function of chorionic gonadotropin, but not during pregnancy. The beta subunit of chorionic gonadotropin is unique, which, on the one hand, determines the specificity of its action, and, on the other hand, allows it to be identified in biological media. In this regard, this test is called "beta-subunit of human chorionic gonadotropin (beta-hCG)".

Knowing the level of beta-hCG in the blood, it is possible to diagnose pregnancy already on the 6-8th day after conception (in the urine, the concentration of beta-hCG reaches the diagnostic level 1-2 days later). Normally, during pregnancy between the 2nd and 5th weeks, the amount of beta-hCG doubles every 1.5 days. With multiple pregnancy, it increases in proportion to the number of fetuses. The maximum level of hCG reaches the 10-11th week, and then gradually decreases. This is due to the fact that from the beginning of the 2nd third of pregnancy, the placenta is able to independently produce enough estrogens and progesterone, with the participation of which the endometrium functions normally, regardless of the secretion of hormones in the ovarian corpus luteum. At the same time, the concentration of CG in the blood of a pregnant woman gradually decreases, and the corpus luteum can function without the effects of CG. During this period, the role of the hormone is to stimulate the production of testosterone in the fetus, which is necessary for the normal development of the external genital organs of the embryo.

Thus, during pregnancy, the level of beta-hCG in the blood first increases and then decreases. According to this indicator, one can judge the successful course of pregnancy and identify violations of the development of the fetus. The test for hCG in the blood is the most reliable method for determining pregnancy in the early stages. HCG appears in the body of a woman from 6-8 days after fertilization. A common rapid pregnancy test that every woman can use at home is also based on measuring hCG in the urine.

Below normal hormone levels at various stages of fetal development suggest ectopic pregnancy, fetal growth retardation, threatened miscarriage, non-progressive pregnancy, or placental insufficiency. The reason for the increased content of beta-hCG may be toxicosis, diabetes mellitus, or an incorrectly set gestational age. A high level of the hormone after a mini-abortion indicates a progressing pregnancy.

Determining the level of hCG is included in the triple test study, the results of which can be used to judge some anomalies in the development of the fetus, but an accurate diagnosis cannot be made. The study only allows you to classify a woman as a risk group for this pathology. In this case, further investigation is necessary. In non-pregnant women, CG is normally absent, but it can be secreted by some abnormal chorion-derived tissues (hydatidiform mole, chorionepithelioma) and some other tumors.

What is research used for?

• For the diagnosis of pregnancy, including multiple, ectopic and non-developing.
• To monitor the progress of pregnancy.
• To detect fetal growth retardation, threatened miscarriage, placental insufficiency.
• For the diagnosis of amenorrhea.
• To monitor the effectiveness of induced abortion.
• As part of a comprehensive examination to identify fetal malformations.
• For the diagnosis of CG-producing tumors.

When is the test ordered?

• If pregnancy is suspected, in particular multiple pregnancy.
• When monitoring the progress of pregnancy.
• When there is an assumption about a complication during pregnancy: fetal growth retardation, the threat of spontaneous abortion, non-developing or ectopic pregnancy, chronic placental insufficiency.
• Confirm successful induced abortion if necessary.
• With a comprehensive examination to identify fetal malformations.
• When finding out the reason for the absence of menstruation (amenorrhea).
• When is the diagnosis of tumors producing hCG.

What do the results mean?

Reference values ​​

Causes of high beta-hCG levels

In the absence of pregnancy, the result of the beta-hCG test should be negative. The detection of beta-hCG suggests that at least 5-6 days have passed since fertilization. Between the 2nd and 5th weeks of pregnancy, during its normal course, the level of beta-hCG doubles every 1.5 days and soon reaches its maximum. Then it starts to slowly decline. The results of the analysis are compared with the normal values ​​for each gestational age. For a correct interpretation of the results, it is necessary to know exactly when the conception occurred.

In pregnant women:

• multiple pregnancies (the rate increases in proportion to the number of fetuses),
• toxicosis,
• prolonged pregnancy,
• maternal diabetes mellitus,
• fetal malformations,
• taking synthetic hormones.

Not pregnant:

• hCG-producing tumors,
• surgical abortion (first 4-5 days after the procedure),
• taking hCG preparations.

Causes of low beta-hCG levels (during pregnancy):

• ectopic or non-developing pregnancy,
• fetal growth retardation,
• threatened miscarriage,
• chronic placental insufficiency,
• fetal death (in the 2nd-3rd trimester of pregnancy).

What can influence the result?

• When diagnosing pregnancy, taking the test too early - when less than 5 days have passed since conception - can lead to a false negative result.

Also recommended

• Alpha-fetoprotein (alpha-FP)
• Antiphospholipid antibodies IgG
• Antiphospholipid antibodies IgM
• Placental lactogen
• Free estriol
• Pregnancy - Prenatal screening for trisomies of the first trimester of pregnancy (Down syndrome), PRISCA
• Plasma pregnancy-associated protein A (PAPP-A)
• Pregnancy - Prenatal screening for trisomies of the second trimester of pregnancy, PRISCA
• Antibodies to steroid-producing cells of the placenta

Who orders the examination?

General practitioner, obstetrician-gynecologist, oncologist.

Literature

• Handbook of Clinical Laboratory Testing During Pregnancy, edited by Ann M. Gronowski. Springer-Verlag LLC, New York, 2004
• Prenatal Diagnosis in Obstetric Practice. M. J. J. Whittle, Blackwell Publishers 1995
• Endocrinology of Pregnancy. Fuller W. Bazer, Humana Press 1998
• Blood Biochemistry. N J Russell, G M Powell, J G Jones, P J, Winterburn and J M Basford, Croom Helm, London and Canberra, 1982
• Blood Chemistry and CBC analysis-Clinical Laboratory Testing from a Functional Perspective. Rychard Weatherby N.D and Scott Fergusson, N.D., Bear Mounting Publishing, 2002.
• Tietz Clinical Guide to Laboratory Tests. Alan H. B. Wu, Saunders/Elsevier, 2006
• Laboratory and Diagnostic Tests. Joyce LeFever Kee - Pearson, Prentice Hall, 8th Edition 2010
• District Laboratory Practice in Tropical Countries. Monica Cheesbrough, Cambridge University Press, second edition, 2005.
• Clinical Chemistry. A Laboratory Perspective. Wendy L. Arneson, Jean M. Brickell, F.A. Davis Company, 2007
• Clinical Chemistry. Michael L. Bishop, Edward P. Fody, Larry E. Schoef, Lippincott Williams & Wilkins, 2005

HCG norms by weeks of pregnancy

Content

1. Table of average hCG norms
2. Table of average hCG norms for carrying twins
3. Table of average hCG values ​​after IVF with engrafted twins
4. Guidelines for free β-hCG subunit
5. Norm РАРР-А
6. What if I am at high risk?
7. How to confirm or deny the results of screening?
8. The doctor says I need an abortion. What to do?

One of the main tests during pregnancy is the study of the level of pregnancy hormone - hCG or human chorionic gonadotropin. If future mothers want to know if the hormone level is normal, we made a summary table of values ​​

Table of average hCG norms:

Gestation period	HCG in honey/ml	HCG in mIU/ml	HCG in ng/ml
1-2 weeks	25-156	5-25 (doubtful result)	-
2-3 weeks	101-4870	5-25 (doubtful result)	-
3-4 weeks	1100 – 31500	25-156	-
4-5 weeks	2560 - 82300	101-4870	-
5-6 weeks	23100 – 151000	1110 -31500	-
6-7 weeks	27300 – 233000	2560 -82300	-
7-11 weeks	20900 – 291000	23100 -233000	23. 7 - 130.4
11-16 weeks	6140 – 103000	20900 -103000	17.4 - 50.0
Weeks 16-21	4720 – 80100	6140 – 80100	4.67 - 33.3
21-39 weeks	2700 – 78100	2700 -78100	-

Table of average hCG norms for carrying twins:

Table of average hCG values ​​after IVF with engrafted twins:

Free hCG β-subunit limits

Free hCG β-subunit measurement is more accurate in determining the risk of Down syndrome in an unborn child than measuring total hCG.

Norms for free β-hCG subunit in the first trimester:

Norms in ng / ml may vary in different laboratories, therefore the data indicated is not final, and in any case you should consult your doctor. If the result is indicated in MoM, then the norms are the same for all laboratories and for all analyzes: from 0.5 to 2 MoM.

If hCG is not normal, then:

1. If the free β-hCG is higher than normal for your gestational age, or more than 2 MoM, then the child has an increased risk of Down syndrome.
2. If the free hCG β-subunit is below normal for your gestational age, or is less than 0.5 MoM, then the baby is at increased risk of Edwards syndrome.

PAPP-A norm

PAPP-A, or "pregnancy-associated plasma protein A" as it is called, is the second indicator used in first trimester biochemical screening. The level of this protein constantly increases during pregnancy, and deviations in the indicator may indicate various diseases in the unborn child.

Norm for PAPP-A depending on the duration of pregnancy:

Gestational age, weeks	HCG in ng/ml
8-9 weeks	0.17 - 1.54 mU/ml, or 0.5 to 2 MoM
9-10 weeks	0.32 - 2.42 mU/ml, or 0.5 to 2 MoM
10-11 weeks	0.46 - 3.73 mU/ml, or 0.5 to 2 MoM
11-12 weeks	0.79- 4.76 mU/ml, or 0.5 to 2 MoM
12-13 weeks	1. 03 - 6.01 mU/ml, or 0.5 to 2 MoM
13-14 weeks	1.47 - 8.54 mU/ml, or 0.5 to 2 MoM

Norms in ng / ml may vary in different laboratories, therefore the data indicated is not final, and in any case you should consult your doctor. If the result is indicated in MoM, then the norms are the same for all laboratories and for all analyzes: from 0.5 to 2 MoM.

If PAPP-A is abnormal:

1. If PAPP-A is lower for your gestational age, or less than 0.5 MoM, your baby is at increased risk of Down syndrome and Edwards syndrome.
2. If PAPP-A is higher than normal for your gestational age, or more than 2 MoM, but other screening values ​​are normal, then there is no cause for concern.

Studies have shown that women with elevated PAPP-A levels during pregnancy are not at greater risk of fetal disease or pregnancy complications than other women with normal PAPP-A.

What if I am at high risk?

If your screening results in an increased risk of having a baby with Down syndrome, then this is not a reason to terminate the pregnancy. You will be referred for a consultation with a geneticist who, if necessary, will recommend examinations: chorionic villus biopsy or amniocentesis

How to confirm or refute the screening results?

If you think that the screening was not done correctly, you should be re-examined at another clinic, but for this you need to retake all the tests and undergo an ultrasound. This method is possible only if the gestational age at the time of the examination does not exceed 13 weeks and 6 days.

The doctor says I need an abortion. What to do?

Unfortunately, there are times when a doctor strongly recommends or even forces an abortion based on screening results. Remember: no doctor has the right to such actions. Screening is not a definitive method for diagnosing Down syndrome and, based on poor results alone, a pregnancy should not be terminated.

Say that you want to consult a geneticist and undergo diagnostic procedures for Down syndrome (or other disease): chorionic villus biopsy (if you are 10-13 weeks pregnant) or amniocentesis (if you are 16-17 weeks pregnant).

The author of the article:

Ananyina Anna Alexandrovna

Obstetrician-gynecologist

Work experience since 2010
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Eat more foods rich in iron: beef tongue, liver, buckwheat and oatmeal, prunes, dried apricots, green apples, etc. But diet alone will not work to raise hemoglobin.
Medical therapy with iron supplements is required. If the problem is associated with insufficient intake of iron into the body, one set of drugs is needed, if with absorption, another. The doctor must select drugs.
Injection therapy may be required for more severe anemia.

If there are no contraindications, natural childbirth is possible. Only an obstetrician-gynecologist should decide on the possibility of EP.

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With an increase in the duration of pregnancy and the growth of the baby, the uterus increases - this can lead to increased tone. Sometimes tension arises in response to the movements of the child. Strong physical exertion, stress, overwork of a pregnant woman can also lead to increased tone.
In early pregnancy, uterine tone may be associated primarily with reduced progesterone production. In this case, the doctor prescribes the patient treatment with progesterone preparations.
Symptoms of increased tone
All pregnant women experience tone differently. Someone - like heaviness and tension in the lower abdomen. Others - as a pulling pain in the lumbar region. In the 2nd and 3rd trimesters of pregnancy, a woman can feel the tone by putting her hand on her stomach: the uterus becomes "stone", then relaxes.

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