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Reference ranges of AMH in early pregnancy: the Generation R Study, a population-based prospective cohort study
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  • Ramon Dykgraaf,
  • Joop Laven,
  • Sarah Timmermans,
  • Maria Adank,
  • Sjoerd van den Berg,
  • Brigitta van de Lang - Born,
  • T I M Korevaar,
  • Ajay Kumar,
  • Bhanu Kalra,
  • Gopal Savjani,
  • Eric Steegers,
  • Yvonne Louwers
Ramon Dykgraaf
Erasmus Medical Center

Corresponding Author:[email protected]

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Joop Laven
Erasmus Medical Center
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Sarah Timmermans
Erasmus Medical Centre
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Maria Adank
Erasmus Medical Center
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Sjoerd van den Berg
Erasmus Medical Center
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Brigitta van de Lang - Born
Erasmus Medical Center
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T I M Korevaar
The Generation R Study Group, Erasmus Medical Center,Netherlands
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Ajay Kumar
Ansh Labs LLC
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Bhanu Kalra
Ansh Labs LLC
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Gopal Savjani
Ansh Labs LLC
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Eric Steegers
Erasmus University Medical Centre
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Yvonne Louwers
Erasmus Medical Center
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Abstract

Objective: The objective of this study is to establish maternal reference values of AMH in a fertile multi-ethnic urban pregnant population and to evaluate the effect of gestational age. Design: The Generation R Study is an ongoing population-based prospective cohort study from early pregnancy onwards. Setting: Rotterdam, the Netherlands, out of hospital setting. Population: In 5806 women serum AMH levels were determined in early pregnancy (median 13.5 weeks; 95% range 10.5-17.2). Methods: The model-based AMH reference ranges for maternal age and gestational age were created using GAMLSS. Associations between AMH and several first trimester biomarkers were analyzed using multivariate linear regression analyses. Main outcome measures: AMH levels in early pregnancy and the association with placental biomarkers, hCG, sFLT, and PLGF. Results: A nomogram of AMH in early pregnancy was developed. Serum AMH levels showed a decline with advancing gestational age. Higher AMH levels were associated with a higher level of hCG and sFLT. This last association was predominantly mediated by hCG. AMH levels were negatively associated with PLGF levels. Conclusion: In this large study we show that AMH levels in the first trimester decrease with advancing gestational age. The association between AMH and the placental biomarkers hCG, sFLT and PLGF suggests a better placental development with a lower vascular resistance in mothers with higher AMH levels. AMH might be useful in predicting adverse pregnancy outcome due to impaired placental development. Keywords: Ovarian reserve, placental biomarker, nomogram, first trimester, human Choriogonadotrophin (hCG), soluble FMS-Like Tyrosine kinase-1 (sFLT), Placental Growth Factor (PLGF).
01 Dec 2021Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
29 Dec 2021Submission Checks Completed
29 Dec 2021Assigned to Editor
31 Dec 2021Reviewer(s) Assigned
26 Jan 2022Review(s) Completed, Editorial Evaluation Pending