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Performance of plasma kisspeptin as a biomarker for miscarriage improves with gestation during the first trimester

Research output: Contribution to journalArticlepeer-review


Ali Abbara, Maya Al-Memar, Maria Phylactou, Christopher Kyriacou, Pei Chia Eng, Rans Nadir, Chioma Izzi-Engbeaya, Sophie A. Clarke, Edouard G. Mills, Elisabeth Daniels, Lechun Huo, Ewa Pacuszka, Lisa Yang, Bijal Patel, Tricia Tan, Paul Bech, Alexander N. Comninos, Hanine Fourie, Tom Kelsey, Tom Bourne & 1 more Waljit S. Dhillo

School/Research organisations


Objective: To compare the performance of kisspeptin and beta human chorionic gonadotropin (βhCG), both alone and in combination, as biomarkers for miscarriage throughout the first trimester.

Design: Prospective, nested case-control study.

Setting: Tertiary Centre, Queen Charlotte Hospital, London, United Kingdom.

Patient(s): Adult women who had miscarriages (n = 95, 173 samples) and women with healthy pregnancies (n = 265, 557 samples).Intervention(s)The participants underwent serial ultrasound scans and blood sampling for measurement of plasma kisspeptin and βhCG levels during the first trimester.

Main Outcome Measure(s): The ability of plasma kisspeptin and βhCG levels to distinguish pregnancies complicated by miscarriage from healthy pregnancies unaffected by miscarriage.

Result(s): Gestation-adjusted levels of circulating kisspeptin and βhCG were lower in samples from women with miscarriages than in women with healthy pregnancies by 79% and 70%, respectively. The area under the receiver-operating characteristic curve for identifying miscarriage during the first trimester was 0.874 (95% confidence interval [CI] 0.844–0.904) for kisspeptin, 0.859 (95% CI 0.820–0.899) for βhCG, and 0.916 (95% CI 0.886–0.946) for the sum of the two markers. The performance of kisspeptin in identifying miscarriage improved with increasing length of gestation, whereas that of βhCG worsened. A decision matrix incorporating kisspeptin, βhCG, and gestational age had 83% to 87% accuracy for the prediction of miscarriage.

Conclusion(s): Plasma kisspeptin is a promising biomarker for miscarriage and provides additional value to βhCG alone, especially during later gestational weeks of the first trimester.


Original languageEnglish
Pages (from-to)809-819
Number of pages11
JournalFertility and Sterility
Issue number3
Early online date27 May 2021
Publication statusPublished - Sep 2021

    Research areas

  • Kisspeptin, Miscarriage, Pregnancy

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