High maternal serum chorionic gonadotropin level in Downs' syndrome pregnancies is caused by elevation of both subunits messenger ribonucleic acid level in trophoblasts.

A unique product of human placenta is CG. Its concentration in maternal blood rises exponentially until 9-10 weeks' gestation, thereafter, it decreases to about 20% of the maximum, remaining constant from 16-17 until 40 weeks. High second-trimester maternal blood level indicates an increased risk for Downs' Syndrome (DS). This study's aim was to determine whether changes occur in the genetic expression of CG subunits in cultured trisomy-21 trophoblasts compared with various gestational age controls. Second-trimester trisomy-21 trophoblasts secrete 10 times more CG than gestational age-matched controls during the first day in culture: 878 (range, 235-2230) IU/g vs. 87 (range, 20-150) IU/g (P < 0.05). This high secretion closely resembles quantities secreted by first-trimester normal trophoblasts: 7500 (range, 3,850-10,000) IU/g. Both subunits' messenger RNA content are substantially increased, CG beta much more than CG alpha, although these genes are not located on chromosome 21. We conclude that at least one cause of high second-trimester maternal blood CG in DS pregnancies is a rise in alpha and beta CG messenger RNA levels in the trophoblast. We propose that at 12-14 weeks, when rapid decrease in maternal blood CG levels can be found, higher than normal values may indicate an increased risk for DS.