Predicting risk of preterm delivery by second-trimester measurement of maternal plasma corticotropin-releasing hormone and α-fetoprotein concentrations

The relationships and predictive abilities of perceived stress, selected clinical risk factors, and corticotropin-releasing hormone (CRH) levels in maternal plasma were investigated for their association with preterm labor (PTL), preterm birth, and gestational age at delivery. An exploratory, prospective, longitudinal research design was used to measure CRH 4 times over pregnancy, perceived stress at 24 and 32 weeks of pregnancy, clinical risk factors, and genitourinary infections in low-income women. Multiple regression analyses revealed that a model of measurement of perceived stress at 24 or 32 weeks, CRH at 24 or 32 weeks, and PTL (indicated by a diagnosis by the physicians on the medical record and greater than 5 contractions per hour on the fetal monitor) was predictive of as much as 0.23 to 0.27 of the variance in gestational age at birth. Entering ethnicity as a variable into a model did not improve the predictive value. An analysis of variance between Caucasian and Hispanic ethnic groups revealed differences in CRH levels. However, simple regression analysis of ethnicity as a predictor showed a weak r 2 with no significance for prediction. There was some evidence of an association of smoking with stress and both PTL and preterm birth. The measurement of stress combined with the measurement of CRH from maternal plasma may improve the prediction of which pregnant women are at risk for preterm birth. The measurement of CRH has potential as an early biological marker of preterm birth.

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Plasma corticotropin-releasing hormone, β-endorphin and cortisol inter-relationships during human pregnancy

Acta Endocrinologica ◽

10.1530/acta.0.1280339 ◽

1993 ◽

Vol 128 (4) ◽

pp. 339-344 ◽

Cited By ~ 64

Author(s):

Eng-Cheng Chan ◽

Roger Smith ◽

Terry Lewin ◽

Max W Brinsmead ◽

Hong-Ping Zhang ◽

...

Keyword(s):

Cord Blood ◽

Maternal Plasma ◽

Corticotropin Releasing Hormone ◽

Third Trimester ◽

Blood Samples ◽

Releasing Hormone ◽

Human Pregnancy ◽

The Third ◽

Dynamic Relationships

To investigate the dynamic relationships among corticotropin-releasing hormone (CRH), β-endorphin (βEP), cortisol and obstetric events during pregnancy, blood samples were collected from 193 women at 28 weeks, 38 weeks, during labour and on the second postnatal day. Cord blood at delivery was also obtained. We found that: (1) Maternal plasma CRH, βEP and cortisol rose from 28 to 38 weeks. (2) During the third trimester maternal plasma CRH and βEP were correlated (r=0.30, p<0.001). (3) During labour, no correlations were found among maternal plasma CRH, βEP and cortisol. (4) Maternal CRH at labour and the duration of labour were not correlated. (5) Maternal plasma CRH tended to be higher in women who delivered early (more than seven days prior to estimated date of confinement [EDC]) relative to those who were on time (within seven days' EDC) or late (greater than seven days after EDC). (6) CRH in maternal plasma at labour and cord blood were correlated (r = 0.29, p<0.05) as were maternal and fetal βEP (r=0.43, p<0.001). (7) Fetal obstetric difficulty was correlated with fetal βEP (r=0.54, p<0.001). Our findings support the hypothesis that maternal plasma CRH regulates maternal βEP during the third trimester, but other factors are involved during labour and in response to maternal obstetric stress.

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