Corticotropin-releasing hormone, corticotropin-releasing hormone-binding protein, and activin A in maternal serum: prediction of preterm delivery and response to glucocorticoids in women with symptoms of preterm labor.

Abstract

OBJECTIVE:

The aim of this study was to determine prospectively whether serum concentrations of corticotropin-releasing hormone, corticotropin-releasing hormone-binding protein, and activin A (1) predict preterm birth within 10 days of hospital admission or at <37 weeks' gestation among women with symptoms of preterm labor and (2) are affected by glucocorticoid therapy.

STUDY DESIGN:

Serum concentrations of corticotropin-releasing hormone and activin A were measured in 94 women with symptoms of preterm labor between 24 and 34 weeks' gestation, and delivery outcomes were monitored. Corticotropin-releasing hormone-binding protein concentrations were measured in 71 of these women. In a subgroup of 15 women the serum analytes were assayed in conjunction with estriol before and 12 to 24 hours after administration of dexamethasone.

RESULTS:

Forty-six percent (6/13) of the women who were delivered within 10 days of hospital admission had a raised serum corticotropin-releasing hormone level, but the predictive relationship was not significant (chi(2) = 1.7; P =.2). Among the 31 women (including the 6 previously mentioned) who were delivered at <37 weeks' gestation, 39% (12/31) had a raised corticotropin-releasing hormone level. Although a raised corticotropin-releasing hormone concentration was positively associated with delivery at <37 weeks' gestation (chi(2) = 9; P =.003), the predictive diagnostic value was poor, with sensitivity, specificity, and positive and negative predictive values of 39%, 90%, 67%, and 75%, respectively. The serum concentrations of corticotropin-releasing hormone-binding protein and activin A were unrelated to gestational age at delivery. Dexamethasone markedly lowered the serum estriol level (P <.001) but had no effect on concentrations of corticotropinreleasing hormone, corticotropin-releasing hormone-binding protein, and activin A.

CONCLUSION:

Serum concentrations of corticotropin-releasing hormone, corticotropin-releasing hormone-binding protein, and activin A are not clinically useful for the prediction of preterm delivery among women with symptoms of preterm labor and are not affected by administration of glucocorticoids.

• Authors: M A Coleman, J T France, J C Schellenberg, V Ananiev, K Townend, J A Keelan, N P Groome, L M McCowan
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 183 Issue 3 Pg. 643-8 (Sep 2000) ISSN: 0002-9378 [Print] United States
• PMID: 10992187 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Carrier Proteins
• Glucocorticoids
• Activins
• corticotropin releasing factor-binding protein
• Inhibins
• Dexamethasone
• Corticotropin-Releasing Hormone
• Estriol

Topics

• Activins
• Carrier Proteins (blood)
• Corticotropin-Releasing Hormone (blood)
• Dexamethasone (pharmacology, therapeutic use)
• Estriol (blood)
• Female
• Gestational Age
• Glucocorticoids (pharmacology, therapeutic use)
• Humans
• Inhibins (blood)
• Logistic Models
• Obstetric Labor, Premature (blood, diagnosis)
• Pregnancy
• Prospective Studies