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

• Published in: American journal of obstetrics and gynecology Vol. 183; no. 3; pp. 643 - 648
• Main Authors: Coleman, Matthew A.G., France, John T., Schellenberg, Jean-Claude, Ananiev, Valentin, Townend, Kevin, Keelan, Jeffrey A., Groome, Nigel P., McCowan, Lesley M.E.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.09.2000; Elsevier
• Subjects: activin A; Activins; Antenatal glucocorticoids; Biological and medical sciences; Carrier Proteins - blood; corticotropin-releasing hormone; Corticotropin-Releasing Hormone - blood; corticotropin-releasing hormone–binding hormone; Delivery. Postpartum. Lactation; Dexamethasone - pharmacology; Dexamethasone - therapeutic use; Estriol - blood; Female; Gestational Age; Glucocorticoids - pharmacology; Glucocorticoids - therapeutic use; Gynecology. Andrology. Obstetrics; Humans; Inhibins - blood; Logistic Models; Maternal, fetal and perinatal monitoring; Medical sciences; Obstetric Labor, Premature - blood; Obstetric Labor, Premature - diagnosis; Pregnancy; preterm delivery; preterm labor; Prospective Studies; preterm labor; corticotropin-releasing hormone; corticotropin-releasing hormone–binding hormone; Antenatal glucocorticoids; preterm delivery; activin A; Pregnancy; Human; Binding protein; Prognosis; Mother; Corticotropin releasing factor; Prediction; Female; Delivery; Activin; Glucocorticoid; Blood plasma
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1067/mob.2000.106592

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 (χ2 = 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 (χ2 = 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. (Am J Obstet Gynecol 2000;183:643-8.)