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.
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.


METHODS
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.


CONCLUSIONS
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.
Coleman
M A
MA
Department of Obstetrics and Gynaecology and the Research Centre in Reproductive Medicine, University of Auckland School of Medicine, Auckland, New Zealand.
France
J T
JT
Schellenberg
J C
JC
Ananiev
V
V
Townend
K
K
Keelan
J A
JA
Groome
N P
NP
McCowan
L M
LM
D028341:Activins; D002352:Carrier Proteins / Q000097:blood*; D003346:Corticotropin-Releasing Hormone / Q000097:blood*; D003907:Dexamethasone / Q000494:pharmacology / Q000627:therapeutic use; D004964:Estriol / Q000097:blood; D005260:Female; D005865:Gestational Age; D005938:Glucocorticoids / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D007265:Inhibins / Q000097:blood*; D016015:Logistic Models; D007752:Obstetric Labor, Premature / Q000097:blood / Q000175:diagnosis*; D011247:Pregnancy; D011446:Prospective Studies
D002352:Carrier Proteins; D005938:Glucocorticoids; D028341:Activins; C067133:corticotropin releasing factor-binding protein; D007265:Inhibins; D003907:Dexamethasone; D003346:Corticotropin-Releasing Hormone; D004964:Estriol