Amniotic fluid and umbilical cord plasma corticotropin-releasing factor (CRF), CRF-binding protein, adrenocorticotropin, and cortisol concentrations in intraamniotic infection and inflammation at term.
BACKGROUND
Pregnant tissues express corticotropin-releasing factor (CRF), a peptide modulating fetal and placental ACTH and cortisol secretion. These actions are modulated by the locally expressed CRF-binding protein (CRF-BP).


OBJECTIVE
The objective of the study was to determine whether CRF, CRF-BP, ACTH, and cortisol concentrations change in amniotic fluid and umbilical cord plasma in the presence of intraamniotic infection/inflammation (IAI) in women with spontaneous labor at term.


METHODS
This was a cross-sectional study.


METHODS
The study was conducted at a tertiary referral center for obstetric care.


METHODS
Patients included women in active labor at term with (n = 39) and without (controls; n = 78) IAI.


METHODS
Amniotic fluid and umbilical cord plasma concentrations of CRF, CRF-BP, ACTH, and cortisol measured by RIA and immunoradiometric assays were measured.


RESULTS
In patients with IAI, amniotic fluid CRF (0.97 +/- 0.18 ng/ml) and CRF-BP (33.06 +/- 5.54 nmol/liter) concentrations were significantly (P < 0.001) higher than in controls (CRF: 0.32 +/- 0.04 ng/ml; CRF-BP: 14.69 +/- 2.79 ml). The umbilical cord plasma CRF and CRF-BP concentrations were significantly (P < 0.001 for all) higher in women with IAI than in controls (CRF: 2.96 +/- 0.35 ng/ml vs. 0.38 +/- 0.18 ng/ml; CRF-BP: 152.12 +/- 5.94 nmol/liter vs. 106.9 +/- 5.97 nmol/liter). In contrast, amniotic fluid and umbilical cord plasma ACTH and cortisol concentrations did not differ between groups.


CONCLUSIONS
Amniotic fluid and umbilical cord plasma CRF and CRF-BP concentrations are increased in women with spontaneous labor at term and IAI. CRF-BP may modulate CRF actions on ACTH and cortisol secretion, playing a pivotal role in limiting the inflammatory process and thus avoiding an overactivation of the fetal/placental hypothalamus-pituitary-adrenal axis at birth.
Department of Pediatrics, Obstetrics, and Reproductive Medicine, University of Siena, Policlinico Le Scotte Viale Bracci, 53100 Siena, Italy. florio@unisi.it
Pasquale
P
Florio
Roberto
R
Romero
Tinnakorn
T
Chaiworapongsa
Juan Pedro
JP
Kusanovic
Michela
M
Torricelli
Phil J
PJ
Lowry
Felice
F
Petraglia
D000324:Adrenocorticotropic Hormone / Q000032:analysis* / Q000097:blood / Q000378:metabolism; D000653:Amniotic Fluid / Q000737:chemistry* / Q000166:cytology / Q000382:microbiology; D001424:Bacterial Infections / Q000097:blood / Q000378:metabolism / Q000473:pathology*; D002352:Carrier Proteins / Q000032:analysis* / Q000097:blood / Q000378:metabolism; D016022:Case-Control Studies; D003346:Corticotropin-Releasing Hormone / Q000032:analysis* / Q000097:blood / Q000378:metabolism; D003430:Cross-Sectional Studies; D005260:Female; D005312:Fetal Blood / Q000737:chemistry* / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis* / Q000097:blood / Q000378:metabolism; D007249:Inflammation / Q000097:blood / Q000378:metabolism / Q000473:pathology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000382:microbiology / Q000473:pathology; D047929:Term Birth / Q000097:blood / Q000378:metabolism
D002352:Carrier Proteins; C067133:corticotropin releasing factor-binding protein; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone