Amniotic Fluid and Umbilical Cord Plasma Corticotropin-Releasing Factor (CRF) CRF-Binding Protein Adrenocorticotropin and Cortisol Concentrations in Intraamniotic Infection and Inflammation at Term

摘要

>Context: 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. >Design: This was a cross-sectional study. >Setting: The study was conducted at a tertiary referral center for obstetric care. >Patients: Patients included women in active labor at term with (n = 39) and without (controls; n = 78) IAI. >Main Outcome Measures: 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.