Rate of rise in maternal plasma corticotrophin-releasing hormone and its relation to gestational length

Abstract

Objective: To assess the relationship between rate of increase in maternal plasma corticotrophin-releasing hormone and gestational length. Design: A prospective observational study. Setting: Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong. Methods: Serial venous samples taken at four to six week intervals from 81 pregnant Chinese subjects were assayed for corticotrophin-releasing hormone concentrations. The investigators responsible for the laboratory assay were blinded to the obstetric outcome. Results: A total of 380 blood samples were taken. Each subject provided three to seven samples (median = 5). Seven of the 81 subjects had preterm delivery. Maternal corticotrophin-releasing hormone levels increased exponentially as gestation advanced. A negative correlation between the rate of rise of logarithmic equivalence of corticotrophin-releasing hormone concentrations (Ln-corticotrophin releasing hormone) per week and the gestational age at delivery was demonstrated (r = - 0.45, P < 0.001). The rate of increase of Ln-corticotrophin releasing hormone concentrations per week was also significantly greater for those who delivered preterm before 37 weeks compared with those with uncomplicated term deliveries (0.27 Vs 0.22, P = 0.018). Conclusions: The rate of increase in maternal plasma corticotrophin-releasing hormone is inversely proportional to gestational length. Results in a Chinese population confirm and extend results from previous caucasian populations. This study provides another piece of evidence on the close link between maternal plasma corticotrophin-releasing hormone and the timing of human parturition. As the hormone is synthesized by the placenta, it supports the suggestion that the human placenta has an important role in determining gestational length.