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The Utility of Plasma CRH as a Predictor of Preterm Delivery

Departments of Endocrinology (W.J.I., T.C.R.P., M.J.E., J.H.L., R.A.D.), Christchurch Hospital and Obstetrics and Gynecology (L.H., R.R., P.S.B.), Christchurch Women’s Hospital, Christchurch, 8001 New Zealand

Address all correspondence to: Dr. M. Jane Ellis, Department of Endocrinology, Christchurch Hospital, Private Bag 4710, Christchurch, 8001 New Zealand. E-mail: jane.ellis{at}cdhb.govt.nz

Abstract

It has been suggested that CRH is a placental clock that controls the duration of pregnancy and that the timing of the rise in CRH may permit prediction of the onset of labor. We have performed a prospective longitudinal study, in 297 women, to examine the utility of a single second-trimester plasma CRH measurement to predict preterm delivery. Venous blood samples were taken at 4-weekly intervals, beginning at 16–20 wk gestation, until delivery for CRH and its binding protein. A time point at which a single plasma CRH test might give optimal data to predict preterm delivery was determined. Thirty-one subjects delivered prematurely (10.4%). Sampling for plasma CRH at 26 wk gestation seemed the optimal time point to maximize sensitivity and specificity of the test. The mean (± SD) plasma CRH in women at this gestation who eventually delivered after spontaneous labor within 1 wk of their due date (39–41 wk, n = 127) was 34.7 ± 27.0 pM. A plasma CRH of more than 90 pM at 26 wk gestation had a sensitivity of 45% and a specificity of 94% for prediction of preterm delivery. The positive predictive value was 46.7%. Calculation of free CRH did not improve these figures. In conclusion, a single measurement of plasma CRH, toward the end of the second trimester, may identify a group at risk for preterm delivery, but over 50% of such deliveries will be unpredicted. These data do not support the routine clinical use of plasma CRH as a predictor of preterm labor.

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