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Preterm Birth: Associated Neuroendocrine, Medical, and Behavioral Risk Factors¹

Department of Psychology, American University (K.E.), Washington, D.C. 20016; Division of Child Development, Disability, and Health, Centers for Disease Control and Prevention (P.T.), Atlanta, Georgia 30333; Danish Epidemiology Sciences Centre, Aarhus University, Aarhus, Denmark; Pediatric and Reproductive Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health (G.C.), Bethesda, Maryland 20892; Neurocrine Biosciences, Inc. (D.E.G., O.K.), San Diego, California 92121; Department of Obstetrics and Gynecology, University of Colorado (J.M.), Denver, Colorado 80217; and Department of Physiology and Biophysics, Georgetown University (J.S.), Washington, D.C. 20007

Address all correspondence and requests for reprints to: Jay Schulkin, Ph.D., Department of Physiology and Biophysics, Basic Science Building, Georgetown University, Washington, D.C. 20007. E-mail: jschulkin{at}acog.org

Abstract

Increased CRH secretion by the placenta of pregnant women has been associated with preterm birth. Certain indices of risk, both medical and psychosocial in nature, have been linked to preterm delivery. Levels of total, bound, and free CRH, CRH-binding protein (CRH-BP), and cortisol were measured prospectively in a large sample of pregnant Danish women who delivered preterm and term infants. Measures of maternal serum hormones were taken at 7–23 and 27–37 weeks gestation and, for those who delivered at term, at 37–43 weeks gestation. At 7–23 weeks gestation, maternal levels of total CRH (P = 0.01), bound CRH (P = 0.03), and CRH-BP (P = 0.01) were higher in the preterm than in the term group. At 27–37 weeks gestation, levels of total CRH (P < 0.0001), bound CRH (P < 0.0001), free CRH (P < 0.0001), and cortisol (P < 0.0001) were all higher in the preterm than the term group, whereas levels of CRH-BP (P < 0.0001) were lower in the preterm than in the term group. The best medical and behavioral factors associated with preterm delivery were, respectively, previous preterm delivery (P < 0.0001) and engagement in certain risk-taking behaviors (P = 0.008). The positive relations between preterm delivery and various adverse medical and socioeconomic variables with increases in placental secretion of CRH suggest that the latter may participate in the pathophysiology of preterm delivery.

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