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The Measurement of Maternal Plasma Corticotropin-Releasing Factor (CRF) and CRF-Binding Protein Improves the Early Prediction of Preeclampsia

Department of Pediatrics, Obstetrics, and Reproductive Medicine, University of Siena (P.F., A.I., F.M.R., F.S., M.T., F.P.), 53100 Siena, Italy; and School of Animal and Microbial Sciences, University of Reading (P.J.L.), Reading RG6 6AJ, United Kingdom

Address all correspondence and requests for reprints to: Dr. Felice Petraglia, Department of Pediatrics, Obstetrics, and Reproductive Medicine, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy. E-mail: petraglia{at}unisi.it.

In the present study we measured maternal plasma concentrations of two placental neurohormones, corticotropin-releasing factor (CRF) and CRF-binding protein (CRF-BP), in 58 at-risk pregnant women consecutively enrolled between 28 and 29 wk of pregnancy to evaluate whether their evaluation may predict third trimester-onset preeclampsia (PE). The statistical significance was assessed by t test. The cut-off points for defining altered CRF and CRF-BP levels for prediction of PE were chosen by receiving operator characteristics curve analysis, and the probability of developing PE was calculated for several combinations of hormone testing results. CRF and CRF-BP levels were significantly (both P < 0.0001) higher and lower, respectively, in the patients (n = 20) who later developed PE than in those who did not present PE at follow-up. CRF at the cut-off 425.95 pmol/liter achieved a sensitivity of 94.8% and a specificity of 96.9%, whereas CRF-BP at the cut-off 125.8 nmol/liter combined a sensitivity of 92.5% and a specificity of 82.5% as single markers for prediction of PE. The probability of PE was 34.5% in the whole study population, 93.75% when both CRF and CRF-BP levels were changed, and 0% if both hormone markers were unaltered. The measurement of CRF and CRF-BP levels may add significant prognostic information for predicting PE in at-risk pregnant women.

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