This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints, Permissions and Rights Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Florio, P. Articles by Petraglia, F. Search for Related Content PubMed PubMed Citation Articles by Florio, P. Articles by Petraglia, F. Related Collections Neuroendocrinology and Pituitary Pediatric Endocrinology Female Endocrinology

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

Department of Pediatrics, Obstetrics, and Reproductive Medicine (P.F., M.T., F.P.), University of Siena, 53100 Siena, Italy; Perinatology Research Branch (R.R., T.C., J.P.K.), National Institute of Child Health and Human Development/ National Institutes of Health/Department of Health and Human Services, Bethesda, Maryland 20814, and Detroit, Michigan 48202, and Wayne State University/Hutzel Hospital, Department of Obstetrics and Gynecology, Detroit, Michigan 48202; and School of Animal and Microbial Sciences (P.J.L.), University of Reading, Whiteknights Campus, Reading RG6 6UR, United Kingdom

Address all correspondence and requests for reprints to: Pasquale Florio, M.D., Ph.D., Chair of Obstetrics and Gynecology, Department of Pediatrics, Obstetrics, and Reproductive Medicine, University of Siena, Policlinico "Le Scotte" Viale Bracci, 53100 Siena, Italy. E-mail: florio{at}unisi.it.

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.