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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.