TY - JOUR
T1 - Patterns of Plasma Corticotropin-Releasing Hormone, Progesterone, Estradiol, and Estriol Change and the Onset of Human Labor
AU - Smith, R.
AU - Smith, J.I.
AU - Shen, X.
AU - Engel, P.J.
AU - Bowman, M.E.
AU - Mcgrath, S.A.
AU - Bisits, A.M.
AU - Mcelduff, P.
AU - Giles, W.B.
AU - Smith, David
PY - 2009
Y1 - 2009
N2 - Context: Clinical prediction of preterm delivery is largely ineffective, and the mechanism mediating progesterone (P) withdrawal and estrogen activation at the onset of human labor is unclear.Objectives: Our objectives were to determine associations of rates of change of circulating maternal CRH in midpregnancy with preterm delivery, CRH with estriol (E3) concentrations in late pregnancy, and predelivery changes in the ratios of E3, estradiol (E2), and P.Design and Setting: A cohort of 500 pregnant women was followed from first antenatal visits to delivery during the period 2000–2004 at John Hunter Hospital, New South Wales, Australia, a tertiary care obstetric hospital.Patients: Unselected subjects were recruited (including women with multiple gestations) and serial blood samples obtained.Main Outcome Measures: CRH daily percentage change in term and preterm singletons at 26 wk, ratios E3/E2, P/E3, and P/E2 and the association between E3 and CRH concentrations in the last month of pregnancy (with spontaneous labor onset) were assessed.Results: CRH percentage daily change was significantly higher in preterm than term singletons at 26 wk (medians 3.09 and 2.73; P = 0.003). In late pregnancy, CRH and E3 concentrations were significantly positively associated (P = 0.003). E3/E2 increased, P/E3 decreased, and P/E2 was unchanged in the month before delivery (medians: E3/E2, 7.04 and 10.59, P <0.001; P/E3, 1.55 and 0.98, P <0.001; P/E2, 11.78 and 10.79, P = 0.07).Conclusions: The very rapid rise of CRH in late pregnancy is associated with an E3 surge and critically altered P/E3 and E3/E2 ratios that create an estrogenic environment at the onset of labor. Our evidence provides a rationale for the use of CRH in predicting preterm birth and informs approaches to delaying labor using P supplementation.
AB - Context: Clinical prediction of preterm delivery is largely ineffective, and the mechanism mediating progesterone (P) withdrawal and estrogen activation at the onset of human labor is unclear.Objectives: Our objectives were to determine associations of rates of change of circulating maternal CRH in midpregnancy with preterm delivery, CRH with estriol (E3) concentrations in late pregnancy, and predelivery changes in the ratios of E3, estradiol (E2), and P.Design and Setting: A cohort of 500 pregnant women was followed from first antenatal visits to delivery during the period 2000–2004 at John Hunter Hospital, New South Wales, Australia, a tertiary care obstetric hospital.Patients: Unselected subjects were recruited (including women with multiple gestations) and serial blood samples obtained.Main Outcome Measures: CRH daily percentage change in term and preterm singletons at 26 wk, ratios E3/E2, P/E3, and P/E2 and the association between E3 and CRH concentrations in the last month of pregnancy (with spontaneous labor onset) were assessed.Results: CRH percentage daily change was significantly higher in preterm than term singletons at 26 wk (medians 3.09 and 2.73; P = 0.003). In late pregnancy, CRH and E3 concentrations were significantly positively associated (P = 0.003). E3/E2 increased, P/E3 decreased, and P/E2 was unchanged in the month before delivery (medians: E3/E2, 7.04 and 10.59, P <0.001; P/E3, 1.55 and 0.98, P <0.001; P/E2, 11.78 and 10.79, P = 0.07).Conclusions: The very rapid rise of CRH in late pregnancy is associated with an E3 surge and critically altered P/E3 and E3/E2 ratios that create an estrogenic environment at the onset of labor. Our evidence provides a rationale for the use of CRH in predicting preterm birth and informs approaches to delaying labor using P supplementation.
U2 - 10.1210/jc.2008-2257
DO - 10.1210/jc.2008-2257
M3 - Article
VL - 94
SP - 2066
EP - 2074
JO - Journal of Endocrinology & Metabolism
JF - Journal of Endocrinology & Metabolism
SN - 0021-972X
IS - 6
ER -