Predicting risk of preterm delivery by second-trimester measurement of maternal plasma corticotropin-releasing hormone and α-fetoprotein concentrations

McLean, Mark; Bisits, Andrew; Davies, Joanne; Walters, William A. W.; Hackshaw, Allan; Voss, Kerry De; Smith, Roger

doi:10.1016/s0002-9378(99)70461-8

Cited by 97 publications

(53 citation statements)

References 22 publications

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“…Recent advances in prenatal health care have markers that facilitate more accurate prediction of preterm birth. The use of biological markers to enhance clinical accuracy in predicting preterm birth has been recently proposed [2][3][4][5] . These tests have high capacity to identify the patients with high risk.…”

Section: Discussionmentioning

confidence: 99%

“…Accurate markers to determine whether a pregnant woman is at high risk for premature delivery would potentially allow improved surveillance and more timely intervention to improve the outcome [2][3][4][5] .…”

Section: Introductionmentioning

confidence: 99%

“…Many tests have been reported to predict SPB such as cervicovaginal fetal fibronectin and cervical alpha fetoprotein [2][3][4][5] .…”

Section: Introductionmentioning

confidence: 99%

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Beta-human chorionic gonadotropin concentrations in cervicovaginal secretions as an early marker of preterm delivery

Sak

Sak²,

Gül³

2010

J Clin Exp Invest

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ÖZETAmaç: Preterm doğum erken belirteci olarak serviko-vajinal sekresyonlardaki koriyonik gonadotropin'in rolünü araştırmak.Yöntemler: Bir önceki doğumu erken doğum veya ikinci trimester düşük öyküsü risk faktörü olan, 25-36 gebelik haftasına sahip 55 gebe çalışmaya alındı. Hastaların tü-münde servikovajinal sekresyonlardaki beta-insan koriyonik gonadotropin (β-hCG) düzeyleri radioimmunassay yöntemiyle ticari bir kit kullanılarak ölçüldü. Bulgular:Gebelerden 25'i preterm, 30'u term doğum yaptı. Term ve preterm doğum yapana gebe grupları arasında yaş, gebelik sayısı ve parite açısından farklılık saptanmadı (P>0.05). Preterm doğum grubunda yenidoğan APGAR skorları ve bebeklerin antropometrik ölçümleri term doğum grubundan anlamlı düşük bulundu (P<0.05). Serviko-vaginal β-hCG düzeyleri; preterm grubunda, term doğum grubuna göre anlamlı yüksek bulundu (sırasıyla 94.7±37.7 mIU/ml ve 35.5±14.8 mIU/ml, P<0.001). Beta-hCG için, 75 mIU/ml cut-off değeri olarak alındığında; duyarlılığı %76, özgüllüğü %91.6, pozitif prediktif değeri %95 ve negatif prediktif değeri %79.9 olarak bulundu. Sonuç: Preterm doğum açısından yüksek riskli hastalarda servikovajinal sekresyonlardaki β-hCG konsantrasyonu iyi bir biyokimyasal belirteç olabilir. Servikovajinal sıvılardaki β-hCG düzeyine dayanarak preterm doğum geliştireceği öngörülen hastalarda daha yakın takip ile komplikasyonlar azaltılabilir. Klin Den Ar Derg 2010; 1(1): [16][17][18][19][20] Anahtar kelimeler: Preterm doğum, beta-hCG, prediktif değer, serviko-vajinal sekresyonlar ABSTRACT Objectives: To investigate beta-human corionic gonadotropin (β-hCG) levels in cervicovaginal secretions as an early marker for preterm delivery. Methods:The study included 55 patients at 25-36 of gestational weeks with preterm delivery risk factors including a history of preterm labor in a previous pregnancy or history of second trimester abortion. Beta-human chorionic gonadotropin (β-hCG) levels of cervicovaginal secretions were measured in all patients by the radioimmunoassay method using a commercial kit.Results: Preterm delivery was observed in 25 patients and 30 patients gave term delivery. No significant differences were found between preterm and term delivery groups in age, gravidity and parity (P>0.05). APGAR scores and anthropometric measurements of newborns were significantly lower in preterm delivery group (P<0.001). Preterm delivery group had significantly higher cervicovaginal β-hCG levels compared with normal controls (94.7±37.7 vs. 35.5±14.8 mIU/ml, respectively, P<0.001). When 75 mIU/ml value of β-hCG level was taken as cut-off value; the sensitivity of the test was found as 76%, specifity 91.6%, positive predictive value 95.0% and negative predictive value as 79.9%. Conclusion:Concentrations of β-hCG in cervicovaginal secretions may be a useful early biochemical marker to detect preterm. Based on β-hCG levels in cervicovaginal secretions a closer follow-up may decrease some complications of preterm delivery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Beta-human chorionic gonadotropin concentrations in cervicovaginal secretions as an early marker of preterm delivery

Sak

Sak²,

Gül³

2010

J Clin Exp Invest

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“…Maternal plasma CRH levels at midgestation are higher in women who subsequently have spontaneous PTD than in pregnant women delivering at term [92]; moreover, women affected by threatened preterm labor present higher plasma CRH levels when delivering within 24 h than when delivering later [92]. Measurement of maternal serum CRH would not satisfy the requisites of a screening test for PTD in a low-risk population, although it should be considered a potential marker to be used in populations with a higher risk [93]; however, its clinical relevance has still to be confirmed.…”

Section: Prognostic Toolsmentioning

confidence: 96%

The obstetric syndromes: clinical relevance of placental hormones

Severi

Bonis

Vellucci

et al. 2013

Expert Review of Endocrinology & Metabolism

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Preterm delivery, preeclampsia and intrauterine growth restriction are the major diseases of pregnancy. A key role in their pathogenesis is played by the placenta, which is the source of hormones and other important regulatory molecules providing the metabolic and endocrine homeostasis of the fetal-placental unit. Since obstetric syndromes are characterized by important maternal and neonatal morbidity and mortality worldwide, numerous efforts have been made over the years to prevent and treat them. Due to their complex pathogenesis, however, the therapy is poor and not very effective. Therefore, great emphasis is currently given to the prevention of these diseases through the identification of biochemical and biophysical markers, among which placental factors play a crucial role. The increasing knowledge of the role of placental molecules can indeed lead to the development of new therapeutic and diagnostic tools. The obstetric syndromes: clinical relevance of placental hormonesExpert Rev. Endocrinol. Metab. 8(2), 127-138 (2013)

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“…During pregnancy, cortisol stimulates the production of CRH in the placenta [11]. In several studies, higher levels of both cortisol and CRH have been found in medically complicated pregnancies [12][13][14]. A recent population study of 2.6 million pregnancies in USA revealed that stress in the late 2 nd trimester (month 5 and 6) particularly increases risk of adverse pregnancy outcomes including shortened gestation age, preterm birth (odds ratio (OR)=1.24), low birth weight (OR=1.38), and small for gestational age (OR=1.25) [15].…”

Section: Introductionmentioning

confidence: 99%

Common variants of the mineralocorticoid and glucocorticoid receptor genes may contribute to pregnancy-related anxiety: a pilot study

2012

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AbstractThe hypothalamic-pituitary-adrenal (HPA) axis overactivity is thought to contribute to increased vulnerability to maternal stress. We hypothesize that functionally relevant polymorphic variants of the glucocorticoid (NR3C1) and mineralocorticoid (NR3C2) receptor genes mediating biological effects of cortisol, a major stress hormone, could also modulate the capacity to cope with pregnancy-related anxiety. Genomic DNA from the blood of 42 women with pregnancy-related anxiety and 42 age-matched women with normal pregnancy (5–6th months of gestation) were genotyped for markers rs6195 and rs10482605 of NR3C1 and two NR3C2 polymorphisms (rs5522 and rs2070951) using a Taqman allele discrimination assay. Serum total cortisol was measured using an ELISA technique. The allele Ser363 of rs6195 (the N363S polymorphism of NR3C1) was found to be associated with a higher risk of maternal stress (odds ratio (OR)=5.27; P=0.001). For NR3C2, the allele Val180 of rs5522 (I180V) also showed association with increased risk of neonatal stress (OR=1.97; P=0.038). Both predisposing gene variants were also associated with significantly elevated levels of cortisol in normally pregnant women and females with pregnancy-related anxiety. Our results suggest that pregnancy-related anxiety can be modulated by variants of NR3C1 and NR3C2 associated with increased basal cortisol levels. Thus, our findings provide evidence in support of the suggestion that elevated cortisol levels and HPA axis hyperactivity are implicated in pregnancy-related anxiety.

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Predicting risk of preterm delivery by second-trimester measurement of maternal plasma corticotropin-releasing hormone and α-fetoprotein concentrations

Cited by 97 publications

References 22 publications

Beta-human chorionic gonadotropin concentrations in cervicovaginal secretions as an early marker of preterm delivery

Beta-human chorionic gonadotropin concentrations in cervicovaginal secretions as an early marker of preterm delivery

The obstetric syndromes: clinical relevance of placental hormones

Common variants of the mineralocorticoid and glucocorticoid receptor genes may contribute to pregnancy-related anxiety: a pilot study

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