Editors' ChoicePlacental corticotropin-releasing hormone (CRH), spontaneous preterm birth, and fetal growth restriction: A prospective investigation
Section snippets
Material and methods
We conducted a prospective, longitudinal investigation in a sample of women recruited during pregnancy and monitored through delivery. Our sample included low-risk as well as high-risk pregnancies, and deliveries were differentiated on the basis of presence/absence of labor preceding delivery.
Statistical analysis
Associations among continuous variables were computed with Pearson product-moment correlation coefficients, whereas those involving categorical variables were computed with an exact test of significance (Student t tests for independent samples with unequal Ns), χ2 or odds ratios. When necessary, the t test was modified to allow for unequal variances. The joint contributions of 2 or more predictors on categorical outcomes were computed by using multivariate logistic regression procedures to
Results
The mean plasma concentration of CRH (at 33 weeks' gestation) was 140.81 ± 10.35 pg/mL (±SEM). These values were approximately normally distributed (ie, skewness <2).
Delivery was preceded by labor in all subjects. The mean gestational age at birth was 39.3 ± 0.09 weeks (±SEM), and ranged between 34.5 and 43.1 weeks; 22 of these deliveries (9.5%) were preterm (<37 completed weeks' gestation) and 18 (7.8%) were postterm (>41 completed weeks' gestation). The mean infant birth weight was 3384 ±
Comment
These results demonstrate that in humans, placental CRH plays an impending role in not only the physiology of parturition but also in processes related to fetal growth and maturation. Moreover, our findings are also among the first to suggest that placental CRH directly participates in these physiologic processes, as evidenced by the prospective relationship between elevated CRH levels and relative risk for preterm birth and fetal growth restriction after adjusting for the effects of other
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Supported in part by US PHS (NIH) grants HD-28413, HD-33506, and HD-041696.