Revisiting the placental clock: Early corticotrophin-releasing hormone rise in recurrent preterm birth.

<h4>Objective</h4>To determine if maternal plasma CRH and preterm birth history were associated with recurrent preterm birth risk in a high-risk cohort.<h4>Study design</h4>Secondary analysis of pregnant women with a prior preterm birth ≤35 weeks receiving 17-alpha hydroxypro...

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Autores principales:	Christina L Herrera, Maria E Bowman, Donald D McIntire, David B Nelson, Roger Smith
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/8d96c2036cb243ddb45e7f73c92f19ae
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spelling	oai:doaj.org-article:8d96c2036cb243ddb45e7f73c92f19ae2021-12-02T20:14:35ZRevisiting the placental clock: Early corticotrophin-releasing hormone rise in recurrent preterm birth.1932-620310.1371/journal.pone.0257422https://doaj.org/article/8d96c2036cb243ddb45e7f73c92f19ae2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0257422https://doaj.org/toc/1932-6203<h4>Objective</h4>To determine if maternal plasma CRH and preterm birth history were associated with recurrent preterm birth risk in a high-risk cohort.<h4>Study design</h4>Secondary analysis of pregnant women with a prior preterm birth ≤35 weeks receiving 17-alpha hydroxyprogesterone caproate for the prevention of recurrent spontaneous preterm birth. All women with a 24-week blood sample were included. Maternal plasma CRH level at 24- and 32-weeks' gestation was measured using both enzyme-linked immunosorbent assay (ELISA) and extracted radioimmunoassay (RIA) technologies. The primary outcome was spontaneous preterm birth <37 weeks. The association of CRH, prior preterm birth history, and the two combined was assessed in relation to recurrent preterm birth risk.<h4>Results</h4>Recurrent preterm birth in this cohort of 169 women was 24.9%. Comparing women who subsequently delivered <37 versus ≥37 weeks, mean levels of CRH measured by RIA were significantly different at 24 weeks (111.1±87.5 vs. 66.1±45.4 pg/mL, P = .002) and 32 weeks (440.9±275.6 vs. 280.2±214.5 pg/mL, P = .003). The area under the receiver operating curve (AUC) at 24 and 32 weeks for (1) CRH level was 0.68 (95% CI 0.59-0.78) and 0.70 (95% CI 0.59-0.81), (2) prior preterm birth history was 0.75 (95% CI 0.67-0.83) and 0.78 (95% CI 0.69-0.87), and (3) combined was 0.81 (95% CI 0.73-0.88, P = .001) and 0.81 (95% CI 0.72-0.90, P = .01) respectively for delivery <37 weeks. CRH measured by ELISA failed to correlate with gestational age or other clinical parameters.<h4>Conclusion</h4>In women with a prior preterm birth, CRH levels were higher and had an earlier rise in women who experienced recurrent preterm birth. Second trimester CRH may be useful in identifying a sub-group of women with preterm birth due to early activation of the placenta-fetal adrenal axis. Assay methodology is a variable that contributes to difficulties in reproducibility of CRH levels in the obstetric literature.Christina L HerreraMaria E BowmanDonald D McIntireDavid B NelsonRoger SmithPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 9, p e0257422 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Christina L Herrera Maria E Bowman Donald D McIntire David B Nelson Roger Smith Revisiting the placental clock: Early corticotrophin-releasing hormone rise in recurrent preterm birth.
description	<h4>Objective</h4>To determine if maternal plasma CRH and preterm birth history were associated with recurrent preterm birth risk in a high-risk cohort.<h4>Study design</h4>Secondary analysis of pregnant women with a prior preterm birth ≤35 weeks receiving 17-alpha hydroxyprogesterone caproate for the prevention of recurrent spontaneous preterm birth. All women with a 24-week blood sample were included. Maternal plasma CRH level at 24- and 32-weeks' gestation was measured using both enzyme-linked immunosorbent assay (ELISA) and extracted radioimmunoassay (RIA) technologies. The primary outcome was spontaneous preterm birth <37 weeks. The association of CRH, prior preterm birth history, and the two combined was assessed in relation to recurrent preterm birth risk.<h4>Results</h4>Recurrent preterm birth in this cohort of 169 women was 24.9%. Comparing women who subsequently delivered <37 versus ≥37 weeks, mean levels of CRH measured by RIA were significantly different at 24 weeks (111.1±87.5 vs. 66.1±45.4 pg/mL, P = .002) and 32 weeks (440.9±275.6 vs. 280.2±214.5 pg/mL, P = .003). The area under the receiver operating curve (AUC) at 24 and 32 weeks for (1) CRH level was 0.68 (95% CI 0.59-0.78) and 0.70 (95% CI 0.59-0.81), (2) prior preterm birth history was 0.75 (95% CI 0.67-0.83) and 0.78 (95% CI 0.69-0.87), and (3) combined was 0.81 (95% CI 0.73-0.88, P = .001) and 0.81 (95% CI 0.72-0.90, P = .01) respectively for delivery <37 weeks. CRH measured by ELISA failed to correlate with gestational age or other clinical parameters.<h4>Conclusion</h4>In women with a prior preterm birth, CRH levels were higher and had an earlier rise in women who experienced recurrent preterm birth. Second trimester CRH may be useful in identifying a sub-group of women with preterm birth due to early activation of the placenta-fetal adrenal axis. Assay methodology is a variable that contributes to difficulties in reproducibility of CRH levels in the obstetric literature.
format	article
author	Christina L Herrera Maria E Bowman Donald D McIntire David B Nelson Roger Smith
author_facet	Christina L Herrera Maria E Bowman Donald D McIntire David B Nelson Roger Smith
author_sort	Christina L Herrera
title	Revisiting the placental clock: Early corticotrophin-releasing hormone rise in recurrent preterm birth.
title_short	Revisiting the placental clock: Early corticotrophin-releasing hormone rise in recurrent preterm birth.
title_full	Revisiting the placental clock: Early corticotrophin-releasing hormone rise in recurrent preterm birth.
title_fullStr	Revisiting the placental clock: Early corticotrophin-releasing hormone rise in recurrent preterm birth.
title_full_unstemmed	Revisiting the placental clock: Early corticotrophin-releasing hormone rise in recurrent preterm birth.
title_sort	revisiting the placental clock: early corticotrophin-releasing hormone rise in recurrent preterm birth.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/8d96c2036cb243ddb45e7f73c92f19ae
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Revisiting the placental clock: Early corticotrophin-releasing hormone rise in recurrent preterm birth.

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