Emanuel R L, Robinson B G, Seely E W, Graves S W, Kohane I, Saltzman D, Barbieri R, Majzoub J A
Children's Hospital, Endocrine Division, Boston, MA 02115.
Clin Endocrinol (Oxf). 1994 Feb;40(2):257-62. doi: 10.1111/j.1365-2265.1994.tb02477.x.
Corticotrophin releasing hormone, a hypothalamic neuropeptide also made in placenta, may regulate fetal maturation in a stress-responsive manner. The objectives of this study were: (1) to determine if levels of corticotrophin releasing hormone in the amniotic fluid correlate with fetal lung maturation; (2) to confirm that third trimester plasma levels of corticotrophin releasing hormone are increased in patients with pregnancy-induced hypertension compared to normotensives, and (3) to increase the recovery of extracted corticotrophin releasing hormone from plasma and amniotic fluid.
(1) Levels of corticotrophin releasing hormone in amniotic fluid during the third trimester were compared with those of saturated phosphatidyl choline. (2) Corticotrophin releasing hormone levels were measured in a group of normotensive pregnant women during the entire gestation period. Corticotrophin releasing hormone levels during the third trimester were compared in normotensives and patients with pregnancy-induced hypertension.
Twenty-one non-pregnant normal volunteers and 63 pregnant women.
Blood pressure, corticotrophin releasing hormone in plasma and amniotic fluid, and saturated phosphatidyl choline in amniotic fluid.
Corticotrophin releasing hormone levels in amniotic fluid samples during the third trimester ranged from 12 to 98 pmol/l and positively correlated with the saturated phosphatidyl choline levels, but not with gestational age. A significant difference existed in plasma corticotrophin releasing hormone concentration between gestational age-matched third trimester normotensive and hypertensive gravids: corticotrophin releasing hormone levels were significantly lower in normotensives (223 +/- 65 pmol/l) than in patients with pregnancy-induced hypertension (544 +/- 106 pmol/l, P = 0.001). Plasma corticotrophin releasing hormone increased with gestational age from 51 pmol/l (range 8.4-85) at 25-32 weeks to 375 pmol/l (range 35-1386) at 33-40 weeks. During the third trimester the rise in plasma corticotrophin releasing hormone conformed to an exponential mathematical model of a positive feedback loop between placental corticotrophin releasing hormone and fetal adrenal cortisol.
During the third trimester of pregnancy there is a positive correlation between the level of amniotic fluid corticotrophin releasing hormone and that of saturated phosphatidyl choline. The positive correlation between amniotic fluid corticotrophin releasing hormone and saturated phosphatidyl choline, but not between amniotic fluid corticotrophin releasing hormone and gestational age, suggests that a factor(s), such as stress, may affect both amniotic fluid corticotrophin releasing hormone and saturated phosphatidyl choline in parallel. Furthermore, our data are consistent with the hypothesis that the rise in placental corticotrophin releasing hormone is coupled to an increase in fetal glucocorticoid and lung maturation, and that stresses such as pregnancy-induced hypertension may accelerate this process.
促肾上腺皮质激素释放激素是一种下丘脑神经肽，也在胎盘中产生，可能以应激反应的方式调节胎儿成熟。本研究的目的是：（1）确定羊水促肾上腺皮质激素释放激素水平与胎儿肺成熟是否相关；（2）证实与血压正常的孕妇相比，妊娠高血压患者妊娠晚期血浆促肾上腺皮质激素释放激素水平升高；（3）提高从血浆和羊水中提取的促肾上腺皮质激素释放激素的回收率。
（1）将妊娠晚期羊水促肾上腺皮质激素释放激素水平与饱和磷脂酰胆碱水平进行比较。（2）在一组血压正常的孕妇整个妊娠期测量促肾上腺皮质激素释放激素水平。比较血压正常者和妊娠高血压患者妊娠晚期促肾上腺皮质激素释放激素水平。
21名非妊娠正常志愿者和63名孕妇。
血压、血浆和羊水中的促肾上腺皮质激素释放激素以及羊水中的饱和磷脂酰胆碱。
妊娠晚期羊水样本中促肾上腺皮质激素释放激素水平为12至98 pmol/l，与饱和磷脂酰胆碱水平呈正相关，但与胎龄无关。孕周匹配的妊娠晚期血压正常和高血压孕妇的血浆促肾上腺皮质激素释放激素浓度存在显著差异：血压正常者（223±65 pmol/l）的促肾上腺皮质激素释放激素水平显著低于妊娠高血压患者（544±106 pmol/l，P = 0.001）。血浆促肾上腺皮质激素释放激素随孕周增加，从25至32周时的51 pmol/l（范围8.4 - 85）升至33至40周时的375 pmol/l（范围35 - 1386）。在妊娠晚期，血浆促肾上腺皮质激素释放激素的升高符合胎盘促肾上腺皮质激素释放激素与胎儿肾上腺皮质醇之间正反馈回路的指数数学模型。
妊娠晚期羊水中促肾上腺皮质激素释放激素水平与饱和磷脂酰胆碱水平呈正相关。羊水中促肾上腺皮质激素释放激素与饱和磷脂酰胆碱呈正相关，但与羊水中促肾上腺皮质激素释放激素和胎龄无关，这表明诸如应激等因素可能同时平行地影响羊水中的促肾上腺皮质激素释放激素和饱和磷脂酰胆碱。此外，我们的数据与以下假设一致，即胎盘促肾上腺皮质激素释放激素的升高与胎儿糖皮质激素增加和肺成熟相关，并且诸如妊娠高血压等应激可能加速这一过程。
