CONCENTRATIONS OF CORTICOTROPIN-RELEASING HORMONE IN THE UMBILICAL-CORD BLOOD OF PREGNANCIES COMPLICATED BY PREECLAMPSIA

The effect of pre-eclampsia on concentrations of corticotrophin releas ing hormone (CRH) in umbilical-cord blood of fetuses at delivery was s tudied in order to determine if fetal CRH is elevated in this disorder when compared with uncomplicated pregnancy. Placental CRH may be a re gulator of fetal pituitary-adrenal function and we therefore also meas ured ACTH, cortisol and dehydroepiandrosterone sulfate (DHEAS) in the umbilical-cord blood. The mean umbilical-cord plasma CRH in the fetuse s from pregnancies complicated by pre-eclampsia, 667 +/- 153 pg mL(-1) , was significantly higher than the plasma CRH in the fetuses from nor motensive pregnancies, 185 +/- 22 pg mL(-1) (P < 0.001). The mean feta l cortisol concentration was significantly higher in pre-eclampsia, th an in the normotensive, pregnancies (pre-eclampsia, 13.5 +/- 1.8; norm otensive, 7.6 +/- 1.3 mu g dL(-1); P < 0.001). Plasma DHEAS was 217 +/ - 23 mu g dL(-1) in the umbilical-cord blood of the fetuses from pregn ancies complicated by pre-eclampsia and 281 +/- 35 mu g dL(-1) in the normotensive pregnancies (P < 0.01). Placental CRH synthesis and relea se, in contrast to hypothalamic CRH, appears to be stimulated by gluco corticoids. In pregnancies complicated by uteroplacental insufficiency , as may occur in pre-eclampsia, placental CRH production may be enhan ced by increased fetal glucocorticoids. In turn, placental CRH may mod ulate fetal pituitary-adrenal steroidogenesis to favour increased cort isol secretion. Thus, placental CRH may play an important role in the fetal response to a compromised intrauterine environment.