Lack of correlation between amniotic fluid and maternal plasma contents of beta-endorphin, beta-lipotropin, and adrenocorticotropic hormone in normal and pathologic pregnancies

Neuroendocrine mechanisms in pregnancy and parturition

The complex mechanisms controlling human parturition involves mother, fetus, and placenta, and stress is a key element activating a series of physiological adaptive responses. Preterm birth is a clinical syndrome that shares several characteristics with term birth. A major role for the neuroendocrine mechanisms has been proposed, and placenta/membranes are sources for neurohormones and peptides. Oxytocin (OT) is the neurohormone whose major target is uterine contractility and placenta represents a novel source that contributes to the mechanisms of parturition. The CRH/urocortin (Ucn) family is another important neuroendocrine pathway involved in term and preterm birth. The CRH/Ucn family consists of four ligands: CRH, Ucn, Ucn2, and Ucn3. These peptides have a pleyotropic function and are expressed by human placenta and fetal membranes. Uterine contractility, blood vessel tone, and immune function are influenced by CRH/Ucns during pregnancy and undergo major changes at parturition. Among the others, neurohormones, relaxin, parathyroid hormone-related protein, opioids, neurosteroids, and monoamines are expressed and secreted from placental tissues at parturition. Preterm birth is the consequence of a premature and sustained activation of endocrine and immune responses. A preterm birth evidence for a premature activation of OT secretion as well as increased maternal plasma CRH levels suggests a pathogenic role of these neurohormones. A decrease of maternal serum CRH-binding protein is a concurrent event. At midgestation, placental hypersecretion of CRH or Ucn has been proposed as a predictive marker of subsequent preterm delivery. While placenta represents the major source for CRH, fetus abundantly secretes Ucn and adrenal dehydroepiandrosterone in women with preterm birth. The relevant role of neuroendocrine mechanisms in preterm birth is sustained by basic and clinic implications.

Cushing's syndrome in pregnancy: an overview

Cushing's syndrome (CS) during pregnancy is a rare condition with fewer than 150 cases reported in the literature. Adrenal adenomas were found to be the commonest cause, followed by Cushing's disease. The gestation dramatically affects the maternal hypothalamic-pituitary-adrenal axis, resulting in increased hepatic production of corticosteroid-binding globulin (CBG), increased levels of serum, salivary and urinary free cortisol, lack of suppression of cortisol levels after dexamethasone administration and placental production of CRH and ACTH. Moreover, a blunted response of ACTH and cortisol to exogenous CRH may also occur. Therefore, the diagnosis of CS during pregnancy is much more difficult. Misdiagnosis of CS is also common, as the syndrome may be easily confused with preeclampsia or gestational diabetes. Because CS during pregnancy is usually associated with severe maternal and fetal complications, its early diagnosis and treatment are critical. Surgery is the treatment of choice for CS in pregnancy, except perhaps in the late third trimester, with medical therapy being a second choice. There does not seem to be a rationale for supportive treatment alone.

The hypothalamic-pituitary-adrenal axis in pregnancy: challenges in disease detection and treatment

Pregnancy dramatically affects the hypothalamic-pituitary-adrenal axis leading to increased circulating cortisol and ACTH levels during gestation, reaching values in the range seen in Cushing's syndrome (CS). The cause(s) of increased ACTH may include placental synthesis and release of biologically active CRH and ACTH, pituitary desensitization to cortisol feedback, or enhanced pituitary responses to corticotropin-releasing factors. In this context, challenges in diagnosis and management of disorders of the hypothalamic-pituitary-adrenal axis in pregnancy are discussed. CS in pregnancy is uncommon and is associated with fetal morbidity and mortality. The diagnosis may be missed because of overlapping clinical and biochemical features in pregnancy. The proportion of patients with primary adrenal causes of CS is increased in pregnancy. CRH stimulation testing and inferior petrosal sinus sampling can identify patients with Cushing's disease. Surgery is a safe option for treatment in the second trimester; otherwise medical therapy may be used. Women with known adrenal insufficiency that is appropriately treated can expect to have uneventful pregnancies. Whereas a fetal/placental source of cortisol may mitigate crisis during gestation, unrecognized adrenal insufficiency may lead to maternal or fetal demise either during gestation or in the puerperium. Appropriate treatment and management of labor are reviewed.

Umbilical cord beta-endorphin and early childhood motor development

Stress during delivery has been associated with elevated umbilical cord plasma beta-endorphin levels. Published research suggests that much cord beta-endorphin originates from fetal pituitary. Intact pituitary function is required for normal growth and development. Relationships between cord beta-endorphin and child development have not been previously reported. We measured paired maternal and cord plasma beta-endorphin concentration in a set of 106 low risk deliveries by solid phase two-site immunoradiometric assay. Geometric mean maternal and cord beta-endorphin concentrations were 128 pg/ml and 196 pg/ml, respectively, with corresponding ranges of 33-533 pg/ml and 70-579 pg/ml. Cord beta-endorphin concentration was significantly higher than maternal, regardless of delivery mode, and the two were significantly correlated (r = 0.231; P = 0.017). Multiple regression modeling showed that forceps delivery, maternal beta-endorphin concentration, bradycardia, vaginal delivery, and birth weight each made independent contributions to elevated cord beta-endorphin. Depressed cord beta-endorphin predicted more day 2 neurological soft signs, lower 6-month mental development, and lower 36-month motor score on psychometric tests of the children. Poorer fine motor control and coordination were predominantly associated with lower beta-endorphin. Level of cord beta-endorphin independent of delivery stress exerted the primary influence upon child motor development. Higher levels of stress-independent beta-endorphin may play a direct role in motor development.

Third trimester POMC disregulation predicts use of anesthesia at vaginal delivery

In a prospective study, third trimester plasma levels of BE and ACTH were determined in 58 women who delivered vaginally. Peptide regulation was compared between subjects who used conduction anesthesia at delivery and subjects who did not. Third trimester levels of maternal BE and ACTH were significantly related; however, the relationship was significant only in subjects who did not receive conduction anesthesia (n = 24) at delivery. The normal co-release pattern between BE and ACTH in subjects receiving conduction anesthesia (n = 34) during birth was uncoupled. The use of conduction analgesia during vaginal delivery was significantly related to a disregulation index created to quantify the BE-ACTH release pattern. Uncoupled ACTH and BE patterns may result from modified control of pro-opiomelanocortin (POMC) expression during pregnancy or unique proteolytic processing of POMC, and may alter pain tolerance during delivery.

Human embryo modulates placental function in the first trimester; effects of neural tissues upon chorionic gonadotropin and progesterone secretion

We investigated the effect of embryonal neural and adrenal tissues (7-14 weeks gestational age) upon beta hCG secretion by homologous placental explants in static and dynamic cultures. In static co-culture significant inhibition by SC and brain was noted at 7-9 weeks. Similarly, in superfusion, using a novel co-chambering technique there was a significant reduction in the area under the curve but not peak frequency of spontaneous pulsatile beta hCG secretion. Incubations with neural tissues 11 weeks and above caused a stimulatory effect upon beta hCG secretion in both models. The effect of adrenal tissue in static cultures was different, namely slightly inhibitory at 7-9 weeks and inhibitory at 11 weeks and above. In superfusion, the effect of adrenal tissue was not significant. Extracted neural tissue 7-9 weeks incubated with placental explants exhibited inhibitory effects upon beta hCG secretion as well. Buffer-based extracts of neural tissues effect was more pronounced than alcohol-based extracts regarding beta hCG secretion. The effect of extracts was dose-dependent and effects were noted up until a 2000-fold dilution. In contrast, the buffer SC extract had no effect on progesterone (P) secretion while the alcohol extract effect was inhibitory at 7-9 weeks and stimulatory at greater than 11 weeks. Superfused explants pattern of beta hCG secretion was inhibited by one minute pulse of the SC buffer extract. In conclusion, the human neural tissue of embryonal origin may modulate placental hCG and P secretion during early pregnancy.

Response of plasma immunoreactive beta-endorphin and corticotropin to isometric exercise in uncomplicated pregnancy and in pregnancy-induced hypertension

The response of plasma immunoreactive beta-endorphin (ir-beta E) and corticotropin to isometric exercise was studied in 10 women with pregnancy-induced hypertension (PIH) and in nine healthy women subjected to a handgrip test in the third trimester of gestation. The mean basal concentration of corticotropin was higher in the PIH than in the control group, 3.8 +/- 0.3 (SE) pmol/l and 2.2 +/- 0.2 pmol/l, respectively (p = 0.002). No significant difference was found in the basal ir-beta E level, 6.9 +/- 0.9 pmol/l and 6.1 +/- 1.0 pmol/l, respectively. In response to the handgrip test, the corticotropin and ir-beta E concentrations rose significantly in all subjects (p = 0.001 and p = 0.02, respectively) without any significant differences between the groups. These findings indicate that an isometric exercise is sufficient to increase the secretion of ir-beta E and corticotropin during pregnancy. Increased basal concentration of corticotropin in women with PIH may be explained by significantly increased circulating corticotropin-releasing hormone, 1451 +/- 323 pmol/l, as compared to 528 +/- 190 pmol/l in the control group.

Cortisol and transcortin in human seminal plasma and amniotic fluid as estimated by modern specific assays

Cortisol concentrations in human seminal plasma, as estimated by the very specific Amersham 'Amerlite' luminescence immunoassay, were 176 +/- 43 (85-260) nmol/l, that is, 63.7 +/- 15.5 (31-94) ng/ml (mean +/- SD, n = 21). This is about 60% of random levels in blood serum and is the first description of cortisol in seminal fluid. In human amniotic fluid at 16-22 weeks of gestation, cortisol concentrations were lower, at 72.6 +/- 14.6 (63-124) nmol/l, that is, 29.3 +/- 5.3 (23-45) ng/ml (n = 21). Concentrations were about 15% of random maternal serum levels in the second trimester of pregnancy. The cortisol concentrations in both fluids were considerably higher than those reported for saliva, which has a mean of about 10 nmol/l. Transcortin (corticosteroid binding globulin, CBG), has been found in human seminal plasma and amniotic fluid for the first time. Concentrations were low, with values up to 12 micrograms/ml, with no significant difference between the two fluids, when using the IRE-Megenix monoclonal iodinated radioimmunoassay. Transcortin concentrations were about 10% of levels in non-pregnant blood serum, compared with about 0.1% for saliva. The higher concentrations of transcortin could perhaps account for the greater diffusion of cortisol into seminal plasma and amniotic fluid. The presence of beta-endorphin, ACTH and cortisol in amniotic fluid, seminal fluid, ovarian follicular fluid, endometrial fluid and gastric fluid may possibly, indicate the existence of a small paracrine ACTH-cortisol axis in the relevant secretory tissues.

Opioids and the developing organism: a comprehensive bibliography, 1984-1988

A comprehensive bibliography of the literature concerned with opioids and the developing organism for 1984-1988 is presented. Utilized with companion papers (Neurosci. Biobehav. Rev. 6:439-479; 1982; 8:387-403; 1984), these articles cover the clinical and laboratory references beginning in 1875. For the years 1984, 1985, 1986, 1987, and 1988, a total of 877 citations were recorded. A series of indexes accompanies the citations in order to make the literature more accessible. These indexes are divided into clinical and laboratory topics, and subdivided into such topics as the type of opioid explored and the general area of biological interest (e.g., physiology).

Maternal and embryonal/fetal beta-endorphin concentrations during the first trimester of pregnancy

In this study, we have determined the beta-endorphin concentrations in the plasma of 11 cases during the first 3 months of pregnancy, as well as the corresponding products of conception, collected by hysterosuction, during the course of voluntary abortion. The purpose of this study is to compare the values obtained by the analysis of maternal plasma and the material collected by hysterosuction. The beta-endorphin concentrations were obtained by radioimmunologic methods using a kit which allows a separation from beta-lipotropin. The specimens obtained by hysterosuction (8 +/- 1.7 pmol/l) showed significantly higher levels of beta-endorphin than those observed in the maternal plasma (2.6 +/- 0.3 pmol/l). Thus, already in the earliest gestational period, the data are consistent with a feto-placental origin for this opioid peptide.

Adrenocorticotropic hormone and catecholamines in maternal, umbilical and neonatal plasma in relation to vaginal delivery

The aim of this study was to evaluate the effect of vaginal delivery on both ACTH and catecholamines (DA, NE, E) secretion in the mother, the fetus (umbilical artery) and the newborn. Blood samples were obtained from 19 normal pregnant women and the corresponding umbilical cords, and from the newborns. Seventeen normal nonpregnant women, matched for age and parity, were also included in the study as "nonpregnant controls". The results demonstrate that in the mother, plasma catecholamines (CA) concentrations during labor and delivery are elevated above the values reported for normal nonpregnant women and there is a predominant E response. The concentrations of CA in umbilical arteries are very high compared to those in the corresponding mother and they fall rapidly after birth. Unlike that in the mother, the predominant CA response to parturition in the fetus and newborn infant is NE. The extraction rate of DA, NE and E from placenta is approximately 60%. The peripheral plasma levels of ACTH in pregnant women during labor are twice and 10 times as high as those observed in the corresponding umbilical arteries and in nonpregnant women respectively. At delivery they increase further. No significant differences are found between the values measured in the arterial cord blood and those in the venous cord blood and in the newborns. A way of explaining the prevalence of E and the higher ACTH/E ratio found in the mother in comparison with the fetus could be that in the mother the stress response to parturition is regulated mainly by the pituitary-adrenal axis, whereas in the fetus there is a prevalent stimulation of the sympathetic nervous system.

Correlation between the number of placental opioid receptors, mode of delivery, and maternal narcotic use

Human placental opioid receptors were assayed using the radioactive opioid agonist, etorphine, to determine the number of binding sites in villous tissue membrane preparations. Significant differences in receptor concentration per milligram of protein of tissue were found between placentas obtained following vaginal or abdominal delivery (P less than 0.002). Labor itself did not alter apparent receptor numbers. In patients with maternal narcotic abuse during pregnancy, no opioid binding could be detected regardless of the mode of delivery, suggesting possible receptor down-regulation.

Pregnancy related changes of opiate receptors identified in rat uterine membranes by 3H-naloxone binding

3H-Naloxone was used to demonstrate the presence of specific opiate binding sites in uterine membrane preparations of rats. 3H-Naloxone binding (0.41-27 nM) was found to be rapid, saturable and reversible showing two populations of binding sites with the characteristic of high (KD 2.2 nM; Bmax 46.6 fmol/mg prot.) and low (KD 18.1 nM; Bmax 143.7 fmol/mg prot.) affinity. The number and affinity of the binding sites labelled by 3H-naloxone in the uterus were measured in the rat at mid (14 days), late (21 days) pregnancy and at parturition. The high and low affinity recognition sites labelled by 3H-naloxone showed a consistent reduction during pregnancy and at parturition without changes in the affinity constant. We concluded that pregnancy and parturition are associated with significant changes in the number of the opiate receptors bound in the uterus by 3H-naloxone. This phenomenon which seems to be linked with the several pregnancy-related changes in the levels of endogenous peptides and hormones could be relevant to further explain the pregnancy related changes in pain perception and maternal behavior.

Endogenous opiates: 1984

This paper is the seventh in an annual series of reviews of research involving the endogenous opiate peptides, each installment being restricted to work published during the previous year. As in the past three years, the review this year is limited to non-analgesic and behavioral studies of the opiate peptides. The specific topics this year include: stress, tolerance and dependence, consummatory responses, gastric and renal activity, alcohol, mental illness, learning and memory, cardiovascular responses, respiratory effects, thermoregulation, seizures and neurological disorders, activity, and miscellaneous other topics.