Abnormal umbilical artery Doppler waveforms and cord blood corticotropin-releasing hormone

Objective: To determine whether placental secretion of corticotropin-releasing hormone into the fetal circulation is increased in pregnancies complicated by umbilical-placental vascular insufficiency. Methods: Twenty women with abnormal Doppler umbilical artery flow velocity waveforms and six women with uncomplicated term pregnancies and normal umbilical artery now velocity waveforms had cord blood concentrations of corticotropin-releasing hormone, ACTH, cortisol, and beta-hCG estimated. Results: The mean cord blood colticotropin-releasing hormone concentration was significantly higher in pregnancies with abnormal umbilical artery now velocity waveforms than in normal pregnancies (108 +/- 27 versus 24 +/- 8 pg/mL, P =.019). Elevated cord blood corticotropin-releasing hormone levels were seen in the abnormal group regardless of the presence or absence of preeclampsia or fetal growth restriction. There were no significant differences in cord blood cortisol, ACTH, or beta-hCG concentrations. Conclusion: The concentration of corticotropin-releasing hormone in the fetal circulation is significantly increased in pregnancies complicated by abnormal umbilical artery now velocity waveforms. This may represent a stress-responsive compensatory mechanism in the human placenta.