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Am J Perinatol 2020; 37(12): 1195-1200
DOI: 10.1055/s-0040-1708801
SMFM Fellowship Series Article

Association between Maternal Serum Hormones along the Maternal–Fetal Hypothalamic–Pituitary–Adrenal Axis and Successful Vaginal Delivery Measured Prior to Labor Induction

Chase R. Cawyer 
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Elena Lobashevksy
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Glenda Corley-Topham
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Sarah Anderson
2   UCHealth Maternal Fetal Medicine Clinic, Memorial Hospital Central, Colorado Springs, Colorado
,
John Owen
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Akila Subramaniam
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
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Abstract

Objective This study aimed to evaluate if maternal serum hormones along the maternal–fetal hypothalamic–pituitary–adrenal (HPA) axis, when drawn prior to labor induction, differed between women who delivered vaginally and those who underwent cesarean.

Study Design This was a prospective observational study at a single perinatal center performed from August 2017 to May 2018. Nulliparous women with uncomplicated singleton pregnancies ≥39 weeks had maternal serum collected prior to induction. Corticotrophin-releasing hormone (CRH) was measured by ELISA; dehydroepiandrosterone sulfate (DHEA-S), cortisol, estriol (E3) estradiol (E2), and progesterone (P4) were measured by chemiluminescent reaction. Mean analyte concentrations as well as three ratios (E2/P4, E3/P4, and E2/E3) were compared between women who had a vaginal versus cesarean delivery. Logistic regression was used to model the relationship between CRH and the odds of vaginal birth. We estimated that a sample size of 66 would have 90% power to detect a 25% difference in mean CRH levels assuming a vaginal:cesarean ratio of 2:1 with a baseline CRH concentration of 140 (standard deviation = 36) pg/mL.

Results Of the 88 women who had their serum analyzed, 27 (31%) underwent cesarean. Mean maternal serum CRH levels were similar between the vaginal delivery and cesarean groups (122.6 ± 95.2 vs. 112.3 ± 142.4, p = 0.73). Similarly, there were no significant differences in any other maternal serum analytes or ratios. Logistic regression showed a nonsignificant odds ratio for successful vaginal birth (p = 0.69) even when evaluating only the 16 women who had a cesarean for an arrest disorder (p = 0.08).

Conclusion In low-risk nulliparous women undergoing full-term labor induction, there were no differences noted in a broad array of other maternal-fetal HPA-axis hormones between women who had a vaginal or cesarean delivery.

Keywords

corticotrophin-releasing hormone - labor induction - maternal–fetal hypothalamic–pituitary–adrenal axis - cesarean section

Note

This study was presented at the 39th Annual Meeting–The Pregnancy Meeting, Las Vegas, NV, February 11–16, 2019.




Publication History

Received: 15 October 2019

Accepted: 13 February 2020

Article published online:
25 March 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

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