Library

Notes: Objective To measure the plasma levels of corticotrophin-releasing hormone and corticotrophin-releasing hormone binding protein in normal pregnancy and in pregnancies complicated by pre-eclampsia.Setting John Radcliffe Hospital, Oxford and St Thomas's Hospital, London.Subjects One hundred and twenty pregnant women sampled prospectively throughout gestation, of whom 91 experienced a normal pregnancy and eight developed pre-eclampsia; in a second study, 10 women with severe pre-eclampsia, presenting at a range of gestational ages, were sampled once and compared with appropriately matched normal pregnant women.Main outcome measure Plasma levels of corticotrophin-releasing hormone determined by immunoradiometric assay. Plasma levels of corticotrophin-releasing hormone binding protein measured by direct radioimmunoassay.Results In the prospective study, plasma samples from women with pre-eclampsia exhibited higher (390.2 versus 292.7 pmol/l at 36 weeks) levels of corticotrophin-releasing hormone and significantly lower (5.24 versus 8.14 nmol/l at 36 weeks, P 0.002) levels of corticotrophin-releasing hormone binding protein than normal controls. In the second, single time point study a significant elevation in CRH (P 〈 0.002) and reduction in CRH-BP (P 〈 0.001) was found in pre-eclamptic pregnancies compared with controls.Conclusions In human pregnancies complicated by pre-eclampsia there is an elevated level of corticotrophin releasing hormone whilst there is less corticotrophin-releasing hormone binding protein; therefore there is a net increase in free potentially bioactive hormone which may play a role in the pathology of the disease.

Notes: Summary. Maternal plasma concentrations of corticotrophin releasing factor (CRF) and endogenous digoxin-like immunoreactivity (EDLI) were estimated in 80 normal and 88 abnormal pregnancies which were sampled sequentially from 24 weeks gestation to delivery. A slope was fitted for each woman's antenatal EDLI and CRF values, both of which rose significantly during gestation, and the mean of the slopes for the normal and abnormal groups for each value compared. There was no evidence of significant mean differences between groups for EDLI but there was evidence of a significant mean difference for CRF (P〈0.05). After adjustment for other variables which may affect pregnancy outcome, the slopes for CRF were found not to be significantly related to outcome.

Notes: Summary. Corticotrophin-releasing factor (CRF) was measured directly in maternal plasma using an immunoradiometric assay (IRMA). In the first and second trimester CRF levels were within the non-pregnant range (mean 15 pg/ml). A total of 72 women was followed sequentially from 28 weeks until delivery and CRF levels rose from a median of 20 pg/ml at 28 weeks to 1320 pg/ml at 40 weeks and 1732 pg/ml during labour. There was a strong correlation (rs= 0·81, P〈0·001) between gestational age and CRF levels. The rate of rise of CRF (pg/ml) per week was associated with weight gain (rs= 0·36, P〈0·05) but with no other obstetric variable. There was an association between umbilical cord and maternal plasma CRF levels (rs= 0·54, P〈0·01).

Notes: Summary. Maternal plasma levels of cortiocotrophin-releasing factor (CRF) have been measured in abnormal pregnancy states to assess their potential as biochemical markers for at-risk pregnancies. CRF levels were not significantly altered in patients with hydatidiform mole, polyhydramnios or diabetes. CRF levels were elevated in pregnancies complicated by accidental antepartum haemorrhage at 28 weeks (P〈0·03) but not for the rest of the third trimester. In twin pregnancies CRF levels were significantly raised throughout the third trimester (28–32 weeks, P〈0·01; 34–36 weeks, P〈0·001). In patients with pregnancy-induced hypertension (28 weeks, P〈0·001; 32–36 weeks, P〈0·001; and 38–40 weeks, P〈0·01), preterm labour and premature rupture of the membranes (28 weeks, P〈0·004; 30–32 weeks, P〈0·002; and 34–36 weeks, P〈0·001), CRF levels were significantly raised and in some patients levels were elevated 11 weeks before the onset of signs or symptoms. These observations raise the possibility that maternal CRF measurement may be of use as a predictive indicator of certain at-risk pregnancies.

Notes: Objective To assess pregnant women's knowledge of, and attitudes towards, antenatal HIV testing, and its acceptability to them.Setting Antenatal clinic at Guy's Hospital, London, six community antenatal clinics and a midwifery group practice.Population Eight hundred and forty-three women attending the antenatal clinics.Method The women received a leaflet explaining HIV testing, and completed a questionnaire before and after their booking appointment. This included an assessment of their knowledge of, and attitudes towards HIV testing, and its acceptability.Results Seven hundred and eighty-nine women (94%) completed questionnaires. Fifty-one percent (n= 405) were Caucasian, 25% (n= 195) African, 11% (n= 86) West Indian and 13% (n= 100) were from other ethnic groups. Fifty-eight percent received the HIV information leaflet, of whom 86% had read it. Knowledge relating to HIV was good, the median knowledge score being 6 out of a possible 8, but it was less in non-Caucasian women and those with lower educational qualifications. Knowledge was not related to uptake of testing. Thirty-five percent of women accepted the offer of an HIV test, rates being higher in hospital clinics (41%) than in the midwifery group practice (10%) and the community clinics (30%). Women more likely to accept the offer of an HIV test were non-Caucasian (P = 0.0443), those who had thought about the HIV test before this pregnancy (P= 0.0298) and those seeing one particular midwife (P= 0.0003). Most women (67%) thought that all pregnant women should be offered the HIV test and then make their own decision. Overall, 64% women did not change their original pre-discussion decision on testing for HIV. Thirty-six percent of women changed their decision from ‘yes’ to ‘no’ or ‘don't know’ after seeing the midwife. Women attending the community clinics (P= 0.003) and those who had been tested before (P= 0.0451) were more likely to change their decision.Conclusion This study, in a multiethnic population, has shown that knowledge regarding HIV is good but does not increase the uptake of testing. Women prefer to be offered the HIV test and make their own choice regarding whether to accept it.