Human placenta and the hypothalamic-pituitary-adrenal axis

Abstract

Maternal plasma bound and free cortisol rises during pregnancy, while maternal plasma IR-ACTH is initially low but soon rises inspite of the further increase of plasma free cortisol. This rise of plasma ACTH during pregnancy, can not be attributed to changes of plasma levels of estrogens or progesterone. It is possible that the human placenta is responsible for the rise in maternal plasma ACTH during pregnancy. There are two possible mechanisms by which this effect could occur: 1) by the placental secretion of CRH into the maternal circulation, which stimulates the maternal pituitary to secrete ACTH, and 2) the secretion of placental POMC-derived peptides. Recent data indicate that the human placenta is capable of both of these actions: A) The POMC and CRH genes are expressed in human placenta; B) the human term placenta is able to secrete both CRH and POMC-derived peptides in vitro; C) the CRH present in the plasma of pregnant women is bioactive and in sufficient levels to be effective on maternal pituitary; D) synthetic hCRH can stimulate the release of placental POMC peptides in vitro. We conclude that the human placenta may be a modulator of the HPA axis during pregnancy in a number of possible ways. Additional experimental work should clarify the intriguing interaction between the HPA axis and the human placenta during pregnancy, labor and delivery.