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High copeptin concentrations in umbilical cord blood after vaginal delivery and birth acidosis


Wellmann, S; Benzing, J; Cippà, G; Admaty, D; Creutzfeldt, R; Mieth, R; Beinder, E; Lapaire, O; Morgenthaler, N G; Haagen, U; Szinnai, G; Bührer, C; Bucher, H U (2010). High copeptin concentrations in umbilical cord blood after vaginal delivery and birth acidosis. Journal of Clinical Endocrinology and Metabolism, 95(11):5091-5096.

Abstract

CONTEXT: The pituitary-secreted nonapeptide arginine-vasopressin (AVP) is unstable and therefore unsuited for diagnostic use, but its secretion can be estimated by measuring copeptin, the C-terminal portion of the AVP precursor (pro-AVP).

OBJECTIVE: Our objective was to investigate perinatal factors affecting copeptin concentrations in infants at birth and at 3 d of life.

DESIGN AND SETTING: We conducted a prospective cross-sectional study at a tertiary university hospital.

PATIENTS: Copeptin plasma concentrations were evaluated in 177 infants at birth, including 117 paired arterial/venous umbilical cord and 102 venous blood samples obtained at 3 d of life.

MAIN OUTCOME MEASURE: Copeptin concentrations were determined by a C-terminal pro-AVP luminescence immunoassay.

RESULTS: Arterial umbilical cord copeptin concentrations were consistently higher than matched venous ones (median 18 vs. 10 pmol/liter, P < 0.001), but both values were closely related (R(s) = 0.825; P < 0.001), and both were negatively related to arterial umbilical cord pH (R(s) arterial/venous = -0.578/-0.639; P < 0.001). Although exceedingly high copeptin concentrations were observed after vaginal birth in umbilical cord arterial [median (5-95% range) = 1610 (85-5000) pmol/liter] and venous [793 (6-4836) pmol/liter] plasma, copeptin concentrations were low after primary cesarean section [arterial/venous = 8 (3-907)/5 (5-504) pmol/liter]. Postnatal body weight loss was associated with increased copeptin concentrations at d 3 (R(s) = 0.438; P < 0.001) and was inversely related to copeptin concentrations at birth (R(s) = -0.289 and -0.309; both P = 0.001).

CONCLUSION: Vaginal birth is associated with a large release of copeptin that exceeds all values published so far, including those in critically ill adult patients with shock or brain injury. Thus, vaginal birth is arguably the most intense stressor in life.

CONTEXT: The pituitary-secreted nonapeptide arginine-vasopressin (AVP) is unstable and therefore unsuited for diagnostic use, but its secretion can be estimated by measuring copeptin, the C-terminal portion of the AVP precursor (pro-AVP).

OBJECTIVE: Our objective was to investigate perinatal factors affecting copeptin concentrations in infants at birth and at 3 d of life.

DESIGN AND SETTING: We conducted a prospective cross-sectional study at a tertiary university hospital.

PATIENTS: Copeptin plasma concentrations were evaluated in 177 infants at birth, including 117 paired arterial/venous umbilical cord and 102 venous blood samples obtained at 3 d of life.

MAIN OUTCOME MEASURE: Copeptin concentrations were determined by a C-terminal pro-AVP luminescence immunoassay.

RESULTS: Arterial umbilical cord copeptin concentrations were consistently higher than matched venous ones (median 18 vs. 10 pmol/liter, P < 0.001), but both values were closely related (R(s) = 0.825; P < 0.001), and both were negatively related to arterial umbilical cord pH (R(s) arterial/venous = -0.578/-0.639; P < 0.001). Although exceedingly high copeptin concentrations were observed after vaginal birth in umbilical cord arterial [median (5-95% range) = 1610 (85-5000) pmol/liter] and venous [793 (6-4836) pmol/liter] plasma, copeptin concentrations were low after primary cesarean section [arterial/venous = 8 (3-907)/5 (5-504) pmol/liter]. Postnatal body weight loss was associated with increased copeptin concentrations at d 3 (R(s) = 0.438; P < 0.001) and was inversely related to copeptin concentrations at birth (R(s) = -0.289 and -0.309; both P = 0.001).

CONCLUSION: Vaginal birth is associated with a large release of copeptin that exceeds all values published so far, including those in critically ill adult patients with shock or brain injury. Thus, vaginal birth is arguably the most intense stressor in life.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Obstetrics
04 Faculty of Medicine > University Hospital Zurich > Clinic for Neonatology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2010
Deposited On:07 Jan 2011 10:31
Last Modified:05 Apr 2016 14:31
Publisher:Endocrine Society
ISSN:0021-972X
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:10.1210/jc.2010-1331
PubMed ID:20702521
Permanent URL: http://doi.org/10.5167/uzh-41208

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