Abstract
The aim of this paper was to confirm the efficacy of adrenocorticotropin depot (ACTH-depot) therapy in pregnancies with threatened miscarriage and preterm delivery through the desired stimulation of the adrenal glands controlled by the rest of organism. The activity of hypothalamic-pituitary-adrenal axis plays a key role in pregnancy. Such naturally stimulated endogenous corticosteroid hormones are free from unwanted side effects of their synthetics analogs. Low level of maternal blood ACTH and insufficient increase of induced by hypothalamic hormones oxytocinases (cystine-β-aminopeptidases) were indication to ACTH-depot therapy (0.5 mg/week) in our consecutive prospective studies. Contrary to antenatal use of synthetic corticosteroids, there are no temporal limits of this therapy, which has to be more often recommended into clinical prevention of fetal morbidity, treatment of premature delivery, and finally elimination of the newborn's mortality caused by the neuroendocrinological gestoses.
Highlights
Hormonal therapy during pregnancy must take into consideration the state of both the mother and the fetus
Any damage to the placenta, or only hypoxia, leads to a decrease of the concentration of these enzymes in the mother’s blood, which automatically results in the increase of oxytocin and vasopressin and corticotropin-realising hormone (CRH) and gonadotropinrealising hormone (GnRH), which, in consequence, provokes a change in the production of steroid hormones, essential for the pregnancy
The following years brought an increasing interest in assessment of aminopeptidase activity in obstetrics, but in 1966 Babuna and Yenen published a study on the modification of the original chemical assessment of oxytocinase that hindered investigations of enzyme monitoring in pregnancy [9]
Summary
Hormonal therapy during pregnancy must take into consideration the state of both the mother and the fetus. There is an increase in the production of hormones and enzymes of the placenta, the function that has an essential meaning in the mutual mother-fetus neuro-immunoendocrine relationship [1,2,3,4] This applies especially to the synthesis and concentration adjustment of isooxytocinases (cystine-beta-aminopeptidase (CAP1) and isocystine-beta-aminopeptidase (CAP2)), which decompose hypothalamic hormones [5,6,7]. The following years brought an increasing interest in assessment of aminopeptidase activity in obstetrics, but in 1966 Babuna and Yenen published a study on the modification of the original chemical assessment of oxytocinase that hindered investigations of enzyme monitoring in pregnancy [9]. In women with hypothalamic insufficiency syndromes that have not been diagnosed in time, intrauterine death of the fetus occurs in at least 50% of cases, for which replacement hormonal therapy with adrenocorticotropin of prolonged activity (ACTH-depot) is successful [3, 12]
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