The pregnancy zone protein response during gestation: a metabolic challenge

Prospective studies of pregnant women were performed to compare individual variations in the plasma concentration of sex hormone binding globulin (SHBG) and pregnancy zone protein (PZP) during pregnancy, and to elucidate the degree of co-variation between these oestrogen sensitive proteins during gestation. The plasma concentration of SHBG manifested continuous increase reaching a 12-fold peak at delivery. The increase of the protease inhibitor PZP paralleled that of SHBG reaching a peak with a 25-fold increase by the beginning of the third trimester. Then it started to decline, while that of SHBG continued to increase. The synthesis of the protease inhibitor may also continue to increase during late gestation but its elimination from the circulation may be accelerated when the syncytiotrophoblastic area in contact with the maternal blood approaches its maximum. The unusually wide individual variation of PZP concentrations in non-pregnant women was confirmed. However, the individual levels increased proportionally during the progress of pregnancy, and we may speak of low, medium and high reactors for PZP. One initial conclusion to be drawn from the present findings is that the value of the plasma PZP concentration can only be interpreted from a pathophysiologic point of view if the patient's baseline level is known.