Increased cortisol metabolism in women with pregnancy-related hypertension

Kosicka, Katarzyna; Siemiątkowska, Anna; Szpera-Goździewicz, Agata; Krzyścin, Mariola; Bręborowicz, Grzegorz H.; Główka, Franciszek

doi:10.1007/s12020-018-1586-4

Cited by 25 publications

(18 citation statements)

References 46 publications

(73 reference statements)

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“…Hyperactivity of the hypothalamic pituitary adrenal (HPA) axis and hypercortisolism is a normal physiologic response in healthy pregnancies [47]. Both PE and gHTN have been characterized by lower cortisol levels as compared to normotensive pregnant women, suggesting that there may be increased cortisol metabolism in these conditions [48,49]. Our findings support this decreased level with a downregulation of the tetrahydrocorticosterone metabolite.…”

Section: Discussionsupporting

confidence: 71%

Early Pregnancy Serum Metabolite Profiles Associated with Hypertensive Disorders of Pregnancy in African American Women: A Pilot Study

Ferranti

Frediani

Mitchell

et al. 2020

Journal of Pregnancy

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Hypertensive disorders of pregnancy (HDP) are the most common cardiometabolic complications of pregnancy, affecting nearly 10% of US pregnancies and contributing substantially to maternal and infant morbidity and mortality. In the US, women of African American race are at increased risk for HDP. Early biomarkers that reliably identify women at risk for HDP remain elusive, yet are essential for the early identification and targeting of interventions to improve maternal and infant outcomes. We employed high-resolution metabolomics (HRM) to identify metabolites and metabolic pathways that were altered in early (8-14 weeks) gestation serum samples of pregnant African American women who developed HDP after 20 weeks’ gestation (n=20)—either preeclampsia (PE; n=11) or gestational hypertension (gHTN; n=9)—compared to those who delivered full term without complications (n=80). We found four metabolic pathways that were significantly (p<0.05) altered in women who developed PE and five pathways that were significantly (p<0.05) altered in women who developed gHTN compared to women who delivered full term without complications. We also found that four specific metabolites (p<0.05) were distinctly upregulated (retinoate, kynurenine) or downregulated (SN-glycero-3-phosphocholine, 2′4′-dihydroxyacetophenone) in women who developed PE compared to gHTN. These findings support that there are systemic metabolic disruptions that are detectable in early pregnancy (8-14 weeks of gestation) among pregnant African American women who develop PE and gHTN. Furthermore, the early pregnancy metabolic disruptions associated with PE and gHTN are distinct, implying they are unique entities rather than conditions along a spectrum of the same disease process despite the common clinical feature of high blood pressure.

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Section: Discussionsupporting

confidence: 71%

Early Pregnancy Serum Metabolite Profiles Associated with Hypertensive Disorders of Pregnancy in African American Women: A Pilot Study

Ferranti

Frediani

Mitchell

et al. 2020

Journal of Pregnancy

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“…There are many studies evaluating 11β-HSD 2 activity and the level of cortisol in different disease entities accompanying pregnancy, for example, pre-eclampsia or foetal hypotrophy [26,27], and taking into account the influence of stress or anxiety [28] but only a few of them concern physiological pregnancies and the mode of delivery. Many authors emphasize that both the mode of delivery and the type of anaesthesia administered are associated with the foetal hormonal stress response [29][30][31][32][33][34]. Schuller-and colleagues found that newborns delivered through the maternal passage by natural forces are characterised by higher cortisol levels and demonstrate a higher pain expression compared to children born by caesarean section [35].…”

Section: Discussionmentioning

confidence: 99%

Does the Caesarean Section Impact on 11β HSD2 and Fetal Cortisol?

Słabuszewska-Jóźwiak

Włodarczyk

Kilian

et al. 2020

IJERPH

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Purpose: Comparison of the activity of 11beta-hydroxysteroid dehydrogenase type 2 in the placenta and the umbilical cord blood cortisol level between caesarean sections with or without uterine contraction and vaginal delivery groups. Cortisol is the main stress hormone responsible for the normal adaptation of the neonate to extrauterine life. The disorders resulting from a dysfunction of the 11β-HSD 2–cortisol system can explain the higher risk of developing diseases in children born by caesarean section. Methods: 111 healthy, pregnant women in singular pregnancy at term of delivery were included into the study. The study comprised 11β-HSD 2 in placental tissue from 49 pregnant women delivering by elective caesarean section and 46 pregnant women delivering by vagina. In 16 cases of the elective caesarean section, regular uterine contractions were declared. Cortisol level was estimated in umbilical cord blood directly after delivery. Results: We found no statistically significant differences in the activity of 11β-HSD 2 in placentas delivered via caesarean sections (29.61 on average in elective caesarean sections and 26.65 on average in intrapartum caesarean sections) compared to vaginal deliveries (31.94 on average, p = 0.381), while umbilical cord blood cortisol in the elective caesarean sections group was significantly lower (29.86 on average) compared to the vaginal deliveries (55.50 on average, p < 0.001) and intrapartum caesarean sections (52.27 on average, p < 0.001). Conclusions: The model of placental 11β-HSD 2 activity and umbilical cord blood cortisol concentration seems to be significant in conditions of stress associated with natural uterine contractions in labour.

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“…Additionally, human cortisol secretion follows a circadian rhythm, which was not accounted for in this study (42). However, Kosicka et al (19) controlled for diurnal variation by taking early-morning blood samples and drew the same conclusion that the maternal serum cortisol-to-cortisone ratio was reduced in PE. Cortisol secretion is influenced by external factors, including stress and anxiety (43).…”

Section: Discussionmentioning

confidence: 99%

A Lower Maternal Cortisol-to-Cortisone Ratio Precedes Clinical Diagnosis of Preterm and Term Preeclampsia by Many Weeks

Jayasuriya

Hughes

Sovio

et al. 2019

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Previous studies have shown reduced placental levels of 11- β -hydroxysteroid dehydrogenase type 2 (11 β HSD2) in preeclampsia (PE). However, it is unknown if the maternal cortisol-to-cortisone ratio is predictive of placental complications of pregnancy. Objective To determine the relationship between the maternal serum cortisol-to-cortisone ratio at different stages of pregnancy and the risk of PE or fetal growth restriction (FGR). Design Women from the Pregnancy Outcome Prediction Study experiencing PE (n = 194) or FGR (n = 185), plus a random sample of healthy controls (n = 279), were studied. Steroids were measured at ∼12, ∼20, ∼28, and ∼36 weeks of gestational age (wkGA). Separate analyses were performed for outcomes with term or preterm delivery. Associations were modeled using logistic regression. Results At 28 wkGA, the cortisol-to-cortisone ratio was negatively associated (OR per 1 SD increase, 95% CI)] with preterm PE (OR 0.33, 95% CI 0.19 to 0.57), term PE (OR 0.61, 95% CI 0.49 to 0.76), and preterm FGR (OR 0.50, 95% CI 0.29 to 0.85). At 36 wkGA, the cortisol-to-cortisone ratio was negatively associated with term PE (OR 0.42, 95% CI 0.32 to 0.55) but not term FGR (OR 1.07, 95% CI 0.87 to 1.31). Associations were not materially affected by adjustment for maternal characteristics. Conclusions A lower maternal serum cortisol-to-cortisone ratio precedes clinical manifestation of PE and preterm FGR by many weeks, despite previous reports of reduced levels of placental 11 β HSD2 in these conditions. Our observations implicate enhanced maternal 11 β HSD2 activity or reduced 11 β HSD type 1 activity in the pathophysiology of PE.

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Increased cortisol metabolism in women with pregnancy-related hypertension

Cited by 25 publications

References 46 publications

Early Pregnancy Serum Metabolite Profiles Associated with Hypertensive Disorders of Pregnancy in African American Women: A Pilot Study

Early Pregnancy Serum Metabolite Profiles Associated with Hypertensive Disorders of Pregnancy in African American Women: A Pilot Study

Does the Caesarean Section Impact on 11β HSD2 and Fetal Cortisol?

A Lower Maternal Cortisol-to-Cortisone Ratio Precedes Clinical Diagnosis of Preterm and Term Preeclampsia by Many Weeks

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