A Lower Maternal Cortisol-to-Cortisone Ratio Precedes Clinical Diagnosis of Preterm and Term Preeclampsia by Many Weeks.
Jayasuriya, Nimesh A
The Journal of clinical endocrinology and metabolism
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Jayasuriya, N. A., Hughes, A. E., Sovio, U., Cook, E., Charnock-Jones, S., & Smith, G. (2019). A Lower Maternal Cortisol-to-Cortisone Ratio Precedes Clinical Diagnosis of Preterm and Term Preeclampsia by Many Weeks.. The Journal of clinical endocrinology and metabolism, 104 (6), 2355-2366. https://doi.org/10.1210/jc.2018-02312
Context: Previous studies have shown reduced placental levels of 11-beta-hydroxysteroid dehydrogenase-type 2 (11βHSD2) in preeclampsia. However, it is not known 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 preeclampsia or fetal growth restriction (FGR). Design: Women from the Pregnancy Outcome Prediction (POP) study experiencing preeclampsia (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 modelled using logistic regression. Results: At 28 wkGA, the cortisol to cortisone ratio was negatively associated (odds ratio (OR) per one standard deviation increase, 95% confidence interval (CI)) with preterm preeclampsia (OR 0.33, 95% CI 0.19-0.57), term preeclampsia (OR 0.61, 95% CI 0.49-0.76) and preterm FGR (OR 0.50, 95% CI 0.29-0.85). At 36 wkGA, the cortisol to cortisone ratio was negatively associated with term preeclampsia (OR 0.42, 95% CI 0.32-0.55) but not term FGR (OR 1.07, 95% CI 0.87-1.31). Associations were not materially affected by adjustment for maternal characteristics. Conclusions: A lower maternal serum cortisol to cortisone ratio precedes clinical manifestation of preeclampsia and preterm FGR by many weeks, despite previous reports of reduced levels of placental 11βHSD2 in these conditions. Our observations implicate enhanced maternal 11βHSD2 activity or reduced 11βHSD1 activity in the pathophysiology of preeclampsia
Humans, Fetal Growth Retardation, Pre-Eclampsia, Cortisone, Hydrocortisone, 11-beta-Hydroxysteroid Dehydrogenase Type 2, Incidence, Case-Control Studies, Pregnancy, Adult, Infant, Premature, Female
The POP study was funded by the National Institute for Health Research (NIHR) Cambridge Comprehensive Biomedical Research Centre (Women’s Health theme), and a project grant from the Medical Research Council (United Kingdom; G1100221). The study was also supported by GE Healthcare (donation of two Voluson i ultrasound systems for the POP study), and by the NIHR Cambridge Clinical Research Facility, where all research visits took place. A.E.H. was an Academic Clinical Fellow funded by NIHR.
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
External DOI: https://doi.org/10.1210/jc.2018-02312
This record's URL: https://www.repository.cam.ac.uk/handle/1810/289508