Document Detail

Fetal adrenal gland volume and cortisol/dehydroepiandrosterone sulfate ratio in inflammation-associated preterm birth.
MedLine Citation:
PMID:  18310376     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Fetal adaptation to stress is regulated in part by the pituitary-adrenocortical system. The stress hormones dehydroepiandrosterone sulfate (DHEAS) and cortisol have opposing effects: cortisol suppresses while DHEAS enhances immune functions. We sought to estimate the impact of intraamniotic inflammation on fetal adrenal gland volume and cortisol-to-dehydroepiandrosterone sulfate ratio (fetal stress ratio) in pregnancies complicated by preterm birth.
METHODS: Fifty-one consecutive singleton fetuses of mothers who had an indicated amniocentesis to rule out infection were analyzed. Intraamniotic inflammation was assessed by proteomic profiling of amniotic fluid for the biomarkers of the Mass Restricted score. The Mass Restricted score ranges from 0 (biomarkers absent) to 4 (all biomarkers present), with Mass Restricted scores of 3 or 4 indicating severe intraamniotic inflammation. Fetal adrenal gland volume was assessed by three-dimensional ultrasonography and corrected for estimated fetal weight. Interleukin-6 (IL-6), cortisol, and DHEAS were measured by immunoassay.
RESULTS: Women with intraamniotic inflammation delivered earlier (27.8+/-3.4 weeks, n=16, compared with 32.3+/-3.0 weeks, n=35, P<.001), and their fetuses had higher cord blood IL-6 (P=.011) and higher corrected adrenal gland volumes (P=.027). Cord blood IL-6 levels were in direct relationship with corrected adrenal volume (r=0.372, P=.019), fetal cortisol (r=0.428, P=.010), and DHEAS (r=0.521, P<.001). However, fetuses exposed to intraamniotic inflammation had an overall lower fetal stress ratio (P=.034). These results maintained after adjusting for gestational age, uterine contractions, and steroid exposure.
CONCLUSION: Fetuses exposed to intraamniotic inflammation have higher adrenal gland volumes and lower cortisol-to-DHEAS ratios, suggesting that the fetal adrenocortical axis plays a role in the intrauterine adaptation to inflammation.
Catalin S Buhimschi; Ozhan M Turan; Edmund F Funai; Humberto Azpurua; Mert-Ozan Bahtiyar; Sifa Turan; Guomao Zhao; Antonette Dulay; Vineet Bhandari; Joshua A Copel; Irina A Buhimschi
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  111     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-03-03     Completed Date:  2008-04-24     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  715-22     Citation Subset:  AIM; IM    
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MeSH Terms
Adrenal Glands / anatomy & histology*
Amniotic Fluid / chemistry
Biological Markers / analysis
Chorioamnionitis / physiopathology*,  ultrasonography
Dehydroepiandrosterone Sulfate / blood*
Fetal Blood / chemistry*
Hydrocortisone / blood
Infant, Newborn
Infant, Premature / blood
Interleukin-6 / blood
Organ Size
Pituitary-Adrenal System
Premature Birth / physiopathology*
Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
Ultrasonography, Prenatal*
Grant Support
R01 HD 047321-01/HD/NICHD NIH HHS; R01 HD047321/HD/NICHD NIH HHS; R01 HD047321-01/HD/NICHD NIH HHS; R01 HD047321-02/HD/NICHD NIH HHS; R01 HD047321-03/HD/NICHD NIH HHS; R01 HD047321-04/HD/NICHD NIH HHS; R01 HD047321-05/HD/NICHD NIH HHS
Reg. No./Substance:
0/Biological Markers; 0/Interleukin-6; 57B09Q7FJR/Dehydroepiandrosterone Sulfate; WI4X0X7BPJ/Hydrocortisone

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