Changes in concentrations of cortisol, dehydroepiandrosterone sulphate and progesterone in fetal and maternal serum...

In fetuses, adrenal steroids have been implicated in organ maturation and in some species in initiation of labour. The fetal adrenal gland differs from the adult in its complement of steroid metabolizing enzymes. This study sought to examine the changes in peripheral cortisol, progesterone and dehydroepiandrosterone sulphate (DHEAS) in unstressed fetuses during pregnancy.

Paired maternal and fetal samples were collected from 47 patients. Fetal blood samples were collected by transabdominal needling. All fetuses were appropriately grown for age which ranged from 18 to 41 weeks.

Hormones were measured using specific, validated immunoassays.

Fetal progesterone (mean, 822 nmol/l; 95% data intervals 196-1449 nmol/l) varied considerably between individuals but there was no significant change in serum concentration with gestational age, nor was there any difference between male and female fetuses. There was a small, but significant (y = 0.339x2 - 13.5x + 231; r = 0.72, P = 0.0001) rise in cortisol in the fetal circulation from 32 to 41 weeks gestational age, whereas the mean fetal DHEAS concentration decreased linearly with gestational age from 4.1 mumol/l at 18 weeks to 2.6 mumol/l at 41 weeks (r = -0.41; P = 0.007). Mean progesterone concentration in the maternal serum increased linearly from 98 nmol/l at 18 weeks to 783 nmol/l at 41 weeks. In the fetus there was a significant correlation between progesterone and cortisol concentrations.

These results are compatible with the proposed role of cortisol in fetal lung maturation, confirm high levels of progesterone in the fetus from an early stage of gestation, and provide further evidence for placental progesterone being the precursor of fetal cortisol.