Blunted stress response in small for gestational age neonates
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Published on: June 13, 2021
Leonhard Schäffer1, Deborah Müller-Vizentini, Tilo Burkhardt
1Department of Obstetrics, University of Zürich 8091, Switzerland. leonhard.schaeffer@usz.ch
Insights
Small for gestational age (SGA) neonates exhibit a blunted hypothalamus-pituitary-adrenal (HPA) axis stress response. This suggests intrauterine conditions may permanently alter HPA regulation, impacting future adult health.
Area of Science:
- Endocrinology
- Neonatal Medicine
- Developmental Biology
Background:
- Intrauterine development adversities impact offspring health.
- Hypothalamus-pituitary-adrenal (HPA) axis dysregulation is linked to hypertension and metabolic syndrome in small for gestational age (SGA) individuals.
- Altered HPA axis function may underlie SGA-associated long-term health issues.
Purpose of the Study:
- To investigate stress response patterns in SGA neonates.
- To determine if intrauterine-induced HPA axis maladaptation persists postnatally.
Main Methods:
- Salivary cortisol and cortisone levels were measured in SGA and appropriate for gestational age (AGA) neonates.
- Measurements were taken during resting conditions and after a pain-induced stress event.
- Multiple stepwise regression analysis excluded confounding factors like delivery mode, gender, and gestational age.
Main Results:
- AGA neonates showed a significant increase in salivary cortisol and cortisone post-stress.
- SGA neonates displayed a blunted steroid release in response to the stress stimulus.
- No significant influence of delivery mode, gender, or gestational age on stress response patterns was found.
Conclusions:
- SGA neonates exhibit a blunted physiological activation of the HPA axis to stress.
- Intrauterine-induced alterations in HPA axis regulation appear to persist into the postnatal period.
- This persistent HPA axis dysregulation supports its role in the fetal origins of adult diseases.
Abstract:
There is evidence that adverse conditions during intrauterine development affect future health of the offspring. Hypothalamus-pituitary-adrenal (HPA) axis dysregulation is assumed to play an important role in the association of small for gestational age (SGA) and the pathogenesis of hypertension and the metabolic syndrome. Stress response patterns in SGA neonates may identify a link with intrauterine-induced permanent maladaptation of the HPA axis. Salivary cortisol and cortisone levels were therefore analyzed during resting conditions and in response to a pain-induced stress event in SGA (<5th percentile) and appropriate for gestational age (AGA) neonates born > or =34 wk of gestation. In AGA neonates, salivary cortisol and cortisone levels significantly increased after the stress event (p < 0.05). In contrast, SGA infants exhibited a blunted steroid release after stress induction (p = 0.76, p = 0.65, respectively). No influence of mode of delivery (p = 0.93), gender (p = 0.21), and gestational age (p = 0.57) on stress response patterns was observed in a multiple stepwise regression. SGA neonates show a blunted physiologic activation of the HPA axis in response to a stress stimulus. Thus, intrauterine-induced alteration of HPA axis regulation seems to persist into the postnatal period and represents a prerequisite for the hypothesis of HPA axis involvement in the fetal origin of adult diseases.
