Mapping of Determinants of Urinary Sex Steroid Metabolites During Late Pregnancy: Results from Two Spanish Cohorts

Steroid hormones (SHs), including sex steroids and corticosteroids, are crucial for a healthy pregnancy. We aimed to comprehensively characterize the maternal SH metabolome in late pregnancy and identify clinical, lifestyle, and sociodemographic determinants influencing SH metabolism with a replication in an independent cohort. Urinary SH metabolites were analyzed in 1221 third-trimester pregnant women (aged 28 to 37 years) from two Spanish cohorts, BiSC (2018-2021, n = 721) and INMA-Sabadell (2004-2006, n = 500), using targeted UHPLC-MS/MS. We quantified 50 SH metabolites, resulting in 13 hormone groups, 9 sulfate/glucuronide ratios, and 17 estimated steroid enzymatic activities across steroidogenesis pathways. We applied elastic net regression to identify determinants, and multivariable linear regression models to estimate variance explained. Among the 47 and 28 determinants from BiSC and INMA-Sabadell, respectively, 10 determinant-SH metabolome pairs showed statistically significant associations (p < 0.05), supporting robust replication. Maternal BMI was the main determinant linked to higher corticosteroid and androgen metabolites. Higher physical activity was associated with lower glucocorticoids and progestogen metabolites, while older maternal age was related with lower levels of androgen and corticosteroid metabolites. Tobacco exposure in the first trimester predicted higher levels of cortisol metabolites. Latin American women had lower cortolone levels compared with Spanish women. Parity, dietary fat intake, sleep, alcohol intake, and sex of the fetus contributed to smaller variations in different SHs. This dual-cohort analysis provides the most detailed and replicated evidence to date of how clinical, lifestyle, and sociodemographic factors shape the maternal SH metabolome during late pregnancy.