Maternal serum steroid hormones in vaginal delivery and caesarean section

The hormonal interplay between the mother and the fetal-placental unit may influence the mode of delivery. This study aimed to investigate the association between maternal peripartal serum concentrations of sex hormone-binding globulin (SHBG) and 10 steroid hormones with delivery outcomes.

This observational study included 171 healthy pregnant women with spontaneous onset of labor: 117 had vaginal delivery and 54 underwent urgent cesarean section (C-section). Serum concentrations of aldosterone, androstenedione, cortisol, cortisone, corticosterone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), 17-hydroxyprogesterone, progesterone, and total testosterone were determined by liquid chromatography-tandem mass spectrometry (LC-MS/MS), while free testosterone was calculated. Sex hormone-binding globulin was measured by chemiluminescent microparticle immunoassay. Group differences were tested with the Mann-Whitney U test, and associations with delivery mode were assessed by logistic regression and receiver operating characteristic (ROC) analysis.

Compared with the vaginal delivery group, women who underwent urgent C-section had significantly lower serum concentrations of SHBG, corticosterone, cortisol, aldosterone, progesterone, 17-hydroxyprogesterone, DHEA, DHEAS, and free testosterone (all P < 0.001). In multivariate logistic regression, aldosterone (odds ratio, OR 0.11, 95% CI 0.04 to 0.27, P < 0.001) and DHEAS (OR 0.74, 95% CI 0.58 to 0.94, P = 0.011) were independently associated with delivery mode. ROC analysis showed that aldosterone > 0.9 nmol/L predicted vaginal delivery with AUC 0.874, sensitivity 88%, and specificity 77%.

Low maternal aldosterone concentrations showed the strongest association with urgent C-section, suggesting that aldosterone may play a protective role in successful vaginal delivery.