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Altered adrenal steroid production in term infants having respiratory acidosis
C A Harlin1, J M Tucker, C L Winkler
1Department of Obstetrics and Gynecology, University of Alabama, Birmingham 35294.
Insights
Fetal stress from pregnancy complications alters adrenal steroidogenesis. Respiratory acidosis during labor further impacts fetal adrenal function, decreasing dehydroepiandrosterone sulfate and increasing cortisol.
Area of Science:
- Neonatal Medicine
- Endocrinology
- Perinatal Biology
Background:
- Pregnancy complications linked to fetal stress show altered fetal adrenal steroidogenesis, with reduced dehydroepiandrosterone sulfate (DHEAS) and normal/increased cortisol.
- Previous studies suggest fetal stress impacts adrenal hormone production.
Purpose of the Study:
- To investigate adrenal steroidogenesis in term infants with respiratory acidosis.
- To compare adrenal steroidogenesis in acidotic infants, non-acidotic infants with pregnancy complications (controls), and infants from uncomplicated pregnancies (normals).
Main Methods:
- Analysis of umbilical cord serum levels of dehydroepiandrosterone sulfate (DHEAS) and cortisol.
- Comparison of 36 term infants with respiratory acidosis against matched control and normal infants.
Main Results:
- Acidotic infants exhibited the lowest DHEAS levels and highest cortisol levels.
- Control infants showed intermediate levels for both DHEAS and cortisol.
- Normal infants had the highest DHEAS levels and lowest cortisol levels.
Conclusions:
- Pregnancy complications significantly alter fetal adrenal steroidogenesis, characterized by decreased DHEAS and increased cortisol.
- Intrauterine deterioration leading to respiratory acidosis during labor imposes an additional detrimental effect on fetal adrenal function.
Abstract:
Prior studies have provided evidence for reduced fetal adrenal production of dehydroepiandrosterone sulfate and normal or increased production of cortisol in association with pregnancy complications believed to result in fetal stress. In the present study, we sought to determine the status of adrenal steroidogenesis in 36 term infants having respiratory acidosis and to compare acidotic infants to (i) non-acidotic infants matched for pregnancy complications, gestational age, and method and indications for delivery (control infants), and (ii) non-acidotic infants of non-complicated pregnancies who were also matched for gestational age and delivery method (normal infants). Umbilical cord serum levels of dehydroepiandrosterone sulfate were lowest in acidotic infants, intermediate in the condition matched control infants and highest in the non-acidotic infants of normal pregnancies. On the other hand, cortisol levels were highest in acidotic infants, intermediate in control infants and lowest in the normal infants. These data suggest that various pregnancy complications give rise to significant alterations in adrenal steroidogenesis (decreased dehydroepiandrosterone sulfate and increased cortisol). Intrauterine deterioration during labor with resultant respiratory acidosis has an additional effect on fetal adrenal function.