Abstract
ObjectivesThe aim of the study was to analyze the plasma and urinary cortisol (F) and cortisone (E) levels in normotensive and hypertensive pregnant women. The parameters known to reflect the function of 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) were calculated to verify the changes in glucocorticoid balance over the course of gestational hypertension (GH) and pre-eclampsia (PE).Materials and MethodsThis retrospective case-control study included women in the third trimester of pregnancy, diagnosed with: GH (n = 29), PE (n = 26), or chronic hypertension (CH; n = 22). Normotensive women in their third trimester of pregnancy were also included (controls; n = 43). The plasma and urinary F and E levels were measured with the HPLC-FLD method. The 11β-HSD2 function was estimated by calculating the following ratios: plasma F/E and urinary free F to urinary free E (UFF/UFE). A statistical analysis was performed based on case-control structure.Results and DiscussionPE was characterized by lower plasma F levels (639.0 nmol/L), UFF/Cr levels (3.80 μg/mmol) and F/E ratio (3.46) compared with that of the controls (811.7 nmol/L, 6.28 μg/mmol and 5.19, respectively) with marked abnormalities observed in the changes of F/E and UFF/UFE ratios with advancing gestation. GH patients showed significant disparities in the urinary steroid profile with lower UFF/UFE ratio (0.330 vs. 0.401) compared with the normotensive controls and abnormal changes in the UFF/UFE throughout pregnancy. The observed tendency towards lower F/E and UFF/UFE ratios in PE and GH patients may reflect more intensive F metabolism over the course of those disorders. In the normal pregnancy group, the plasma F/E and UFF/UFE ratios tended to present inverse correlations with advancing gestation. This trend was much less marked in PE and GH patients, suggesting that the abnormalities in 11β-HSD2 functions progressed with the GA. The birth weights of neonates born from pre-eclamptic pregnancies were lower than those from uncomplicated pregnancies, although only when the babies were born prematurely. Children born at term to normotensive mothers or mothers suffering from PE had comparable birth weights.
Highlights
Hypertensive disorders of pregnancy (HDsP) complicate up to 10% of pregnancies and are among the most common causes of poor perinatal outcomes [1,2,3]
PE was characterized by lower plasma F levels (639.0 nmol/L), UFF/Cr levels (3.80 μg/ mmol) and F/E ratio (3.46) compared with that of the controls (811.7 nmol/L, 6.28 μg/mmol and 5.19, respectively) with marked abnormalities observed in the changes of F/E and UFF/ UFE ratios with advancing gestation
Glucocorticoids in Hypertensive Disorders of Pregnancy the plasma F/E and urinary free F to urinary free E (UFF/UFE) ratios tended to present inverse correlations with advancing gestation. This trend was much less marked in PE and gestational hypertension (GH) patients, suggesting that the abnormalities in 11β-HSD2 functions progressed with the gestational age (GA)
Summary
Hypertensive disorders of pregnancy (HDsP) complicate up to 10% of pregnancies and are among the most common causes of poor perinatal outcomes [1,2,3] These disorders significantly increase the risk of pre-term deliveries, placental abruptions and maternal and neonatal deaths. The syndrome is characterized by excessive F, which begins to interact with the mineralocorticoid receptor and results in sodium and water retention and eventually causes hypervolemic hypertension [7] In pregnancy, this enzyme provides an additional function because it is present in the placenta; it protects the baby from the deleterious effects of maternal glucocorticoids (GCs) whose concentrations in pregnant women are several times higher than in the developing fetus. This abnormal function should be evident in maternal matrices; reports on this subject are contradictory [14,15,16,17]
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