Abstract
BackgroundCortisol is a hormone involved in many physiological functions including fetal maturation and epigenetic programming during pregnancy. This study aimed to use hair cortisol as a biomarker of chronic inhaled corticosteroid (ICS) exposure and assess the potential effects of asthma on the hypothalamic-pituitary-adrenal (HPA) axis in pregnant women. We hypothesized that pregnant women with asthma treated with ICS would exhibit lower hair cortisol concentrations, indicative of adrenal suppression, compared to women with asthma not using ICS and women who do not have asthma.MethodsWe performed an observational retrospective cohort study. Hair samples were analyzed from pregnant women with asthma, with (n = 56) and without (n = 31) ICS treatment, and pregnant women without asthma (n = 31). Hair samples were segmented based on the growth rate of 1 cm/month and analyzed by enzyme immunoassay to provide cortisol concentrations corresponding to preconception, trimesters 1–3, and postpartum. Hair cortisol concentrations were compared within and among the groups using non-parametric statistical tests.ResultsHair cortisol concentrations increased across trimesters for all three groups, but this increase was dampened in women with asthma (P = 0.03 for Controls vs. ICS Treated and Controls vs. No ICS). ICS Treated women taking more than five doses per week had hair cortisol concentrations 47 % lower in third trimester than Controls. Linear regression of the third trimester hair cortisol results identified asthma as a significant factor when comparing consistent ICS use or asthma as the predictor (F(1, 25) = 9.7, P = 0.005, R2adj = 0.257).ConclusionsHair cortisol successfully showed the expected change in cortisol over the course of pregnancy and may be a useful biomarker of HPA axis function in pregnant women with asthma. The potential impact of decreased maternal cortisol in women with asthma on perinatal outcomes remains to be determined.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-0962-4) contains supplementary material, which is available to authorized users.
Highlights
Cortisol is a hormone involved in many physiological functions including fetal maturation and epigenetic programming during pregnancy
Three groups of pregnant women were recruited from June 2012 to December 2014: women with inhaled corticosteroid (ICS)-treated asthma (ICS Treated), and two comparison groups consisting of women without asthma (Controls) and a disease-matched group of women with asthma not treated with ICS (No ICS)
Fourteen additional hair samples from the ICS Treated group could not be analyzed due to insufficient quantity, inaccurate segmentation, ICS being used to treat a condition other than asthma, or hair being collected too early in first trimester (T1) or >6 months postpartum
Summary
Cortisol is a hormone involved in many physiological functions including fetal maturation and epigenetic programming during pregnancy. This study aimed to use hair cortisol as a biomarker of chronic inhaled corticosteroid (ICS) exposure and assess the potential effects of asthma on the hypothalamic-pituitary-adrenal (HPA) axis in pregnant women. Cortisol has many important functions in the body including metabolism, regulation of blood pressure, and roles in the inflammatory and stress responses. The hypothalamus and pituitary gland are activated to release a series of hormones that signal the adrenal cortex to release cortisol. Asthma is a common chronic inflammatory disease for which the recommended therapy for long-term control is inhaled corticosteroids (ICS) [1]. While generally believed to confer less systemic exposure than systemic corticosteroids, in severe cases, the use of ICS may cause adrenal insufficiency or crisis [2, 3]
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