The role of the hypothalamic-pituitary-adrenal axis in preparing the fetus for birth

Abstract

When I returned to New Zealand in 1959, after 6 years in the United Kingdom in postgraduate clinical training, I was appointed to a junior academic position in Auckland University’s Postgraduate School of Obstetrics and Gynaecology. One of my first responsibilities was to establish a research program. To this end, I sought the counsel of a colleague more experienced in research, A. William Liley of fetal transfusion fame. His wise advice was to look for the most important problems in the discipline and determine which ones were potentially solvable and then to choose the one that excited me most. Identifying the most important problem in obstetrics was easy—it was then, and still is, preterm labor. I reasoned that a solution to the question of the nature of the mechanism initiating normal labor at term should provide the key to understanding preterm labor. When I reviewed the literature and discovered the 1933 paper of Malpas, 1 Malpas P. Prematurity and malformation of the foetus. J Obstet Gynaecol Br Emp. 1933; 40: 1046-1053 Crossref Scopus (36) Google Scholar I realized that circumstantial evidence implicated the fetal pituitary and adrenal glands in initiating labor in human pregnancy. The excitement came from the realization that the hypothesis was testable in an animal model with which I was already familiar, the fetal sheep.