比较不良分娩结局孕妇与正常分娩结局孕妇产前皮质醇和 DHEA-S 的特征。

Comparative profiling of prenatal cortisol and DHEA-S among pregnant women with poor birth outcome and pregnant women with normal birth outcome.

机构信息

Indian Institute of Public Health Gandhinagar, Lekawada, Gandhinagar, India.

University of Canberra, Canberra, Australian Capital Territory, Australia.

出版信息

Clin Endocrinol (Oxf). 2021 Dec;95(6):863-872. doi: 10.1111/cen.14569. Epub 2021 Aug 16.

DOI:10.1111/cen.14569

PMID:34370329

Abstract

CONTEXT

Cortisol and dehydroepiandrosterone-sulfate (DHEA-S) are indispensable hormones for normal pregnancy. It is unclear if these hormones, specifically DHEA-S can offer value for predicting poor birth outcome.

OBJECTIVE

To compare prenatal cortisol and DHEA-S levels among pregnant women with normal or poor birth outcome.

METHODS

Plasma and saliva were collected prospectively from women in second-third trimester of pregnancy. Women with normal birth outcome (NBO) (n = 501) included live birth, no pregnancy complications and ≥2.5 kg infant birth weight. Women with poor birth outcome included adverse birth outcome (ABO) (n = 50) or low birth weight outcome (LBW) (n = 147). Enzyme-linked immunosorbent assay was performed to measure hormone concentrations in plasma and saliva.

RESULTS

Circulatory-DHEA-S levels in pregnant women with ABO were higher than women with NBO (p = .043). Among ABO, only stillbirth cases demonstrated significant increase in circulatory-DHEA-S levels (p = .006). Circulatory and salivary cortisol/DHEA-S ratio was lower among women with stillbirth (p = .004) and ABO outcome (p = .043) respectively compared with women with NBO. Consistently, increased odds of ABO were observed in pregnant women with highest circulatory-DHEA-S levels (odds ratio quartile score 1 vs. 4, 2.79, p = .027) and lowest salivary cortisol/DHEA-S ratio (score 4 vs. 2, 2.83, p = .025). Increased odds of stillbirth outcome were observed in pregnant women with highest circulatory-DHEA-S levels (odds ratio quartile score 1 vs. 4, 8.47, p = .046) and lowest circulatory cortisol/DHEA-S ratio (score 4 vs. 1, 4.803, p = .048). Associations remained significant after adjusting for confounders. Women with LBW did not demonstrate significant changes in cortisol or DHEA-S levels.

CONCLUSION

Prenatal measurement of DHEA-S or cortisol/DHEA-S ratio may offer significant value for predicting adverse birth, specifically stillbirth outcome.

摘要

背景

皮质醇和脱氢表雄酮硫酸酯（DHEA-S）是正常妊娠所必需的激素。目前尚不清楚这些激素，特别是 DHEA-S 是否具有预测不良分娩结局的价值。

目的

比较正常分娩结局和不良分娩结局孕妇的产前皮质醇和 DHEA-S 水平。

方法

前瞻性收集孕妇妊娠中期和晚期的血浆和唾液。正常分娩结局（NBO）（n=501）包括活产、无妊娠并发症和婴儿出生体重≥2.5kg。不良分娩结局包括不良分娩结局（ABO）（n=50）或低出生体重结局（LBW）（n=147）。采用酶联免疫吸附法检测血浆和唾液中激素浓度。

结果

ABO 孕妇的循环 DHEA-S 水平高于 NBO 孕妇（p=0.043）。在 ABO 中，只有死产病例的循环 DHEA-S 水平显著升高（p=0.006）。与 NBO 相比，死产（p=0.004）和 ABO 结局（p=0.043）孕妇的循环和唾液皮质醇/DHEA-S 比值均较低。同样，循环 DHEA-S 水平最高的孕妇发生 ABO 的可能性增加（四分位分数 1 与 4 相比，优势比 quartile score 1 vs. 4, 2.79, p=0.027），唾液皮质醇/DHEA-S 比值最低（分数 4 与 2 相比，2.83, p=0.025）。循环 DHEA-S 水平最高的孕妇（四分位分数 1 与 4 相比，优势比 quartile score 1 vs. 4, 8.47, p=0.046）和循环皮质醇/DHEA-S 比值最低的孕妇（四分位分数 4 与 1 相比，4.803, p=0.048）发生死产结局的可能性增加。调整混杂因素后，相关性仍然显著。LBW 孕妇的皮质醇或 DHEA-S 水平无显著变化。