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Longitudinal Study of Progestins, Mineralocorticoids, and Glucocorticoids throughout Human Pregnancy^*

Departments of Pediatrics (H.G.D., A.H., M.H., D.K.) and Obstetrics and Gynecology, Klinikum Grofihadern (H.T.V.), University of Munich Munich, West Germany
the Department of Pediatrics, University of Kiel (W.G.S.) Kiel, West Germany
the Department of Clinical Biochemistry, University of Bonn (F.B.) Bonn, West Germany

Address requests for reprints to: Helmuth G. Dörr, M.D., Department of Pediatrics, University of Munich Medical School, Lindwurmstrasse 4, D-8000 Munich 2, West Germany

The maternal adrenal cortex seems to be involved in the adaptation to pregnancy. To study in detail adrenocortical secretion during pregnancy, we measured plasma aldosterone, corticosterone, 11-deoxycorticosterone, progesterone, 17-hydroxyprogesterone, 11-deoxycortisol, cortisol, and cortisone simultaneously by RIA after extraction and automated Sephadex LH-20 chromatography of 10 normal pregnant women longitudinally throughout pregnancy at weeks 8–10, 14–17, 21–24, 28–32, and 38 as well as at the time of admission to the delivery room. The mean plasma progesterone and 17-hydroxyprogesterone concentrations increased from 37.2 ± 6.5 (± SE) and 8.2 ± 1.0 nmol/L, respectively, in early gestation to maximum levels of 138.0 ± 25.7 and 22.8 ± 2.2 nmol/L at week 38 (P < 0.01). Plasma glucocorticoid levels rose 2- to 3-fold (P < 0.01) from weeks 8–10 (corticosterone, 18.5 ± 5.4; 11-deoxycortisol, 1.9 ± 0.2; cortisone, 24.2 ± 4.2; cortisol, 195.5 ± 37.6 nmol/L) to week 38 (corticosterone, 42.9 ± 11.2; 11-deoxycortisol, 4.6 ± 0.5; cortisone, 71.5 ± 13.6; cortisol, 420 ± 63 nmol/L). Similarly, plasma mineralocorticoid levels increased 5- to 7-fold (P < 0.01) from weeks 8–10 (11-deoxycorticosterone, 0.69 ± 0.12; aldosterone, 0.41 ± 0.08 nmol/L) to maximum levels at week 38 (5.3 ± 0.9 and 2.1 ± 0.3 nmol/L, respectively). At the time of admission to the delivery room, plasma 11-deoxycortisol, corticosterone, and cortisol concentrations were higher (P < 0.02) than at 38 weeks, but plasma progestin and mineralocorticoid concentrations were not. We conclude that the source of the elevated maternal corticosteroid levels in pregnancy in addition to the estrogen-mediated rise in corticosteroid-binding globulin is the maternal adrenal cortex itself. The peak glucocorticoid levels at admission to the delivery room reflect increased maternal and fetal stress with the onset of labor.

^* This work was supported by grants (Do 273/1-3) from the Deutsche Forschungsgemeinschaft.

Received October 12, 1988.

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