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Maternal Serum Steroid Hormones And Impending Caesarean Section: Role Of Aldosterone In The Childbirth

Context: The role of maternal adrenal steroids is to regulate electrolytes and blood volume of mother during pregnancy. Together with estrogen ( E2) and P4, they regulate fetal access to nutrients, electrolytes and water by regulating maternal volume expansion, perfusion of the uterus and placenta, and substrate availability. Indirectly by controlling it, adrenal steroids can influence mode of delivery. Objective:The hormonal autocrine and paracrine signaling pathway between the mother and the fetal-placental unit could affect the mode of delivery. We investigated the association between the peripartal serum concentration of sex hormone binding protein (SHBG) and 10 selected steroid hormones in pregnant women and the mode of delivery. Patientss and Methods:Serum samples were collected out of 184 women. There were 2 groups of pregnant women whose delivery started with regular contractions: the ones whose pregnancies ended with a vaginal delivery and those who gave birth via urgent C-section. For determining the serum concentrations of SHBG and selected steroid hormones, LC-MS/MS was utilized. Mann Whitney U test was utilized to show difference in serum concentration of SHBG and steroids between these 2 groups. Univariate and multivariate logistic regressions and ROC analysis were utilized to show association between serum concentration of SHBG and selected steroid hormones and mode of delivery. Results:Statistically significant difference was identified between the serum concentrations of corticosterone (p 0.02), cortisol (p 0.04), aldosterone (p 0.007) and dehidroepiandrosterone (DHEAS) (p 0.04) between these two groups. ROC analysis showed that all the examinees whose level of aldosterone is less than 0.916 nmol/L have a 0.27 times greater chance to give birth via C-section (AUC 0.732, 95% CI 0.660-0.796, sensitivity 91.67, specificity 55, 76, p<0.001). Conclusion: Mode of delivery and the serum concentration of some steroid hormones are correlated. Attention should be paid to the result which demonstrates that aldosterone could be possible predictor of urgent C-section.

aldosterone ; cesarean section ; steroids

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