Pituitary-Adrenal Physiology during Pregnancy:

Simultaneous investigation of urinary and faecal glucocorticoid metabolite concentrations reveals short- versus long-term drivers of HPA-axis activity in a wild primate (Papio ursinus)

Glucocorticoids (GCs), a class of steroid hormones released through activation of the hypothalamic-pituitary-adrenal (HPA) axis, perform many vital functions essential for survival, including orchestrating an organism's response to stressors by modulating physiological and behavioural responses. Assessing changes and variation in GC metabolites from faecal or urine samples allows for the non-invasive monitoring of HPA-axis activity across vertebrates. The time lag of hormone excretion differs between these sample matrices, which has implications for their suitability for studying effects of different temporal nature on HPA-axis activity. However, simultaneous comparisons of predictors of faecal and urinary GC metabolites (fGCs and uGCs, respectively) are lacking. To address this gap, we employ frequent non-invasive sampling to investigate correlates of fGCs and uGCs in wild chacma baboons (Papio ursinus) (n = 17), including long-term (dominance rank, season, female reproductive state) and short-term (time of day, daily weather conditions) factors. Correlated with increasing day length, fGCs gradually decreased from winter to summer. No seasonal effect on uGCs was found but 'rain days' were associated with increased uGCs. Pregnant females had significantly higher fGCs compared to cycling and lactating females, whereas uGCs were not statistically different across reproductive states. A circadian effect was observed in uGCs but not in fGCs. Dominance rank did not affect either fGCs or uGCs. Our study highlights the difference in inherent fluctuation between uGCs and fGCs and its potential consequences for HPA-axis activity monitoring. While uGCs offer the opportunity to study short-term effects, they undergo more pronounced fluctuations, reducing their ability to capture long-term effects. Given the increasing use of urine for biological monitoring, knowledge of this potential limitation is crucial. Where possible, uGCs and fGCs should be monitored in tandem to obtain a comprehensive understanding of short- and long-term drivers of HPA-axis activity.

Cortisol and DHEA in development and psychopathology

Dehydroepiandrosterone (DHEA) and cortisol are the most abundant hormones of the human fetal and adult adrenals released as end products of a tightly coordinated endocrine response to stress. Together, they mediate short- and long-term stress responses and enable physiological and behavioral adjustments necessary for maintaining homeostasis. Detrimental effects of chronic or repeated elevations in cortisol on behavioral and emotional health are well documented. Evidence for actions of DHEA that offset or oppose those of cortisol has stimulated interest in examining their levels as a ratio, as an alternate index of adrenocortical activity and the net effects of cortisol. Such research necessitates a thorough understanding of the co-actions of these hormones on physiological functioning and in association with developmental outcomes. This review addresses the state of the science in understanding the role of DHEA, cortisol, and their ratio in typical development and developmental psychopathology. A rationale for studying DHEA and cortisol in concert is supported by physiological data on the coordinated synthesis and release of these hormones in the adrenal and by their opposing physiological actions. We then present evidence that researching cortisol and DHEA necessitates a developmental perspective. Age-related changes in DHEA and cortisol are described from the perinatal period through adolescence, along with observed associations of these hormones with developmental psychopathology. Along the way, we identify several major knowledge gaps in the role of DHEA in modulating cortisol in typical development and developmental psychopathology with implications for future research.

Associations between social behaviour and adrenal activity in female Barbary macaques: consequences of study design

Faecal glucocorticoid metabolite (fGCM) concentrations have been used to evaluate adrenal activity in a variety of species; including as an indicator of the physiological response to social stress. However, across studies, the relationships between dominance rank, social behaviours and adrenal responses can be inconsistent. Differences in the relationship between rank and glucocorticoids may be due to the relative costs of social status, and the relative frequencies of social stressors and potential coping mechanisms. However, the differences in observed relationships between specific social behaviours and glucocorticoids may be partly explained by sampling frequency, as studies often use average fGCM concentrations collected over a period of weeks or months, rather than fGCM concentrations that are temporally-matched with behavioural data. In this study, we directly compared long-term average and temporally-matched data to determine whether particular social behaviours were related to adrenal activity in female Barbary macaques (Macaca sylvanus) at Trentham Monkey Forest, UK; and whether observed relationships were consistent using these two approaches. Average rates of autogrooming were positively correlated with average fGCM; however, this relationship was not robust in temporally-matched samples. Instead, specific social behaviours associated with agonism were associated with fGCM in temporally-matched samples within individuals. These results indicate that analyses of relationships using long-term average fGCM and temporally-matched samples do not necessarily provide comparable results, highlighting that study design is critical in determining associations between an individual's social behaviour and the relative physiological costs involved.

Reproductive rate, not dominance status, affects fecal glucocorticoid levels in breeding female meerkats

Glucocorticoid hormones (GCs) have been studied intensively to understand the associations between physiological stress and reproductive skew in animal societies. However, we have little appreciation of the range of either natural levels within and among individuals, or the associations among dominance status, reproductive rate and GCs levels during breeding. To address these shortcomings, we examined variation in fecal glucocorticoid metabolites (fGC) during breeding periods in free-ranging female meerkats (Suricata suricatta) over 11 years. The vast majority of variation in fGC levels was found within breeding events by the same female (~87%), with the remaining variation arising among breeding events and among females. Concentrations of fGC generally tripled as pregnancy progressed. However, females with a high reproductive rate, defined as those conceiving within a month following parturition (mean = 9 days postpartum), showed significant reductions in fGC in the final 2 weeks before parturition. Despite these reductions, females with a high reproductive rate had higher fGC levels at conception of the following litter than those breeding at a low rate. After controlling for the higher reproductive rate of dominants, we found no association between levels of fGC and either age or dominance status. Our results suggest that one should be cautious about interpreting associations between dominance status, reproductive skew and GCs levels, without knowledge of the natural variation in GCs levels within and among females.

Evaluation of levels of cortisol in saliva using electro-chemical luminescence in low-risk and high-risk pregnancies

OBJECTIVES: to compare the levels of cortisol (cortisolemia refers to the level of cortisol in blood) in women with a high-risk pregnancy compared with those with a low-risk pregnancy, by way of evaluation of levels of cortisol in saliva, using the electrochemical luminescence technique (ECL). METHODS: 38 women aged between 17 and 40 years in the third trimester of pregnancy were divided in two groups: 20 low-risk pregnancies and 18 high-risk ones. Cortisol in saliva was collected at midnight and measured using ECL. The mean levels of cortisol in saliva in the two groups were compared using the Kruskal-Wallis test. RESULTS: the mean systolic and diastolic pressure was normal in both groups. The levels of cortisol in the saliva of women with high-risk pregnancies was significantly higher than those for the low-risk pregnancy group (20.2 (±21,1) nmol/L vs 11.4(±16.2) nmol/L; p=0.007). CONCLUSIONS: a high risk pregnancy involves higher levels of cortisol than a low-risk one. The levels of cortisol in saliva, as measured using ECL, can be used to identify hypercortisolism in pregnancy.

Hydrocortisone improves somnolence without hypotension in the postpartum period

Hypothalamic-pituitary-adrenal (HPA) axis abnormality and adrenal insufficiency secondary to chronic steroid treatment can be present in the perioperative period. When this occurs in pregnant patients during the peripartum period, the usually expected physiological changes may not be present. The hypotension associated with adrenal insufficiency may be masked by the normal physiological changes of pregnancy and delivery. We report on a patient whose only presenting symptom was mental status changes; this occurred without any significant hemodynamic changes. These mental status changes responded within minutes to a single dose of hydrocortisone. We recommend administering a pharmacological dose of steroid as a maneuver to rule out adrenal insufficiency when faced with a patient with an unexplained altered mental status while other differential diagnoses are considered.

Grooming in Barbary macaques: better to give than to receive?

It is well established that grooming underpins sociality in group-living primates, and a number of studies have documented the stress-reducing effects of being groomed. In this study, we quantified grooming behaviour and physiological stress (assessed by faecal glucocorticoid analysis) in free-ranging Barbary macaques, Macaca sylvanus. Our results indicate that it is the giving rather than the receiving of grooming that is associated with lower stress levels. These findings shed important new light on the benefits of this key behaviour in primate social life.

The endocrinology of pregnancy and fetal loss in wild baboons

An impressive body of research has focused on the mechanisms by which the steroid estrogens (E), progestins (P), and glucocorticoids (GC) ensure successful pregnancy. With the advance of non-invasive techniques to measure steroids in urine and feces, steroid hormones are routinely monitored to detect pregnancy in wild mammalian species, but hormone data on fetal loss have been sparse. Here, we examine fecal steroid hormones from five groups of wild yellow baboons (Papio cynocephalus) in the Amboseli basin of Kenya to compare the hormones of successful pregnancies to those ending in fetal loss or stillbirth. Using a combination of longitudinal and cross-sectional data, we analyzed three steroid hormones (E, P, GC) and related metabolites from 5 years of fecal samples across 188 pregnancies. Our results document the course of steroid hormone concentrations across successful baboon pregnancy in the wild and demonstrate that fecal estrogens predicted impending fetal loss starting 2 months before the externally observed loss. By also considering an additional 450 pregnancies for which we did not have hormonal data, we determined that the probability for fetal loss for Amboseli baboons was 13.9%, and that fetal mortality occurred throughout gestation (91 losses occurred in 656 pregnancies; rates were the same for pregnancies with and without hormonal data). These results demonstrate that our longstanding method for early detection of pregnancies based on observation of external indicators closely matches hormonal identification of pregnancy in wild baboons.

Corticosteroids as potential mechanism regulating variability in reproductive success in monogamous oldfield mice (Peromyscus polionotus)

Male and female mammals undergo profound hormonal changes during pregnancy, some of which are sufficiently dramatic to influence offspring survival. In order to understand the proximate mechanisms regulating the variability in reproductive success within and between individuals, we monitored changes in fecal corticosteroid concentrations over the reproductive cycle in male and female oldfield mice (Peromyscus polionotus subgriseus) to test whether corticosteroid concentrations during pregnancy were associated with offspring survival. In females that successfully raised litters to weaning, fecal corticosteroid concentrations were low until mid-gestation and increased significantly towards term; in females that did not raise their pups to weaning, fecal corticosteroid concentrations were significantly higher at mid-gestation, and remained high until late gestation. The difference in fecal corticosteroid concentrations at mid-gestation between successful and unsuccessful females can be explained by the fact that successful females were lactating. Lactation has been associated with a down-regulation of the hypothalamic-pituitary-adrenal (HPA) axis and, accordingly, a decrease in plasma corticosterone (CORT) in several species, including humans. Males that successfully raised their litters had low fecal corticosteroid concentrations throughout their partner's pregnancy. Unsuccessful males, however, had significantly higher fecal corticosteroid concentrations at term than males that raised their pups to weaning. While these preliminary data require further investigation, we suggest that pre-partum fecal corticosteroid concentrations in males were responsible for the variability in reproductive success.

Adrenal and white cell count responses to chronic stress in gestating and postpartum females of the viviparous skink Egernia whitii (Scincidae)

This study investigates the relationships between plasma corticosterone concentrations and white cell counts in captive females of the viviparous lizard Egernia whitii during two phases of the reproductive cycle. Gestating and postpartum females were captured in the field and held in the laboratory for 4 weeks. Plasma corticosterone and progesterone concentrations and white blood cell counts were examined in blood samples taken at capture and after 24 h, 1 week, and 4 weeks in captivity. At 24 h after capture, plasma corticosterone concentrations in both groups had increased significantly compared with initial values but then returned to initial concentrations after 1 week in captivity and remained low in the 4 week samples. Plasma progesterone concentrations remained elevated in the gestating females until the week 4 sample, just prior to parturition. The hormone data suggest that capture and captivity did not represent a significant long-term stressor to these animals. The increase in plasma corticosterone concentration was associated with heterophilia in the differential leucocyte count in both groups of females. Lymphocyte numbers decreased only in gestating females, suggesting that reproductive status may influence the interaction between adrenal activity and immune function.

Diminished maternal responsiveness during pregnancy in multiparous female common marmosets

Common marmoset monkeys (Callithrix jacchus) live in small groups in which, usually, only a single female breeds and all group members provide infant care. When two females breed concurrently, however, they may commonly kill one another's infants, especially during the peripartum period. To investigate the mechanisms underlying infanticide by breeding females, we characterized responses of multiparous females to infants and determined circulating hormone levels in adult females during early pregnancy, late pregnancy, and the early postpartum period. Additionally, we compared the responses of postpartum females to their own infants and infants of other females (unfamiliar infants). Postpartum females were highly maternal toward both their own and unfamiliar infants, and showed no differences in their behavioral or hormonal responses to the two. During both early and late pregnancy, however, these females exhibited longer latencies to initially approach unfamiliar infants and spent less time carrying unfamiliar infants. Moreover, females spent less time carrying unfamiliar infants during late pregnancy than early pregnancy. Most late pregnant females never carried infants, and those that did rejected them quickly. Prolactin concentrations were higher and progesterone concentrations lower postpartum than in early or late pregnancy, while estradiol concentrations, the estradiol-to-progesterone ratio, and cortisol levels were higher during late pregnancy. Within reproductive conditions, however, maternal behaviors were not correlated with hormone levels. These results suggest that maternal responsiveness in marmosets may be attenuated during pregnancy, especially late pregnancy, and this may contribute to infanticide by breeding females.

Peripartum sex steroid changes and maternal style in rhesus and Japanese macaques

The subtle and complex relationships between the sequential maturation of the endocrine systems during pregnancy and parturition, and the hormonal role in activating the central nervous system to express maternal behavior in primates, are far from being completely understood. Recent studies on the association between sex steroids and maternal behavior have yielded conflicting results in this group. Here we use a comparative approach to assess the correlation between changes in the peripartum endocrine profiles and maternal styles in two closely related macaque species, housed in analogous environments. We included in this study the first seven Japanese macaque and seven rhesus macaque mother-infant pairs born during the birth season of 2001 at the Primate Research Institute, Kyoto University, Japan. We observed each pair 3h/week (six weekly 30-min observation sessions) during the first 12 weeks of lactation. We collected fecal samples twice a week from each mother, starting 4 weeks before parturition and ending 4 weeks after parturition. We tested the hypothesis that neuroendocrine changes during pregnancy and lactation might specifically contribute to the regulation and timing of infant rejection. Despite their biological similarities, we observed a clear difference in maternal style between the two groups concerning rejection rates: rhesus macaque mothers rejected their infants earlier and more frequently throughout the whole 12 weeks of study. On the other hand, protectiveness showed similar patterns and values in the two groups, and maternal warmth was significantly higher in the rhesus group, but it followed a similar pattern over time. We also confirmed an association between maternal rejection and excreted estrogen, but not excreted progesterone, for Japanese macaques. This association was not apparent for the rhesus macaques. This result, coupled with the observation that rhesus mothers are more rejecting than Japanese macaque mothers, tends to support our hypothesis. As a group, rhesus macaques are less inhibited in the rejection of their infants, and this is paralleled by a less marked change in the primacy of estrogen in the last phase of pregnancy. On the contrary, the Japanese group is characterized by higher levels of E(1)C and the E(1)C/PdG ratio. Therefore, according to our hypothesis, their tendency to increase the rejection rate may be suppressed through a feedback loop that enhances maternal motivation and results in a more tolerant outcome toward the infant.

Diagnosis and management of Addison's disease during pregnancy

Although primary adrenal failure is considered a rare condition, recent epidemiological studies indicate a rising incidence of the disease owing to the increase of autoimmune disorders. Addison's disease may be a life-threatening condition and the occurrence of pregnancy has been considered as a dangerous event. Nowadays, adrenal insufficiency during pregnancy is associated with high incidence of serious fetal and maternal complications, as fetal death in utero and post-partum adrenal crises, only if the disorder is not recognized and adequately treated. In this article pathophysiological aspects, clinical features and guidelines of management of pregnancy in Addison's disease are reviewed.