Associations of Maternal Testosterone and Cortisol Levels With Health Outcomes of Mothers and Their Very-Low-Birthweight Infants

Associations of salivary aldosterone levels during pregnancy with maternal blood pressure and birth weight-for-gestational age in a Mexico City birth cohort

OBJECTIVE

To determine associations of maternal salivary aldosterone with blood pressure (BP) in pregnancy and infant birth weight-for-gestational age (BWGA).

METHODS

We measured maternal salivary aldosterone, BP and BWGA z-scores in 471 Mexico City pregnancy cohort participants and performed multivariable linear regression of BP and BWGA on log-aldosterone levels.

RESULTS

Log-aldosterone was positively associated with diastolic BP (β = 0.12 95% CI: 0.04, 0.21). There were no main effects of log-aldosterone on BWGA. However, we detected an interaction between log-aldosterone and BP in association with BWGA; higher log-aldosterone was associated with lower BWGA in the lowest (β = -0.12, 95% CI: -0.26, 0.02) and highest (β = -0.12, 95% CI: -0.29, 0.06) BP tertiles. In contrast, in the middle BP tertile the association was positive (β = 0.09, 95% CI: -0.02, 0.20), p for interaction = 0.03.

CONCLUSION

Higher maternal salivary aldosterone is positively associated with diastolic BP and may affect fetal growth differently depending on concurrent maternal blood pressure.

Perinatal outcomes and offspring long-term neuropsychiatric hospitalizations of mothers with anxiety disorder

Studies regarding the association between anxiety disorders and obstetrical and neonatal complications are inconclusive and sometimes contradictive. The aim of the present study was to assess perinatal outcome of mothers with anxiety disorder and to determine the association between maternal anxiety and long-term neuropsychiatric hospitalizations of the offspring. A hospital-based retrospective cohort study was conducted, comparing pregnancy complications and long-term neuropsychiatric hospitalizations of offspring of mothers with anxiety disorder, during or before the pregnancy and mothers without anxiety. All singleton deliveries between the years 1991 and 2014 in a tertiary medical center were included. To evaluate perinatal outcome of women with anxiety disorders, generalized estimation equation (GEE) models were used to control for confounders. A Kaplan-Meier survival curve was used to compare cumulative incidence of long-term neuropsychiatric hospitalizations, and a Cox proportional hazards model was constructed to control for confounders. During the study period, 242,038 deliveries met the inclusion criteria, of them 0.1% (n = 304) were mothers with anxiety. Using GEE models, controlling for maternal age, maternal anxiety was noted as an independent risk factor for preterm delivery (adjusted OR 1.8, 95% CI 1.32-2.69; P < 0.001), hypertensive disorders (adjusted OR 1.7, 95% CI 1.08-2.69; P = 0.02) and cesarean delivery (adjusted OR 1.6, 95% CI 1.32-2.1; P < 0.001). Offspring born to mothers with anxiety disorders had higher rates of neuropsychiatric-related hospitalizations (6.3 vs 3.1% P = 0.002; Kaplan-Meier log-rank test P < 0.001). Using a Cox proportional hazards model, controlling for confounders such as maternal age, hypertensive disorders, gestational age, birth weight, and cesarean delivery, being born to a mother with anxiety disorders was found to be an independent risk factor for long-term neuropsychiatric hospitalizations of the offspring (adjusted HR 2.4, 95% CI 1.58-3.89; P < 0.001). Pregnancy of women with anxiety disorders is independently associated with adverse perinatal outcome and higher risk for long-term neuropsychiatric hospitalizations of the offspring.

Pregnancy outcome in women with polycystic ovary syndrome in relation to second-trimester testosterone levels

RESEARCH QUESTION

Do women with polycystic ovary syndrome (PCOS) have higher testosterone levels during pregnancy and what role does high testosterone play in the development of obstetric complications?

DESIGN

Retrospective cohort study from Uppsala University Hospital, Sweden. The study population consisted of women with PCOS (n = 159) and a comparison group of women without PCOS matched for body mass index (n = 320). Plasma testosterone levels were measured in the early second trimester by liquid chromatography with tandem mass spectrometry, and women with PCOS were grouped into tertiles according to their testosterone levels. Possible associations with obstetric complications, maternal metabolic factors and offspring birth weight were explored by multivariable logistic and linear regression models.

RESULTS

Compared with women who do not have PCOS, women with PCOS had higher total testosterone (median 1.94, interquartile range [IQR] 1.21-2.64 versus 1.41, IQR 0.89-1.97; P < 0.001), and free androgen index (median 0.25, IQR 0.15-0.36 versus 0.18, IQR 0.11-0.28; P < 0.001). Women with PCOS who had the highest levels of testosterone had increased risk for preeclampsia, even when adjusted for age, parity, country of birth and smoking (adjusted OR 6.16, 95% CI 1.82 to 20.91). No association was found between high testosterone in women with PCOS and other obstetric complications.

CONCLUSIONS

Women with PCOS have higher levels of total testosterone and free androgen index during pregnancy than women without PCOS matched for body mass index. Preliminary evidence shows that women with PCOS and the highest maternal testosterone levels in early second trimester had the highest risk of developing preeclampsia. This finding, however, is driven by a limited number of cases and should be interpreted with caution.