No abstract

Corticosteroid-binding globulin (CBG) is secreted as high-affinity CBG (haCBG), which may be cleaved by tissue proteases to low-affinity CBG (laCBG), releasing free cortisol. Pregnancy and the estrogen-based combined oral contraceptive pill (COCP) increase CBG concentrations twofold to threefold. The relative effects of these two hyperestrogenic states on the CBG affinity forms are unknown. We performed an observational study in 30 pregnant women, 27 COCP takers and 23 controls. We analyzed circulating total CBG, haCBG, laCBG, and free and total cortisol concentrations. In pregnancy, total CBG and haCBG were increased compared to controls (both P < 0.0001); however, laCBG concentrations were similar. In COCP takers, total CBG and haCBG were increased [802 ± 41 vs compared to controls (both P < 0.0001)], but laCBG was also increased (P = 0.03). Pregnancy and use of COCP were associated with a comparable rise in haCBG, but laCBG was lower in pregnancy (P < 0.0001). These results were consistent with an estrogen-mediated increase in CBG synthesis in both hyperestrogenemic states but with reduced CBG cleavage in pregnancy relative to the COCP, perhaps due to pregnancy-induced CBG glycosylation. Speculatively, increased circulating haCBG concentrations in pregnancy may provide an increased reservoir of CBG-bound cortisol to prepare for the risk of puerperal infection or allow for cortisol binding in the face of competition from increased circulating progesterone concentrations.

(Reg Anesth Pain Med. 2016;41(6):763–772) In 2007, there were 1.4 million cesarean deliveries (1 in 3 live births) in the United States alone. Pain after cesarean delivery can be severe in many patients, with 78% of women undergoing cesarean delivery reporting moderate to severe postoperative pain within the first 24 hours postoperatively. Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in the treatment of this postoperative pain despite them being generally viewed as “weak” analgesics. This meta-analysis was conducted to assess the analgesic efficacy of NSAIDs in postoperative cesarean delivery patients as well as secondary outcomes such as opioid-related adverse side effects and quality of breastfeeding.