2019
DOI: 10.1177/1753495x19847832
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Glucocorticoids in pregnancy

Abstract: The physiological changes that occur during pregnancy include altered regulation of the hypothalamo-pituitary-adrenal axis. The fetoplacental unit plays a major role in this, together with alteration of circulating cortisol-binding globulin levels, with a net effect to increase both total and free cortisol levels. Importantly, there are several pathological conditions that require steroid treatment or replacement during pregnancy, and optimizing therapy is clearly crucial. The potential for acute and … Show more

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Cited by 30 publications
(29 citation statements)
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“…The maternal HPA axis undergoes remarkable adjustments and stimulation during the challenging period of pregnancy. 40 In early pregnancy, GCs are essential for implantation, decidualization and preventing embryo rejection by cross-reaction with the maternal immune system. 183 Throughout gestation, the maternal adrenal glands gradually become hypertrophic due to the placental secretion of CRH.…”
Section: Epigenetics Programming Resulting From Metabolic Alterationsmentioning
confidence: 99%
See 2 more Smart Citations
“…The maternal HPA axis undergoes remarkable adjustments and stimulation during the challenging period of pregnancy. 40 In early pregnancy, GCs are essential for implantation, decidualization and preventing embryo rejection by cross-reaction with the maternal immune system. 183 Throughout gestation, the maternal adrenal glands gradually become hypertrophic due to the placental secretion of CRH.…”
Section: Epigenetics Programming Resulting From Metabolic Alterationsmentioning
confidence: 99%
“…This enzyme is responsible for the conversion of cortisol into inactive cortisone. 40,186 Therefore, 11β-HSD-2 acts as a physiological shield to prevent excessive foetal exposure to maternal cortisol. 40,183,186 In utero GC overexposure has been associated with pregnancy adversities, such as preeclampsia, hypertensive disorders, and IUGR (Figure 2).…”
Section: Epigenetics Programming Resulting From Metabolic Alterationsmentioning
confidence: 99%
See 1 more Smart Citation
“…Glucocorticoid replacement during pregnancy is essential when hypothalamic-pituitary-adrenal function is impaired [118]. Steroid replacement in this context should take into account the potentially greater requirement secondary to the pregnancy-induced changes to the hypothalamic-pituitary-adrenal axis (increased CBG, increased placental corticotropin-releasing hormone secretion [119] and 2- to 3-fold increases in total cortisol concentrations, peaking in the 2nd and 3rd trimesters) [120], aiming to avoid undesirable effects on the fetus. Women appropriately treated with replacement therapy can expect to have uneventful pregnancies of a normal duration, with no fetal compromise.…”
Section: Managing Pregnancymentioning
confidence: 99%
“…During pregnancy, women experience increased levels of glucocorticoid concentrations to support this immunosuppressive status. Compared to pre-pregnancy, these levels approximately double during the third trimester and at 2 and 3 months postpartum [ 56 , 57 ]. Human placental lactogen, prolactin, and human chorionic gonadotropin also have high values during pregnancy and contribute to immunosuppressive status [ 58 ].…”
Section: Evolution Of Psoriasis Activity During Pregnancymentioning
confidence: 99%