Pregnancy greatly affects the steroidal module of the Athlete Biological Passport

Abstract

Concentrations of urinary steroids are measured in anti-doping test programs to detect doping with endogenous steroids. These concentrations are combined into ratios and followed over time in the steroidal module of the Athlete Biological Passport (ABP). The most important ratio in the ABP is the testosterone/epitestosterone (T/E) ratio but this ratio is subject to intra-individual variations, especially large in women, which complicates interpretation. In addition, there are other factors affecting T/E. Pregnancy, for example, is known to affect the urinary excretion rate of epitestosterone and hence the T/E ratio. However, the extent of this variation and how pregnancy affect other ratios has not been fully evaluated. Here we have studied the urinary steroid profile, including 19-norandrosterone (19-NA), in 67 pregnant women and compared to postpartum. Epitestosterone was higher and, consequently, the T/E and 5αAdiol/E ratios were lower in the pregnant women. Androsterone/etiocholanolone (A/Etio) and 5αAdiol/5βAdiol, on the other hand, were higher in the first trimester as compared to postpartum (p<0.0001 and p=0.0396, respectively). There was no difference in A/T during pregnancy or after. 19-NA was present in 90.5% of the urine samples collected from pregnant women. In this study, we have shown that the steroid profile of the ABP is affected by pregnancy, and hence can cause atypical passport findings. These atypical findings would lead to unnecessary confirmation procedures, if the patterns of pregnancy are not recognized by the ABP management units.

Urinary steroid profile in relation to the menstrual cycle

“…E has been shown to exert anti‐androgenic properties in animal studies, and it is possible that E amplifies the estrogenic effects 18,19 . This theory is supported by the marked increase in urinary levels of E (but not the other ABP metabolites) observed during pregnancy 20 …”

“…18,19 This theory is supported by the marked increase in urinary levels of E (but not the other ABP metabolites) observed during pregnancy. 20 Interestingly, E was the urinary metabolite correlating with P serum levels to a much larger extent than the other urinary steroids.…”

Longitudinal evaluation of multiple biomarkers for the detection of testosterone gel administration in women with normal menstrual cycle

“…Resulting DNA concentration was measured using a Qubit® 3.0 fluorometer (Life Technologies, Carlsbad, CA, USA). The UGT2B17 copy number variation analysis was performed using a premade copy number assay (HS03185327_CN, Life Technologies, Carlsbad, CA, USA) as previously described using a Roche LightCycler 480 real‐time PCR system 31 . The human RNase P gene was used as internal positive control to monitor reaction quality.…”

Analytical Approaches in Human Sports Drug Testing: Recent Advances, Challenges, and Solutions

“…Detected irregularities trigger evaluations by dedicated experts in accordance with defined workflows, and further investigations can follow, including target testing or additional analyses of existing doping control specimens, depending on the module and sample matrices available. Options to refine the ABP have been constantly assessed, ,− and the ABP’s sensitivity toward pharmacological interventions − but also (potential) confounding factors − has been continuously studied.…”