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Geburtshilfe Frauenheilkd 2016; 76(07): 799-808
DOI: 10.1055/s-0042-107078
Original Article
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

Maternal Serum Lipid, Estradiol, and Progesterone Levels in Pregnancy, and the Impact of Placental and Hepatic Pathologies

Mütterlicher Lipid-, Estradiol- und Progesteronspiegel in der Schwangerschaft in Abhängigkeit von Plazenta- und Leberpathologien
U. Pecks
1   Department of Obstetrics and Gynecology, University Hospital of the RWTH, Aachen, Germany
3   Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
,
W. Rath
3   Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
,
N. Kleine-Eggebrecht
1   Department of Obstetrics and Gynecology, University Hospital of the RWTH, Aachen, Germany
,
N. Maass
3   Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
,
F. Voigt
1   Department of Obstetrics and Gynecology, University Hospital of the RWTH, Aachen, Germany
,
T. W. Goecke
1   Department of Obstetrics and Gynecology, University Hospital of the RWTH, Aachen, Germany
,
M. G. Mohaupt
2   Department of Nephrology, Hypertension and Clinical Pharmacology and Department of Clinical Research, Inselspital University Hospital Bern, Bern, Switzerland
,
G. Escher
2   Department of Nephrology, Hypertension and Clinical Pharmacology and Department of Clinical Research, Inselspital University Hospital Bern, Bern, Switzerland
› Author Affiliations
Further Information

Publication History

received 11 September 2015
revised 05 April 2016

accepted 20 April 2016

Publication Date:
20 July 2016 (online)

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Abstract

Objective: Lipids and steroid hormones are closely linked. While cholesterol is the substrate for (placental) steroid hormone synthesis, steroid hormones regulate hepatic lipid production. The aim of this study was to quantify circulating steroid hormones and lipid metabolites, and to characterize their interactions in normal and pathological pregnancies with a focus on hepatic and placental pathologies. Methods: A total of 216 serum samples were analyzed. Group A consisted of 32 patients with uncomplicated pregnancies who were analyzed at three different time-points in pregnancy (from the first through the third trimester) and once post partum. Group B consisted of 36 patients (24th to 42nd week of gestation) with pregnancy pathologies (IUGR n = 10, preeclampsia n = 13, HELLP n = 6, intrahepatic cholestasis n = 7) and 31 controls with uncomplicated pregnancies. Steroid profiles including estradiol, progesterone, and dehydroepiandrosterone were measured by GC-MS and compared with lipid concentrations. Results: In Group A, cholesterol and triglycerides correlated positively with estradiol (cholesterol ρ = 0.50, triglycerides ρ = 0.57) and progesterone (ρ = 0.49, ρ = 0.53) and negatively with dehydroepiandrosterone (ρ = − 0.47, ρ = − 0.38). Smoking during pregnancy affected estradiol concentrations, leading to lower levels in the third trimester compared to non-smoking patients (p < 0.05). In Group B, cholesterol levels were found to be lower in IUGR pregnancies and in patients with HELLP syndrome compared to controls (p < 0.05). Steroid hormone concentrations of estradiol (p < 0.05) and progesterone (p < 0.01) were lower in pregnancies with IUGR. Discussion: Lipid and steroid levels were affected most in IUGR pregnancies, while only minor changes in concentrations were observed for other pregnancy-related disorders. Each of the analyzed entities displayed specific changes. However, since the changes were most obvious in pregnancies complicated by IUGR and only minor changes were observed in pregnancies where patients had impaired liver function, our data suggests that placental rather than maternal hepatic function strongly determines lipid and steroid levels in pregnancy.

Zusammenfassung

Zielsetzung: Lipide und Steroidhormone stehen in wechselseitiger Beziehung zueinander. Cholesterin ist Ausgangssubstanz für die (plazentare) Steroidhormonsynthese. Die Lipidproduktion in der Leber wird von Steroidhormonen reguliert. Ziel der Studie war es, die Konzentration von Steroidhormonen und Lipiden im Blut im Verlauf der Schwangerschaft und bei Schwangerschaftspathologien mit Beteiligung von Leber oder Plazenta zu quantifizieren. Methoden: 216 Serumproben wurden analysiert. Gruppe A bestand aus 32 Patientinnen mit unkomplizierter Schwangerschaft, denen zu drei Zeitpunkten im Schwangerschaftsverlauf sowie einmal postpartal Blut abgenommen wurde. Gruppe B bestand aus 36 Patientinnen (24.–42. SSW) mit Schwangerschaftspathologien (intrauterine Wachstumsrestriktion [IUGR] n = 10, Präeklampsie n = 13, HELLP-Syndrom n = 6, intrahepatische Cholestase n = 7) sowie 31 Frauen mit unkomplizierter Schwangerschaft. Ein Steroidprofil einschließlich Estradiol, Progesteron und Dehydroepiandrosteron wurde mit der Gaschromatografie-Massenspektrometrie (GC-MS) erstellt und mit Lipidkonzentrationen verglichen. Ergebnisse: In der Gruppe A korrelierten Cholesterin- und Triglyzeridwerte positiv mit Estradiol (Cholesterin ρ = 0,50, Triglyzeride ρ = 0,57) und Progesteron (ρ = 0,49, ρ = 0,53) und negativ mit Dehydroepiandrosteron (ρ = − 0,47, ρ = − 0,38). Rauchen während der Schwangerschaft führte zu niedrigeren Estradiolkonzentrationen im 3. Trimenon im Vergleich zu Nichtrauchern (p < 0,05). In der Gruppe B wies die IUGR-Gruppe deutlichste Veränderungen auf. Hier zeigten sich verglichen mit der Kontrollgruppe insbesondere Werte für Cholesterin, Estradiol (p < 0,05) und Progesteron (p < 0,01) erniedrigt. Diskussion: Jede der analysierten pathologischen Entitäten wies ein spezifisches Lipid- und Steroidhormon-Profil auf. Die deutlichsten Abweichungen von unkomplizierten Schwangerschaften zeigten Frauen mit IUGR. Schwangerschaften mit pathologischem Leberfunktionstest zeichneten sich durch eher geringe Veränderungen aus. Dies deutet darauf hin, dass Lipid- und Steroidspiegel während der Schwangerschaft stärker von der plazentaren als von der hepatischen Funktion bestimmt werden.

Key words

pregnancy - steroids - lipids - IUGR - preeclampsia

Schlüsselwörter

Schwangerschaft - Steroide - Lipide - intrauterine Wachstumsretardierung (IUGR) - Präeklampsie
 

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