title: Impaired fetal adrenal function in intrahepatic cholestasis of pregnancy.
abstract: BACKGROUND
  Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-associated liver disease of unknown etiology. The aim of this study was to investigate the change in maternal and fetal adrenal function in clinical and experimental ICP.
  
  
  METHODS
  The maternal and fetal serum levels of cortisol and dehydroepiandrosterone sulfate (DHEAS) were determined in 14 women with ICP and in pregnant rats with estrogen-induced intrahepatic cholestasis.
  
  
  RESULTS
  In women with ICP, the fetal serum cortisol and DHEAS levels were significantly higher than those in women with normal pregnancy, after correcting the impact of gestational age at delivery. The relationship between fetal cortisol and maternal cholic acid levels was bidirectional; the fetal cortisol tended to increase in mild ICP, while it decreased in severe ICP. In pregnant rats with estrogen-induced cholestasis, the fetal cortisol level was significantly lower in the group with oxytocin injection, compared with the group without oxytocin injection (191.92±18.86 vs. 272.71±31.83 ng/ml, P<0.05). In contrast, the fetal cortisol concentration was increased after oxytocin injection in normal control rats.
  
  
  CONCLUSIONS
  The data indicate that fetal stress-responsive system is stimulated in mild ICP, but it is suppressed in severe ICP, which might contribute to the occurrence of unpredictable sudden fetal death. Further studies are warranted to explore the role of impaired fetal adrenal function in the pathogenesis of ICP and the clinical implications.
authors.affiliation: Department of Maternal and Fetal Medicine, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
authors.forename: Chunfang
authors.initials: C
authors.lastname: Wang
authors.forename: Xiaojun
authors.initials: X
authors.lastname: Chen
authors.forename: Shu-Feng
authors.initials: SF
authors.lastname: Zhou
authors.forename: Xiaotian
authors.initials: X
authors.lastname: Li
mesh_terms: D000311:Adrenal Glands / Q000503:physiopathology*; D000328:Adult; D000818:Animals; D016022:Case-Control Studies; D002780:Cholestasis, Intrahepatic / Q000097:blood / Q000503:physiopathology*; D019826:Cholic Acid / Q000378:metabolism; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D036861:Delivery, Obstetric; D005260:Female; D005333:Fetus / Q000378:metabolism / Q000503:physiopathology*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008111:Liver Function Tests; D010121:Oxytocin / Q000008:administration & dosage / Q000494:pharmacology; D011247:Pregnancy; D051381:Rats; D017207:Rats, Sprague-Dawley
chemical_list: D010121:Oxytocin; D019314:Dehydroepiandrosterone Sulfate; D019826:Cholic Acid; D006854:Hydrocortisone