title: Androgens in pregnancy: roles in parturition.
abstract: BACKGROUND
  Understanding the physiology of pregnancy enables effective management of pregnancy complications that could otherwise be life threatening for both mother and fetus. A functional uterus (i) retains the fetus in utero during pregnancy without initiating stretch-induced contractions and (ii) is able to dilate the cervix and contract the myometrium at term to deliver the fetus. The onset of labour is associated with successful cervical remodelling and contraction of myometrium, arising from concomitant activation of uterine immune and endocrine systems. A large body of evidence suggests that actions of local steroid hormones may drive changes occurring in the uterine microenvironment at term. Although there have been a number of studies considering the potential role(s) played by progesterone and estrogen at the time of parturition, the bio-availability and effects of androgens during pregnancy have received less scrutiny. The aim of this review is to highlight potential roles of androgens in the biology of pregnancy and parturition.
  
  
  METHODS
  A review of published literature was performed to address (i) androgen concentrations, including biosynthesis and clearance, in maternal and fetal compartments throughout gestation, (ii) associations of androgen concentrations with adverse pregnancy outcomes, (iii) the role of androgens in the physiology of cervical remodelling and finally (iv) the role of androgens in the physiology of myometrial function including any impact on contractility.
  
  
  RESULTS
  Some, but not all, androgens increase throughout gestation in maternal circulation. The effects of this increase are not fully understood; however, evidence suggests that increased androgens might regulate key processes during pregnancy and parturition. For example, androgens are believed to be critical for cervical remodelling at term, in particular cervical ripening, via regulation of cervical collagen fibril organization. Additionally, a number of studies highlight potential roles for androgens in myometrial relaxation via non-genomic, AR-independent pathways critical for the pregnancy reaching term. Understanding of the molecular events leading to myometrial relaxation is an important step towards development of novel targeted tocolytic drugs.
  
  
  CONCLUSIONS
  The increase in androgen levels throughout gestation is likely to be important for establishment and maintenance of pregnancy and initiation of parturition. Further investigation of the underlying mechanisms of androgen action on cervical remodelling and myometrial contractility is needed. The insights gained may facilitate the development of new therapeutic approaches to manage pregnancy complications such as preterm birth.
authors.affiliation: Medical Research Council Centre for Reproductive Health, The University of Edinburgh, Queen's Medical Research Institute, Edinburgh EH16 4TJ, United Kingdom and Tommy's Centre for Maternal and Fetal Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh EH16 4TJ, United Kingdom.
authors.forename: Sofia
authors.initials: S
authors.lastname: Makieva
authors.affiliation: Medical Research Council Centre for Reproductive Health, The University of Edinburgh, Queen's Medical Research Institute, Edinburgh EH16 4TJ, United Kingdom and.
authors.forename: Philippa T K
authors.initials: PT
authors.lastname: Saunders
authors.affiliation: Medical Research Council Centre for Reproductive Health, The University of Edinburgh, Queen's Medical Research Institute, Edinburgh EH16 4TJ, United Kingdom and Tommy's Centre for Maternal and Fetal Health, University of Edinburgh, Queen's Medical Research Institute, Edinburgh EH16 4TJ, United Kingdom jane.norman@ed.ac.uk.
authors.forename: Jane E
authors.initials: JE
authors.lastname: Norman
mesh_terms: D000728:Androgens / Q000378:metabolism / Q000502:physiology*; D002584:Cervix Uteri / Q000502:physiology; D004967:Estrogens / Q000494:pharmacology; D005260:Female; D047109:Fetal Development / Q000502:physiology; D005333:Fetus / Q000378:metabolism; D006801:Humans; D007743:Labor, Obstetric / Q000502:physiology*; D036801:Parturition / Q000502:physiology*; D011247:Pregnancy; D047928:Premature Birth / Q000503:physiopathology*; D011374:Progesterone / Q000502:physiology; D014590:Uterine Contraction / Q000502:physiology; D014599:Uterus / Q000502:physiology
chemical_list: D000728:Androgens; D004967:Estrogens; D011374:Progesterone
keywords: androgen; cervix; labour; myometrium; pregnancy