title: Impact of corticosteroid-binding globulin deficiency on pregnancy and neonatal sex.
abstract: BACKGROUND
  Plasma corticosteroid-binding globulin (CBG) transports cortisol but high progesterone levels at the maternal-fetal interface can displace cortisol from its steroid-binding site. A secretion-deficient CBG mutant (A51V) in ∼1 of 36 Chinese causes low circulating CBG levels.
  
  
  OBJECTIVE
  Assess the implications of a CBG deficiency on pregnancy outcomes.
  
  
  METHODS
  From 1978 Chinese women screened at 12-16 weeks' gestation, 50 A51V carriers were identified and 46 were followed with 60 controls throughout pregnancy. Blood samples from another 2051 pregnant women were obtained at term to determine the secondary sex ratio (SSR) of newborns in an extended cohort (n = 101) of A51V mothers.
  
  
  RESULTS
  Among women recruited at 12-16 weeks' gestation, serum CBG increased progressively during pregnancy but was lower (P < .0001) in heterozygous A51V carriers than controls. Two women homozygous for A51V had very low serum CBG but their pregnancies progressed normally. The A51V mothers did not differ from controls in body mass index, gestational age at delivery, duration of parturition, blood pressure, gravidity, infant birth weight and size, or placental weights, and reported no unusual clinical symptoms. Peripheral CBG and progesterone levels correlated (r = 0.459) during first and second trimesters. Progesterone levels were much higher in intervillous blood and correlated (r = 0.637) with CBG levels. A female-skewed SSR in newborns of A51V mothers (0.77) differed (P < .05) from the SSR (1.17) in a reference cohort.
  
  
  CONCLUSIONS
  CBG influences progesterone levels in peripheral blood and at the maternal-fetal interface. The female-skewed SSR suggests that male fetal survival is compromised in CBG-deficient mothers.
authors.affiliation: State Key Laboratory of Reproductive Biology, Institute of Zoology (J.-H.L., C.Z., H.-Y.L., H.W.), Chinese Academy of Sciences, Beijing 100101, China; Department of Human Reproductive Medicine (X.Y., S.P., Y.L.), Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China; and Department of Cellular and Physiological Sciences, Faculty of Medicine (C.U., G.L.H.), the University of British Columbia, Vancouver V6T 1Z3, Canada.
authors.forename: Jing-Hui
authors.initials: JH
authors.lastname: Lei
authors.forename: Xiaokui
authors.initials: X
authors.lastname: Yang
authors.forename: Sha
authors.initials: S
authors.lastname: Peng
authors.forename: Ying
authors.initials: Y
authors.lastname: Li
authors.forename: Caroline
authors.initials: C
authors.lastname: Underhill
authors.forename: Cheng
authors.initials: C
authors.lastname: Zhu
authors.forename: Hai-Yan
authors.initials: HY
authors.lastname: Lin
authors.forename: Hongmei
authors.initials: H
authors.lastname: Wang
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Hammond
mesh_terms: D015992:Body Mass Index; D005221:Fatigue / Q000235:genetics* / Q000378:metabolism; D005260:Female; D030342:Genetic Diseases, Inborn / Q000235:genetics* / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007231:Infant, Newborn; D008297:Male; D010920:Placenta / Q000378:metabolism*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011374:Progesterone / Q000097:blood; D014156:Transcortin / Q000172:deficiency* / Q000235:genetics / Q000378:metabolism
chemical_list: D011374:Progesterone; D014156:Transcortin; D006854:Hydrocortisone