title: The critical importance of the fetal hypothalamus-pituitary-adrenal axis.
abstract: The fetal hypothalamus-pituitary-adrenal (HPA) axis is at the center of mechanisms controlling fetal readiness for birth, survival after birth and, in several species, determination of the timing of birth. Stereotypical increases in fetal HPA axis activity at the end of gestation are critical for preparing the fetus for successful transition to postnatal life. The fundamental importance in fetal development of the endogenous activation of this endocrine axis at the end of gestation has led to the use of glucocorticoids for reducing neonatal morbidity in premature infants. However, the choice of dose and repetition of treatments has been controversial, raising the possibility that excess glucocorticoid might program an increased incidence of adult disease (e.g., coronary artery disease and diabetes). We make the argument that because of the critical importance of the fetal HPA axis and its interaction with the maternal HPA axis, dysregulation of cortisol plasma concentrations or inappropriate manipulation pharmacologically can have negative consequences at the beginning of extrauterine life and for decades thereafter.
authors.affiliation: Department of Physiology and Functional Genomics, University of Florida College of Medicine, FL, USA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wood
authors.affiliation: Department of Pharmacodynamics, University of Florida College of Pharmacy, FL, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Keller-Wood
keywords: HPA; cortisol; fetal hypothalamus-pituitary-adrenal axis