 | THE YOUNG WOMAN AT THE RISE OF THE 21st CENTURY GYNECOLOGICAL AND REPRODUCTIVE ISSUES IN HEALTH AND DISEASE
Copyright © 2000 by the New York Academy of Sciences
description
Annals of the New York Academy of Sciences 900:95-106 (2000)
© 2000 New York Academy of Sciences
Maternal Hypothalamic-Pituitary-Adrenal Axis in Pregnancy and the Postpartum Period: Postpartum-Related Disorders
G. MASTORAKOSa AND
I. ILIAS
Endocrine Unit, "Evgenidion" Hospital, University of Athens, GR-11528, Athens, Greece
aAddress for correspondence: George Mastorakos, M.D., D.Sc., Endocrine Unit, "Evgenidion" Hospital, University of Athens, 20 Papadiamantopoulou Street, GR-11528, Athens, Greece. Fax: +301+3636229.
e-mail: mastorak{at}mail.kapatel.gr
During pregnancy, placenta-derived CRH increases exponentially in the plasma. Circulating levels of CRH-binding protein decrease considerably in the last trimester of pregnancy, resulting in further elevation of bio-available plasma CRH. The adrenal glands during pregnancy gradually become hypertrophic because of the increase in ACTH, which parallels that of CRH. Thus, pregnancy is a transient period of relative hypercortisolism. The activation of the hypothalamic-pituitary-adrenal axis during pregnancy has been proposed to function as a biological clock. In this model, the placenta is perceived as a stress-sensitive organ and placental CRH as a timing starter, determining a preterm, term, or postterm labor. During pregnancy, as well as during the immediate postpartum period, the hypothalamic maternal CRH secretion is suppressed, because of the circulating levels of cortisol. Hypothalamic CRH secretion normalizes within 12 weeks. This transient postpartum maternal hypothalamic CRH suppression, together with the steroid withdrawal that follows parturition, might be causally related to the mood disorders and the vulnerability to autoimmune diseases such as thyroiditis or rheumatoid arthritis often observed during the postpartum period.
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