Diurnal salivary cortisol patterns during pregnancy and after delivery: relationship to plasma corticotrophin-releasing-hormone
Abstract
The circadian rhythm of salivary cortisol was studied in 10 healthy women every 4 weeks throughout pregnancy. In addition, in 12 women the diurnal patterns of salivary cortisol, serum cortisol, plasma ACTH, plasma CRH and serum progesterone were analysed in late third trimester pregnancy and again 3-5 days after delivery. Salivary cortisol profiles exhibited a clear circadian rhythm during pregnancy with an increase in mean salivary cortisol from the 25th to 28th week onwards reaching concentrations in late pregnancy more than twice as high as in non-pregnant controls, rapidly returning to normal concentrations after delivery. The coefficient of variation of salivary cortisol profiles decreased in third trimester pregnancy due to a parallel upward shift of cortisol concentrations (40.2 +/- 3.4% vs 77.6 +/- 6.6% after delivery, P less than 0.01). A diurnal pattern was also found for plasma ACTH and serum cortisol before and after delivery with lower concentrations post-partum (P less than 0.01). In late pregnancy, progesterone concentrations were significantly higher in the evening (930 +/- 85 nmol/l vs 813 +/- 74 nmol/l at 0900 h, P less than 0.01) but showed no diurnal variation post-partum. Plasma CRH was significantly elevated in late third trimester pregnancy (1.22 +/- 0.23 micrograms/l at 0900 h) but showed no diurnal change (1.30 +/- 0.28 micrograms/l at 1900 h). Moreover, no correlation between the free cortisol increase in late pregnancy and plasma CRH was noted despite a wide range of CRH levels (0.13-3.60 micrograms/l). In contrast, a significant correlation was observed between the serum progesterone increase and the salivary cortisol increase in late pregnancy (r = 0.70, P less than 0.05). These findings demonstrate that placental CRH is not the only regulator of maternal ACTH and cortisol release. Instead, our study suggests that placental CRH has little influence on baseline maternal adrenocortical function in pregnancy. The elevated salivary cortisol levels in pregnancy may be explained by glucocorticoid resistance owing to the antiglucocorticoid action of high progesterone concentrations.
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From week 22 of gestation onward, free cortisol levels increase significantly, with a further rise immediately preterm due to a fall in CBG; cortisol levels return to normal after delivery.
“From week 22 of gestation onward, free cortisol levels also increase significantly, with a further rise immediately preterm due to a fall in CBG (42, 119); cortisol levels return to normal after delivery (40).”
From Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [119]
Women with increased estrogen levels due to oral or transdermal contraceptives or pregnancy have increased total serum cortisol due to an increase in CBG.
“women who have increased estrogenlevels due to oral or transdermal contraceptives or pregnancy, have increased total serum cortisol due to an increase in CBG”
From Human steroid biosynthesis, metabolism and excretion are differentially reflected by serum and urine steroid metabolomes: a comprehensive review (2019) · cites this paper as [250]
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- Authors
- ALLOLIO, B., HOFFMANN, J., LINTON, E. A., WINKELMANN, W., KUSCHE, M., & SCHULTE, H. M.
- Affiliations
- University of Cologne (DE)
- Corresponding author
- ALLOLIO, BRUNO
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 1990-08
- Volume
- 33
- Issue
- 2
- Pages
- 279-289
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W2040606026
- Cited by
- 244
- References
- 31
- Citations by year
- 2026: 6 · 2025: 6 · 2023: 4 · 2022: 12 · 2021: 5 · 2020: 10 · 2019: 11 · 2018: 9 · 2017: 10 · 2016: 13 · 2015: 23 · 2014: 18 · 2013: 9 · 2012: 13
- FWCI
- 1.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Deutsche Forschungsgemeinschaft
- Topics
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
- Keywords
- salivary cortisol, circadian rhythm, pregnancy, postpartum period, corticotropin-releasing factor, ACTH, progesterone, adrenocortical function, glucocorticoid resistance, maternal cortisol, third trimester, free cortisol, serum cortisol
- MeSH terms
- Adult, Circadian Rhythm, Corticotropin-Releasing Hormone, Female, Humans, Hydrocortisone, Longitudinal Studies, Pituitary-Adrenal System, Pregnancy, Saliva, Postpartum Period
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