Hair cortisol as a hypothalamic-pituitary-adrenal axis biomarker in pregnant women with asthma: a retrospective observational study
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BACKGROUND: Cortisol is a hormone involved in many physiological functions including fetal maturation and epigenetic programming during pregnancy. This study aimed to use hair cortisol as a biomarker of chronic inhaled corticosteroid (ICS) exposure and assess the potential effects of asthma on the hypothalamic-pituitary-adrenal (HPA) axis in pregnant women. We hypothesized that pregnant women with asthma treated with ICS would exhibit lower hair cortisol concentrations, indicative of adrenal suppression, compared to women with asthma not using ICS and women who do not have asthma. METHODS: We performed an observational retrospective cohort study. Hair samples were analyzed from pregnant women with asthma, with (n = 56) and without (n = 31) ICS treatment, and pregnant women without asthma (n = 31). Hair samples were segmented based on the growth rate of 1 cm/month and analyzed by enzyme immunoassay to provide cortisol concentrations corresponding to preconception, trimesters 1-3, and postpartum. Hair cortisol concentrations were compared within and among the groups using non-parametric statistical tests. RESULTS: Hair cortisol concentrations increased across trimesters for all three groups, but this increase was dampened in women with asthma (P = 0.03 for Controls vs. ICS Treated and Controls vs. No ICS). ICS Treated women taking more than five doses per week had hair cortisol concentrations 47 % lower in third trimester than Controls. Linear regression of the third trimester hair cortisol results identified asthma as a significant factor when comparing consistent ICS use or asthma as the predictor (F(1, 25) = 9.7, P = 0.005, R(2) adj = 0.257). CONCLUSIONS: Hair cortisol successfully showed the expected change in cortisol over the course of pregnancy and may be a useful biomarker of HPA axis function in pregnant women with asthma. The potential impact of decreased maternal cortisol in women with asthma on perinatal outcomes remains to be determined.
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Cortisol rises across pregnancy, most sharply in the early second trimester, then stabilizes across the late second and early third trimesters.
“cortisol rises progressively across pregnancy, the most pronounced rise occurs during the early 2nd trimester, with a relative stabilization across late 2nd and early 3rd trimesters (D’Anna-Hernandez et al., 2011; Smy et al., 2016).”
From Childhood stress and birth timing among African American women: cortisol as biological mediator (2017) · cites this paper as Smy et al., 2016
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Childhood stress and birth timing among African American women: cortisol as biological mediator
Gillespie, S. L., Christian, L. M., Alston, A. D., & Salsberry, P. J. (2017) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2017.06.009 · Cited by 38 · see citing works
- Authors
- Smy, L., Shaw, K., Amstutz, U., Smith, A., Berger, H., Carleton, B., & Koren, G.
- Affiliations
- University of Toronto (CA)
- University of British Columbia (CA)
- University of Bern (CH)
- St. Michael's Hospital (CA)
- Corresponding author
- Carleton, Bruce
- Venue
- BMC Pregnancy and Childbirth
- Published
- 2016-07-20
- Volume
- 16
- Issue
- 1
- Pages
- 176-176
- ISSN
- 1471-2393 (ISSN-L)
- PMC
- PMC4955128
- OpenAlex
- W2497981355
- Cited by
- 23
- References
- 42
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 4 · 2022: 1 · 2021: 3 · 2020: 3 · 2019: 3 · 2018: 3 · 2017: 2
- FWCI
- 2.67
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Pregnancy and Childbirth (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- TSpace (University of Toronto) (submittedVersion, cc-by)
- BORIS (University Library Bern) (submittedVersion, cc-by)
- cIRcle (University of British Columbia) (submittedVersion, cc-by)
- Funders
- Canadian Institutes of Health Research (FRN 116568)
- Canadian Pharmacogenomics Network for Drug Safety (FRN 88362)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Keywords
- hair cortisol, hypothalamic-pituitary-adrenal axis, asthma in pregnancy, inhaled corticosteroids, adrenal suppression, maternal cortisol, biomarkers, perinatal outcomes, fetal maturity
- MeSH terms
- Administration, Inhalation, Adrenal Cortex Hormones, Adrenal Glands, Adult, Asthma, Female, Hair, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Pituitary-Adrenal System, Pregnancy, Pregnancy Complications, Pregnancy Trimester, Third, Biomarkers, Postpartum Period
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