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adrenocorticotropic hormone and cortisol in parturients Author: - - PowerPoint PPT Presentation

Oct 14, 2022 132 likes •418 views

The 11 th Diczfalusy Award Lecture Symposium on Reproductive Health The effect of delivery method on secretion pattern and dissociation phenomenon of adrenocorticotropic hormone and cortisol in parturients Author: Aleksandra Vejnovi

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The effect of delivery method on secretion pattern and dissociation phenomenon of adrenocorticotropic hormone and cortisol in parturients

Author: Aleksandra Vejnović

Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Novi Sad

Orastie, 6th October 2017

The 11th Diczfalusy Award Lecture Symposium on Reproductive Health

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General adaptation syndrome

Adequate stress response Stressors

  • Increased heart rate
  • Increased blood pressure
  • Deeper breathing
  • Muscular strength
  • Increased glycaemia
  • Better perception
  • Physical factors
  • Chemical factors
  • Biological factors
  • Social factors
  • Psychological fastors
  • Examples:
  • Extreme temperature
  • Physical exercise
  • Toxins
  • Bacteria and viruses
  • Argue
  • Fear………………………..
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Stress - definition

▪“The non-specific neuroendocrine response of the body”

(Hans Selye, 1936.)

▪ “The non-specific response of the body to any demand

for change”.

(Hans Selye, 1951.)

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Stress system

▪ Nervous system ▪ Endocrine system ▪ Immune system

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Stress system

CRH

  • Corticotropin-releasing hormone

ACTH

  • Adrenocorticotropic hormone

COR

  • Cortisol

▪ Hypothalamic-pituitary-adrenal axis (HPA)

(available from http://dualibra.com/)

LC

  • Locus coeruleus

NOR

  • Norepinephrine

▪ Sympatico-adrenal system

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Cortisol

Il-6 Il-1 PRL GH ẞ-endorphin NOR epinephrine glycagon ADH

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SLIDE 7

Characteristics of HPA axis function

▪Cirkadijalni ritam (dnevno-noćni ritam) ▪Pulsativno lučenje ▪Stresni odgovor

Time of day Cortisol concentration

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Delivery

▪ Delivery methods

▪ Vaginal delivery ▪ Cesarean section

▪ the expulsion or extraction of a fetus and its membranes through the passageway after 20th gestational week.

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The Goal

▪ To analyse the levels, dynamics and patterns of changes in concentrations of free salivary cortisol, total plasma cortisol and plasma ACTH in mothers whose pregnancy terminated vaginally or by caesarean section ▪ To determine the occurrence of ACTH-cortisol dissociation in parturients.

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Material & Method

▪ Place of investigation:

▪ Clinical Center of Vojvodina

▪ Center for Laboratory Medicine ▪ Department of Gynecology and Obstetrics

▪ Period of invastigation:

▪ 09th June 2014 - 24th July 2014.

▪ Approval obtained from Ethical Committee ▪ Informed Consent

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▪ Subjects:

▪30 parturients

▪ Including criteria:

▪ Healthy parturients , no comorbidities, no chronic therapy, ▪ Regularly controlled pregnancy, normal findings ▪ Singleton pregnancy, ▪ Cephalic presentation, ▪ 37-41 gestational age ▪ Delivered vaginally or performed elective cesarean section

15

Cesarean section (SC)

15

Vaginal delivery (VAG)

30

parturients

Material & Method

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Material & Method - sampling

1h before delivery 2h after delivery at 10 p.m. after delivery

Blood Saliva

3x

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▪ Blood plasma:

▪ Total cortisol ▪ ACTH ▪ CRP

▪ Saliva:

▪ Free cortisol

▪ Spin cycle ▪ 3000 rpm, 3 minutes ▪ 5000 rpm, 10 minutes, - 4°C ▪ Electrochemiluminiscence method ▪ Automated system- Elecsys 2010

▪ Immunoturbidimetric method

▪ Automated system- Architect c8000

Material & Method – laboratory processing

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Statistical data analysis

▪ Descriptive statistics ▪ Distribution of values: Shapiro-Wilk test ▪ Significance of differences: Student t-test and Mann-Whitney U test ▪ Regression Analysis ▪ MANOVA Repeated measures ▪ Microsoft Office – Excel ▪ SPSS 21.0 – programming language R

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Results

Table – Basic data about parturients of both groups SC VAG

Arithmetic mean Minimum Maximum Arithmetic mean Minimum Maximum

Age

31 16 38 29 18 37

Body height

1.68 1.57 1.77 1.67 1.50 1.80

Body weight before pregnancy

81.19 63.5 121 77.93 58 98

Weight gain

16.97 9 27 17.60 8 28

BMI before delivery

22.70 17.72 26.15 21.76 17.36 28.96

Newborn weight

3627.33 2930 4590 3458.67 2630 4260

Newborn length

50.47 48 53 50.07 46 54

Gestational age

39.15 38 41 39.47 38 41

Number of deliveries

1.73 1 3 1.47 1 4

p > 0,05 BMI – body mass index SC- first group VAG- second group

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Results– variability of individual values

Sample 1 Sample 2 Sample 3 Salivary cortisol concentration (nmol/l)

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Analysis of levels, dynamics and secretion pattern of hormone

Table - Descriptive analysis of plasma cortisol (nmol/l) levels by samples and groups SC N AS SD Mediana Minimum Maximum Varians Curtosis Skewness Cp1 15 811.88 182.08 781.70 559.20 1218.00 33153.30 .31 .74 Cp2 15 908.77 237.59 882.90 553.90 1377.00 56448.00

  • .57

.33 Cp3 15 730.07 259.74 725.50 235.40 1049.00 67466.56

  • .90
  • .46

VAG N AS SD Mediana Minimum Maximum Varians Curtosis Skewness Cp1 15 1831.27 765.17 1652.00 1130.00 3952.00 585483.35 3.76 1.94 Cp2 15 1431.58 362.37 1429.00 952.70 2285.00 131311.77 1.78 1.32 Cp3 15 803.25 207.73 844.80 382.80 1123.00 43152.91

  • 0.36
  • 0.43

Cp- plasma cortisol in certain measurement N- number of samples, AS- arithmetic mean, SD- standard deviation

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Graph – Changes of salivary and plasma cortisol concentrations in SC group (left) and VAG group (right)

Cs1 Cs2 Cs3 Cp1 .877** .823** .187 Cp2 .779** .785** .230 Cp3 .095 .246 .666**

0.00 10.00 20.00 30.00 40.00 50.00 60.00 0.00 100.00 200.00 300.00 400.00 500.00 600.00 700.00 800.00 900.00 1000.00

Sample 1 Sample 2 Sample 3 Cortisol concentration in plasma (nmol/l) Cortisol plasma SC Cortisol saliva SC

0.00 50.00 100.00 150.00 200.00 250.00 300.00 0.00 200.00 400.00 600.00 800.00 1000.00 1200.00 1400.00 1600.00 1800.00 2000.00

Sample 1 Sample 2 Sample 3 Cortisol concentration in plasma (nmol/l) Cortisol plasma VAG Cortisol saliva VAG

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Results– cortisol in saliva and blood plasma

Sample 1 Sample 2 Sample 3 Sample 2/1 Sample 3/1

ẋ (SC) 24.64 51.96 23.14 2.16 0.96 ẋ (VAG) 245.20 90.58 24.25 0.58 0.23 p 0.02* 0.12 0.77 4.02E-05** 5.85E-07**

Table - Comparison of salivary cortisol levels between groups by samples and relative changes *p< 0,05; **p<0,01; ẋ-arithmetic mean concentration of certain sample

Sample 1 Sample 2 Sample 3 Sample 2/1 Sample 3/1

ẋ (SC) 811.88 908.77 730.08 1.14 0.94 ẋ (VAG) 1831.27 1431.58 803.25 0.83 0.48 P 2.63E-05** 6.78E-05** 0.40 0.001** 0.0002**

Table - Comparison of plasma cortisol levels between groups by samples and relative changes

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Distribution of values

sample 1 sample 2 sample 3 sample 1 sample 2 sample 3

ACTH Plasma Cortisol

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Graph- Secretion patterns of plasma cortisol and ACTH in SC group (left) and VAG group (right)

0.00 10.00 20.00 30.00 40.00 50.00 60.00

0.00 100.00 200.00 300.00 400.00 500.00 600.00 700.00 800.00 900.00 1000.00 Sample 1 Sample 2 Sample 3

Cortisol concentration in blood plasma (nmol/l) Cortisol plasma SC ACTH SC

0.00 20.00 40.00 60.00 80.00 100.00 120.00 140.00 160.00 180.00 200.00 0.00 200.00 400.00 600.00 800.00 1000.00 1200.00 1400.00 1600.00 1800.00 2000.00 Sample 1 Sample 2 Sample 3

Cortisol concentration in blood plasma (nmol/l)

Cortisol plasma VAG ACTH VAG

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Graph- Secretion patterns of salivary cortisol and ACTH in SC group (left) and VAG group (right)

0.00 10.00 20.00 30.00 40.00 50.00 60.00 Sample 1 Sample 2 Sample 3

Salivary cortisol concentration (nmol/l) & ACTH in plasmia (pg/ml) Cortisol saliva SC ACTH SC

0.00 50.00 100.00 150.00 200.00 250.00 300.00 Sample 1 Sample 2 Sample 3

Salivary cortisol concentration (nmol/l) & ACTH in plasma (pg/ml) Cortisol saliva VAG ACTH VAG

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Distribution of values

sample 1 sample 2 sample 3 sample 1 sample 2 sample 3

ACTH Plasma Cortisol

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Analysis depending on the time of day

200 400 600 800 1000 1200 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Kp refer Kp5 SC Kp5 VAG 10 20 30 40 50 60 70 80 90 100 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 ACTH refer ACTH5 SC ACTH5 VAG

Sample 1 Sample 2 Sample 3 Plasma Cortisol ACTH

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Conclusions

▪ Conclusions: The results of this study indicate the differences in the secretion pattern of ACTH and cortisol depending on delivery method. ▪ Vaginal delivery causes intense and relatively short-lived response of the neuroendocrine system- levels of ACTH and cortisol showed a decreasing trend with a significant degree of mutual influence. ▪ In women delivered by caesarean section is observed the ACTH-cortisol dissociation in terms of decline of ACTH concentrations accompanied by an increase in cortisol levels during delivery. ▪ This indicates the presence of ACTH-independent factors affecting the adrenocortical activity level. The true nature of this phenomenon cannot be clarified by the applied research methodology.

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Egon Diczfalusy

Thank You, professor!

In memoriam