Abstract：OBJECTIVE: To study the effect of intrahepatic cholestasis of pregnancy (ICP) on the functions of the hypothalamic-pituitary-adrenocortical (HPA) axis and adrenal cortex in normal neonates. METHODS: Demographic characteristics, prenatal anxiety and depression, and perceived stress during delivery were investigated in 32 ICP women and 32 controls. The cord blood levels of cortisal, adrenocorticotropic hormone (ACTH), and dehydroepiandrosterone sulfate (DHEAS) were measured by the radioimmunity technique in normal neonates immediately after birth. RESULTS: The scores of prenatal anxiety and depression in ICP women were significantly higher than those in controls (P<0.05 and P<0.01, respectively). There were no significant differences in the perceived stress during delivery between the two groups. The cord blood levels of cortisol and ACTH in neonates from ICP women were significantly lower (P<0.01), while the DHEAS level was significantly higher (P<0.01) than in neonates from controls. The DHEAS/ACTH ratio was significantly higher (P<0.01), while the cortisol /DHEAS ratio was significantly lower in the ICP group (P<0.01) than in the control group. The glycocholic acid level in ICP women was positively correlated with the DHEAS level in neonatal cord blood (r=0.47, P<0.01). CONCLUSIONS: There may be a dissociation between cortisol and DHEAS in neonates with normal birth outcome from ICP women. ICP may result in a decreased responsiveness of HPA axis and an increased secretion of DHEAS by adrenal cortex in these neonates. This suggests that there might be dysfunction of the fetal zones of the adrenal cortex.［Chin J Contemp Pediatr, 2010, 12 (1):5-8］
ZHU Peng,TAO Fang-Biao,JIANG Xiao-Min et al. Effect of intrahepatic cholestasis of pregnancy on the functions of hypothalamic-pituitary-adrenocortical axis and adrenal cortex in normal neonates[J]. CJCP, 2010, 12(1): 5-8.
［1］Beuers U, Pusl T. Intrahepatic cholestasis of pregnancy—a heterogeneous group of pregnancy-related disorders? ［J］. Hepatology, 2006, 43(4):647-649.
［2］Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates［J］. Hepatology, 2004, 40(2):467-474.
［4］Drake AJ, Walker BR. The intergenerational effects of fetal programming:non-genomic mechanisms for the inheritance of low birth weight and cardiovascular risk［J］. J Endocrinol, 2004, 180(1):1-16.
［5］Phillips DI, Jones A. Fetal programming of autonomic and HPA function: do people who were small babies have enhanced stress responses? ［J］. J Physiol, 2006, 572(Pt 1): 45-50.
［8］Buhimschi CS, Turan OM, Funai EF, Azpurua H, Bahtiyar MO, Turan S, et al. Fetal adrenal gland volume and cortisol/dehydroepiandrosterone sulfate ratio in inflammation-associated preterm birth［J］. Obstet Gynecol, 2008, 111(3):715-722.
［9］Bremner D, Vermetten E, Kelley ME. Cortisol, dehydroepiandrosterone, and estradiol measured over 24 hours in women with childhood sexual abuse-related posttraumatic stress disorder［J］. J Nerv Ment Dis, 2007, 195(11):919-927.
［10］Morgan CA 3rd, Southwick S, Hazlett G, Rasmusson A, Hoyt G, Zimolo Z, et al. Relationships among plasma dehydroepiandrosterone sulfate and cortisol levels, symptoms of dissociation, and objective performance in humans exposed to acute stress［J］. Arch Gen Psychiatry, 2004, 61(8):819-825.
［12］Zubair M, Parker KL, Morohashi K. Developmental links between the fetal and adult zones of the adrenal cortex revealed by lineage tracing［J］. Mol Cell Biol, 2008, 28(23):7030-7040.
