Hormones and Pregnancy: Basic Science and Clinical Implications

 

Description:

The endocrine and neuroendocrine system in pregnancy involves highly complex maternal, fetal and placental mechanisms, which are critical for the maintenance of pregnancy, the timing of parturition, for fetal growth and protection from adverse fetal programming. This timely book summarizes the different endocrine aspects related to pregnant women, describing how hormones regulate physiological homeostasis and influence the pathogenesis of disease. The first section of the book covers the role of specific hormones in detail, including oxytocin, hCG and estrogen. The second section discusses gestational disorders such as diabetes, hypertensive disorders and preeclampsia and how the involvement of hormones has clinical implications for management. Best practice for management of endocrine disorders, which can negatively impact pregnancy, such as thyroid disease and obesity, is also reviewed. This book is essential for clinicians and scientists looking to gain knowledge of the role of hormones in pregnancy and how they can best support patients.

 

Table of Contents:

 

Chapter 1 The Neuroendocrinology of Pregnancy

1.1 Introduction

1.2 Hypothalamus-Pituitary-Adrenal (HPA) Axis

1.2.1 Corticotropin-Releasing Hormone (CRH)

1.2.2 Urocortins (Ucns)

1.3 Hypothalamus-Pituitary-Gonadal Axis: Gonadotropin-Releasing Hormone (GnRH)

1.4 Hypothalamus-Growth Hormone Axis: GH-Releasing Hormone (GHRH) and Somatostatin (SST)

1.5 Hypothalamus-Pituitary-Thyroid Axis

1.6 Oxytocin

1.7 Prolactin and Placental Lactogen (hPL)

1.8 Other Neuroendocrine Factors

1.8.1 Neuropeptide Y (NPY)

1.8.2 Relaxin

1.8.3 Parathyroid Hormone-Related Protein (PTHrP)

1.8.4 Opioids

1.8.5 Neurosteroids

1.9 Conclusions

References

Chapter 2 The Placenta as an Endocrine Organ/Placental Endocrinology

2.1 The Placental Maturational Trajectory

2.2 Placental Signaling of the Presence of the Pregnancy

2.2.1 Expression of Syncytin and the Formation of the Trophectoderm

2.2.2 Signaling the Presence of a Fertilized Ovum

2.3 Formation of the Cytotrophoblast and Syncytiotrophoblast Layers

2.4 Regulation of Estrogen and Progesterone Synthesis

2.5 The Presence of Four Different Estrogens: Why Is This Necessary?

2.6 Regulation of Peptide Hormone Production

2.7 Placental Release of Peptide Hormones

2.8 Maternal Targets for Placental Signals

2.8.1 The Endometrium

2.8.2 The Myometrium

2.8.3 Maternal Metabolism

2.8.4 Maternal Brain

2.8.5 Targeting the Breast

2.9 Summary

References

Chapter 3 The Role of Oxytocin in Pregnancy

3.1 Introduction

3.1.1 Oxytocin Biosynthesis

3.1.2 Pulsatile Secretion of Oxytocin

3.1.3 Decoding at the Oxytocin Receptor

3.2 Oxytocin and Reproductive Physiology

3.2.1 Conception and the Initiation of Pregnancy

3.2.2 Maintenance of Pregnancy

3.2.3 Parturition

3.2.4 Postpartum

3.2.5 Breastfeeding

3.2.6 Infant Care, Parenting (Bonding), and Motherhood

3.3 Clinical Application of Oxytocin

3.3.1 Oxytocin Administration for the Induction of Labor

3.3.2 Oxytocin Administration to Facilitate Breastfeeding

3.3.3 Oxytocin Administration for Prevention of Postpartum Hemorrhage (PPH)

3.3.4 Oxytocin Application for Autism, Maternal Depression, and Mental Disorders

3.4 Oxytocin Receptor Antagonists for Obstetric Use

3.4.1 Oxytocin Receptor Antagonists

3.4.2 Effects of Oxytocin Receptor Antagonists in ART: Prevention of Spontaneous Abortion

3.4.3 Effects of Oxytocin Receptor Antagonists on Tocolysis: Prevention of Preterm Labor

3.5 Alternative Applications of Oxytocin and Oxytocin Receptor Antagonists: Clinical Potential and P

3.5.1 Effect of Oxytocin Administration on Male Infertility

3.5.2 Oxytocin and Pain Relief

3.5.3 Control of Food Intake

3.6 Conclusion

References

Chapter 4 The Role of Human Chorionic Gonadotropin in Pregnancy

4.1 Human Chorionic Gonadotropin (hCG)

4.1.1 Placental Hormones

4.1.2 Gonadotropin

4.1.3 hCG

4.1.3.1 Biosynthesis

4.1.3.2 Serum and Urine Concentrations

4.1.3.3 Regulation of hCG

4.2 Biological Functions

4.2.1 Maintenance of Corpus Luteum Function

4.2.2 Testicular Stimulation

4.2.3 Stimulation of the Maternal Thyroid

4.2.3.1 hCG and TSH

4.2.3.2 Thyroid Hormones and Fetal Brain Development

4.2.3.3 Mechanism of Thyroid Effect on the Fetal Brain

4.2.3.4 Other Functions of hCG

4.3 Clinical Application

4.3.1 Pregnancy Tests

4.3.1.1 Measurement of hCG

4.3.1.2 Home Pregnancy Tests

4.3.2 Abnormally High or Low Levels

4.3.2.1 Ectopic Pregnancy

4.3.2.2 Chorionic Disease

4.4 Multimodality Diagnosis

4.4.1 ?-hCG

4.4.2 ?-hCG Levels above the Discriminatory Threshold

4.4.3 ?-hCG Levels below the Discriminatory Zone

References

Chapter 5 The Role of Estrogens in Pregnancy

5.1 Introduction

5.2 Site of Estrogens Synthesis during Pregnancy

5.3 From Pre-implantation to Myometrial Invasion

5.4 Uterine Artery Remodeling

5.5 Angiogenesis and Placenta Development

5.6 Estrogens, Uterine Blood Flow, and Systemic Vasodilation

5.7 Neuroestrogens

5.8 Estrogens and Preeclampsia

5.9 Parturition and Estrogens

5.10 Conclusion

References

Chapter 6 The Role of Progesterone in Pregnancy

6.1 Introduction

6.2 Evolutionary Perspective

6.3 History of Progesterone Discovery

6.4 Mechanism of P4 Action

6.5 Establishment of Pregnancy

6.6 Maintenance of Pregnancy

6.7 Parturition and P4 Withdrawal

6.8 Progestin Therapy to Prevent Pre-term Birth

6.9 Conclusion

Acknowledgments

References

Chapter 7 Hormones and Cardiovascular Systems in Pregnancy

7.1 Introduction

7.2 Cardiovascular Changes

7.2.1 Plasma Volume

7.2.2 Hemodynamic Changes

7.2.3 Cardiac Changes

7.2.4 Maternal Cardiovascular Involvement in Preeclampsia

7.3 Hormonal Change

7.3.1 Estrogen

7.3.1.1 Mechanism of Action

7.3.1.2 Effect on Cardiovascular System

7.3.2 Progesterone

7.3.2.1 Effect on Cardiovascular System

7.3.2.2 Mechanism of Action

7.3.3 Prolactin

7.3.3.1 Mechanism of Action

7.3.3.2 Cardiovascular Effects

7.3.3.3 Vasoinhibin

7.3.4 Relaxin

7.3.4.1 Mechanism of Action

7.3.4.2 Cardiovascular Effects

7.3.5 Renin-Angiotensin-Aldosterone System

References

Chapter 8 Prolactin, Prolactinoma, and Pregnancy

8.1 Introduction

8.2 The Physiology of Prolactin Secretion during Normal Pregnancy and Breastfeeding

8.3 Effects of Hyperprolactinemia on the Gonadotropic Axis and Fertility in Women

8.4 Effects of Hyperprolactinemia on the Gonadotropic Axis and Fertility in Men

8.5 Management of Prolactinoma before Pregnancy

8.6 Management of Prolactinoma during Pregnancy

8.7 Safety of DA Treatment for the Mother and Child

8.8 Breastfeeding and Management of Prolactinoma after Pregnancy

8.9 Management of Prolactinoma after Pregnancy and Breastfeeding

8.10 Conclusions

References

Chapter 9 Growth Hormone Disorders in Pregnancy

9.1 Introduction

9.2 GH and Fertility

9.3 Growth Hormone Deficiency (GHD)

9.4 Growth Hormone Excess (Acromegaly)

References

Chapter 10 Gestational Diabetes

10.1 Introduction

10.2 Metabolic Changes during Normal Pregnancy

10.2.1 Carbohydrates Metabolism

10.2.2 Lipids Metabolism

10.2.3 Placental and Maternal Hormones and Insulin Resistance

10.2.3.1 Placental Hormones

10.2.3.2 Maternal Hormones

10.2.3.3 Inflammation Molecules and Adipokines

10.3 Pathophysiology of Gestational Diabetes

10.4 Risk Factors for Gestational Diabetes

10.5 Screening and Diagnosis

10.5.1 Diagnostic Thresholds

10.5.2 Universal or Selective Screening

10.6 Maternal and Fetal Complications

10.6.1 Short Term Complication for the Offspring

10.6.2 Short Term Complication for the Mother

10.6.3 Maternal Long Term Complications

10.6.3.1 Type 2 Diabetes

10.6.3.2 Cardiovascular Disease

10.6.4 Offspring Long Term Complications

10.7 Management

10.7.1 Lifestyle Intervention and SBGM (Self Blood Glucose Monitoring)

10.7.2 Pharmacological Therapy

10.7.2.1 Insulin Therapy

10.7.2.2 Metformin

10.8 Prevention of Gestational Diabetes

10.9 Conclusion

References

Chapter 11 Obesity and Metabolic Syndrome in Pregnancy

11.1 Obesity and the Global Chronic Disease Epidemic

11.2 The Prevalence of Obesity and Type 2 Diabetes Has Been Rising at Alarming Rates

11.3 Birthweight and Maternal BMI Predict Obesity in Offspring

11.4 Obese Phenotypes and Metabolic Factors That Complicate Pregnancy

11.5 Adverse Pregnancy Outcomes Associated with Obesity

11.6 Physiology and Pathophysiology Leading to Obesity

11.7 Weight Management Approaches to Maternal Obesity

11.8 Pregnancy and Prenatal Outcomes after Bariatric Surgery

11.9 Postnatal Outcomes for Children Born to Mothers after Bariatric Surgery

11.10 Neonatal Issues Associated with Maternal Obesity

11.11 Lactation Issues Associated with Maternal Obesity

11.12 Management Considerations in Pregnancies Complicated by Obesity

Acknowledgments

References

Chapter 12 Hormones and Pre-term Birth

12.1 The Problem of Pre-term Birth

12.1.1 Epidemiology and Demographics

12.1.2 Definitions, Clinical Presentation, and Risk Factors for PTB

12.1.2.1 Definitions and Clinical Presentation

12.1.2.2 Risk Factors

Demographic, Social & Environmental

Maternal Age -

Race & Ethnicity -

Body Mass Index (BMI) -

Family History -

Social Deprivation & Poverty -

Smoking -

Psychological Stress -

Obstetric & Gynecological Factors

Previous PTB -

Previous Second Stage Cesarean Section -

Previous Uterine Curettage or Cervical Surgery -

Risks of Current Pregnancy

Multiple Pregnancy -

Infection-Intra-uterine or vaginal

Male fetus -

12.1.3 Impact of PTB

12.1.3.1 Neonatal Morbidity and Mortality

12.1.3.2 Maternal Morbidity and Mortality

12.2 Hormonal Regulation of Parturition

12.2.1 Role of Hormones in Pregnancy and Labor

12.2.1.1 Progesterone

12.2.1.2 Estrogens

12.2.1.3 Androgens

12.2.1.4 Thyroid Hormones

12.2.2 Corticotropin-Releasing Hormone, Stress and PTB

12.2.3 Physiologic Inflammation and Labor Onset

12.2.4 Infection and PTB

12.3 Prediction and Management of Pre-term Birth

12.3.1 Prediction, Prevention, and Management of PTB in Humans

12.3.1.1 Prediction of PTB

Cervical Length

Fetal Fibronectin and Other Biomarkers

12.3.1.2 Management: Prevent and Delay PTB

Progesterone

Cervical Cerclage

Cervical Pessary

Tocolysis

12.3.1.3 Management: Reduce Morbidity and Mortality of PTB

Antenatal Corticosteroid Therapy (5)

Magnesium Sulphate

Antibiotics

12.3.2 Animal Models and Interventions of the Future

12.3.2.1 Noninfectious (Sterile) Models

12.3.2.2 Infectious Models

12.3.2.3 Prevention of PTB: Animal Models

References

Chapter 13 Thyroid Dysfunction in Pregnancy and Postpartum

13.1 Thyroid Physiology in Pregnancy

13.2 Hyperthyroidism in Pregnancy

13.2.1 Definition, Epidemiology, and Etiology

13.2.2 Clinical Features and Diagnosis

13.2.3 Maternal-Fetal Consequences of Hyperthyroidism

13.2.4 Treatment of Hyperthyroidism in Pregnancy

13.2.5 Counseling for Women with Graves' Disease Planning Pregnancy

13.3 Hypothyroidism in Pregnancy

13.3.1 Definition, Epidemiology, and Etiology

13.3.2 Clinical Features and Diagnosis

13.3.3 Maternal-Fetal Consequences of Hypothyroidism

13.3.4 Treatment of Hypothyroidism in Pregnancy

13.3.5 Universal Screening for Thyroid Dysfunction in Pregnancy?

13.4 Euthyroid Autoimmune Thyroid Disease in Pregnancy

13.5 Postpartum Thyroid Thyroiditis

References

Chapter 14 The Role of Hormones in Hypertensive Disorders of Pregnancy

14.1 Introduction

14.2 The ''Hormonal Origin'' of Preeclampsia

14.3 Role of Hormones in the Metabolic and Cardiovascular Adaptations of Pregnancy

14.4 Placental Hormones in Preeclampsia

14.4.1 Placental Steroid Hormones

14.4.1.1 Estrogens

14.4.1.2 Testosterone

14.4.1.3 Progesterone

14.4.1.4 Cortisol

14.4.2 Placental Peptide Hormones

14.5 Maternal Hormones in Preeclampsia

14.5.1 Role of the Corpus Luteum - Relaxin

14.5.2 Thyroid Hormones

14.5.3 Renin - Angiotensin Aldosterone System (RAAS) and Prorenin

14.5.4 Naturietic Factors and Corin

14.5.5 Arginine Vasopressin and Copeptin

14.5.6 Other Maternal Hormones

14.6 Conclusion

References

Chapter 15 Adrenal Disease in Pregnancy

15.1 Adrenal Function in Pregnancy

15.1.1 Glucocorticoids

15.1.2 Mineralocorticoids

15.1.3 Androgens

15.1.4 Catecholamines

15.1.5 The Fetal Adrenal Gland

15.2 Adrenal Insufficiency: Primary and Secondary

15.2.1 Diagnosis

15.2.2 Etiology

15.2.3 Chronic Corticosteroid Replacement

15.2.4 Monitoring

15.2.5 Stress Dosing during Illness and Labor

15.2.6 Summary

15.3 Congenital Adrenal Hyperplasia

15.3.1 Diagnosis

15.3.2 Fertility

15.3.3 Management

15.3.4 Other Rare Types

15.4 Cushing's Syndrome

15.4.1 Diagnosis

15.4.2 Etiology

15.4.3 Management

15.5 Primary Aldosteronism

15.5.1 Etiology

15.5.2 Diagnosis

15.5.3 Management

15.6 Pheochromocytoma and Paraganglioma

15.6.1 Diagnosis

15.6.2 Genetic Considerations

15.6.3 Management

15.6.4 Delivery

15.7 Adrenocortical Carcinoma

15.7.1 Diagnosis

15.7.2 Management

References

Chapter 16 Hormones and Multiple Pregnancy

16.1 Hormone Levels in Multiple Pregnancies

16.1.1 Human Chorionic Gonadotropin (hCG)

16.1.2 Steroid Hormones

16.1.2.1 Estrogens

16.1.2.2 Progesterone

16.1.2.3 Testosterone

16.1.3 Corticotropin Releasing Hormone (CRH)

16.1.4 Human Placental Lactogen (HPL)

16.1.4.1 Effect of Hormonal Profiles of Twin Pregnancies on the Offspring

16.2 Pathophysiology of Pre-term Delivery in Multiple Pregnancies

16.2.1 Epidemiology and Pathophysiology of Pre-term Birth in Multiple Pregnancies

16.2.2 Hormonal Profiles and Pre-term Delivery in Multiple Gestations

16.3 Conclusions

References

Chapter 17 Hormones in Pregnancy and the Developmental Origins of Health and Disease

17.1 Introduction

17.2 Early Background

17.3 Human Studies

17.4 The Role of the Placenta

17.5 Stress and Glucocorticoids

17.6 Reproductive Function

17.7 Microbiome

17.8 Concluding Comments

References

Index

 

An aparitie	13 Oct. 2022
Autor	Felice Petraglia, Mariarosaria Di Tommaso, Federico Mecacci
Dimensiuni	17.78 x 1.52 x 25.4 cm
Editura	Cambridge University Press
Format	Hardcover
ISBN	9781316516669
Limba	Engleza
Nr pag	218