Hormones regulate many physiological functions and activities such as metabolism, digestion, respiration, sleep, lactation, reproduction, growth, and development. In addition, they are used to communicate between tissues and organs. Changes in cell function occur when hormones bind to specific receptor proteins. On binding, the signal transduction pathway gets activated, which activates gene transcription, resulting in the expression of the target protein. During human pregnancy, various endocrinal and metabolic changes result from physiological changes at the boundary formed between fetus and mother. Two of the essential hormones, which play an essential role during pregnancy are estrogen and progesterone, among other ones. Major hormonal fluctuations can cause complications in the establishment and maintenance of the pregnancy such as miscarriages, preterm labor, or pre-eclampsia.
Progesterone – Progesterone is produced till ten weeks of gestation by the corpus luteum. Progesterone level ranges from 100-200 nanogram per milliliters (ng/ml), while the placenta secretes almost 250 milligrams (mg) progesterone per day upon reaching term gestation. Contrary to estrogen, the progesterone that the placenta produces enters the placenta. A rise in progesterone level at the 32nd week of pregnancy is essential to prevent the risk of preterm labor. Progesterone plays an essential role in suppressing the immunologic response of the mother to fetal antigens, which prevents the maternal bodyâ€™s trophoblast rejection. Progesterone is also responsible for preparing and maintaining the endometrium to process the implantation. Studies have proved that progesterone is required for successful implantation, not the estrogen (oestradiol) produced in ample amounts by the human corpus luteum.
Estrogen – Estrogen is primarily released from the ovary and the placenta during pregnancy in females. Estrogen is responsible for the endometrium thickening and maintaining the menstrual cycle. However, the placenta lacks certain enzymes to make estrogens from cholesterol or progesterone. The fetus did not produce progesterone due to the lack of enzyme 3-B-hydroxysteroid dehydrogenase; thus, progesterone reaches the fetus from the placenta. In return, the fetus provides what is lacking in the placenta (19 Carbon compounds)-the precursor of estrogen.
Human chorionic gonadotropin (hCG) – hCG is a protein hormone. It is the most studied hormone as it prevents corpus luteum from shrinkage and maintains secretion of the progesterone by granulosa cells. It is a crucial pregnancy bio-marker, one of the earliest secreted products. The most definite function of hCG known is the support of the corpus luteum. The hCG stimulates the corpus luteum to secretion 25 mg of progesterone and 0.5 mg of Oestradiol (E2).
Human placental lactogen (HPL) – HPL is utilized in various processes like insulin resistance and enhanced insulin secretion, which helps stimulate lipolysis and increases free fatty acid circulation. In addition, gluconeogenesis is inhibited by HPL and acts as an antagonist in response to insulin action. In the maternal system, inhibit gluconeogenesis induces glucose tolerance, lipolysis, and proteolysis. In addition, HPL exerts metabolic effects during pregnancy through insulin-like growth factors (IGF-1).
Prolactin – The presence of prolactin in luteal function is necessary; its role is less clear. In 1952, the use of the lactogenic hormone, when combined with hemophagocytic lymphohistiocytosis (HLH) / hCG, produced a synergistic luteotropic effect and was found to help support the transformation of the corpus luteum.
hCG as the indicator of pregnancy assessment
Few studies have recommended ultrasound along with endocrinal assessments for pregnancy prediction. Although signs of fetal life cannot always be detected between 6-7 weeks of pregnancy, its absence, along with low levels of hCG, can indicate poor pregnancy outcomes. However, hCG is secreted after the fertilized egg is implanted in the uterus. Maternal urine and blood samples are used for assays in early pregnancy. Urinary excretion shows a proportion of the total hormone production over a period of time, usually 24 hours. hCG levels rise quickly during the first few weeks of pregnancy. hCG levels also indicate the health of the baby or information about the pregnancy. For example, the rapid rise in levels of hCG than the normal values indicates multiple pregnancies or abnormal growth. A slow increase in hormone level is indicative of ectopic pregnancy.
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