Early second-trimester maternal hyperandrogenemia and subsequent preeclampsia: a prospective study

Objective. To explore the hypothesis that maternal androgen levels are elevated before the onset of preeclampsia. Methods. A case-control study in three university hospitals in Norway and Sweden included 29 women with mild preeclampsia and 142 controls. Maternal levels of dehydroepiandrosterone sulfate (DHEAS), androstenedione, testosterone and sex hormone binding globulin (SHBG) were measured, and the free testosterone index (FTI) was calculated in weeks 17 and 33 of gestation. Results. Androstenedione, testosterone and FTI were elevated in gestational weeks 17 and 33 in women who eventually developed preeclampsia, while DHEAS was elevated at week 17 only. At week 17 elevated testosterone and FTI were seen in women bearing both male and female fetuses. At week 33 elevated levels of androstenedione, testosterone and FTI was seen in women with male fetuses only. Comparing the lower tertile with the upper tertile of FTI at week 17 of gestation gave an odds ratio (OR) for preeclampsia of 3.7 [95% confidence interval (CI) 1.3-10.4]. Conclusion. Maternal androgen levels are already elevated in the early second trimester among women who eventually develop preeclampsia. Thus hyperandrogenism may be considered as an early risk marker of preeclampsia and it might be involved in the pathogenesis of preeclampsia.