Maternal steroid hormones in early pregnancy linked to birth outcomes in Chinese cohort

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Frontiers in Medicine Published April 22, 2026 Medically reviewed April 25, 2026 DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Note exploratory associations between maternal steroid hormones and birth outcomes; findings require validation and do not indicate causation.

This was a prospective cohort study of 364 pregnant women in Guangzhou, China. The study measured 19 maternal steroid hormones in early pregnancy using LC-MS/MS and examined associations with adverse birth outcomes (ABOs), including low birth weight, macrosomia, small for gestational age (SGA), large for gestational age, and preterm birth.

For birth length, each 1-SD increase in cortisol was associated with an increase of 0.18 cm (95% CI: 0.02, 0.34). For head circumference, each 1-SD increase in cortisol was associated with an increase of 0.24 cm (95% CI: 0.04, 0.44). For gestational age, each 1-SD increase in estrone was associated with a decrease of 0.20 weeks (95% CI: -0.36, -0.05).

For ABOs, each 1-SD increase in androstenedione was associated with higher odds (OR = 1.36, 95% CI: 1.07, 1.72), as was testosterone (OR = 1.37, 95% CI: 1.08, 1.73) and dihydrotestosterone (OR = 1.32, 95% CI: 1.03, 1.69). An inverse association was seen with 11-deoxycortisol (OR = 0.70, 95% CI: 0.50, 0.98). For SGA, androstenedione (OR = 1.40, 95% CI: 1.01, 1.94) and testosterone (OR = 1.47, 95% CI: 1.08, 1.99) were associated with increased risk, while cortisol (OR = 0.84, 95% CI: 0.72, 0.97) and 11-deoxycortisol (OR = 0.58, 95% CI: 0.35, 0.95) were inversely associated. An androgen mixture was associated with ABOs (OR = 1.40, 95% CI: 1.00, 1.97) and SGA (OR = 1.77, 95% CI: 1.04, 3.01).

Safety and tolerability were not reported. Key limitations include the exploratory nature of the findings, which require validation in larger cohorts, and the lack of reported follow-up duration. The study design does not allow for causal inference. Clinicians should interpret these associations cautiously, recognizing they are preliminary and not yet actionable for practice.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

BackgroundAdverse birth outcomes (ABOs) are major public health concerns. While maternal steroid hormones are essential for fetal development, their individual and combined effects on ABO remain unclear.MethodsThis prospective cohort study included 364 pregnant women (30.7 ± 4.0 years) in Guangzhou, China. Nineteen steroid hormones were measured by LC-MS/MS. Regression and Qgcomp models were used to assess individual and combined associations with ABO, including low birth weight, macrosomia, small for gestational age (SGA), large for gestational age, and preterm birth.ResultsPregnant women with ABO had higher levels of androstenedione (A4) and testosterone (T) and lower levels of 11-deoxycortisol (11-DOF) and estriol (E3). In linear regression models, each 1-SD increase in cortisol (F) was associated with increases of 0.18 cm (95% CI: 0.02, 0.34) in birth length and 0.24 cm (95% CI: 0.04, 0.44) in head circumference, whereas estrone (E1) was inversely associated with gestational age (−0.20 weeks, 95% CI: −0.36, −0.05). In logistic regression analyses, each 1-SD increase in A4 (OR = 1.36, 95% CI: 1.07, 1.72), T (OR = 1.37, 95% CI: 1.08, 1.73), and dihydrotestosterone (DHT) (OR = 1.32, 95% CI: 1.03, 1.69) was associated with higher odds of ABO, whereas 11-DOF was inversely associated with ABO (OR = 0.70, 95% CI: 0.50, 0.98). For SGA, each 1-SD increase in A4 (OR = 1.40, 95% CI: 1.01, 1.94) and T (OR = 1.47, 95% CI: 1.08, 1.99) was associated with increased risk, whereas F (OR = 0.84, 95% CI: 0.72, 0.97) and 11-DOF (OR = 0.58, 95% CI: 0.35, 0.95) were inversely associated. In Qgcomp analyses, the androgen mixture was associated with ABO (OR = 1.40, 95% CI: 1.00, 1.97) and SGA (OR = 1.77, 95% CI: 1.04, 3.01), with A4 and T contributing the largest weights. Consistent directional patterns were observed for androgen-related hormones across outcomes and analytical approaches.ConclusionsMaternal hormonal milieu in early pregnancy may be associated with fetal growth and ABO risk, with consistent patterns for androgen-related hormones. These findings are exploratory and require validation in larger cohorts.

Maternal steroid hormones in early pregnancy linked to birth outcomes in Chinese cohort

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Maternal steroid hormones in early pregnancy linked to birth outcomes in Chinese cohort

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