Regulation of corticosteroids in the fetus: control of birth and influence on adult disease

Maturation of the hypothalamic-pituitary-adrenal (HPA) axis of the fetus during late gestation is a consistent observation across species, and increased fetal glucocorticoids contribute to the stimulus to fetal organ maturation and the onset of parturition. However, precocious elevations in fetal glucocorticoids, whether endogenous or exogenous, have adverse consequences on fetal growth and on programming the HPA axis, as well as on pancreatic and cardiovascular function in later life. These findings emphasize the need for cautious use of synthetic glucocorticoids in pregnant women, and suggest that their administration should be confined to appropriate groups of high-risk pregnancies.