{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T01:37:52Z","timestamp":1790127472274,"version":"4.0.1"},"reference-count":96,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,16]],"date-time":"2025-11-16T00:00:00Z","timestamp":1763251200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>\u03a4he intrauterine environment has a strong connection with the growing fetus and possible effects that can continue up to adulthood. Currently, stress is conceptualized as a modern teratogen. The overwhelming majority of studies indicate that maternal stress during pregnancy may have effects on pregnancy outcomes and fetal development, with long-lasting consequences on child and adult vulnerability to disease. Glucocorticoids are essential for regulating fetal development, growth, and metabolism. The two isoforms of 11beta-hydroxysteroid dehydrogenase enzyme (11\u03b2-HSD) mediate and regulate glucocorticoid actions and biological activity. It has not yet been fully elucidated whether maternal stress during pregnancy affects 11\u03b2-HSD isoenzyme activity and expression and results in possible adverse effects on fetal development, metabolism, and pregnancy outcomes. This review examines a possible pathophysiological mechanism by which maternal stress during pregnancy affects placental 11\u03b2-HSD isoenzyme activity, thereby causing adverse effects on the physiological status of pregnancy, fetal development, and metabolism. Furthermore, the main outcome of the review is the following: chronic and acute maternal stress during pregnancy affects the activity and the expression of placental 11\u03b2-HSD isoenzymes and has possible subsequent unfavorable results on preeclampsia, preterm birth, and fetuses with intrauterine growth restriction (IUGR) or small for gestational age (SGA) fetuses.<\/jats:p>","DOI":"10.3390\/ijms262211071","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T10:24:58Z","timestamp":1763375098000},"page":"11071","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Effect of Maternal Stress on 11beta-Hydroxysteroid Dehydrogenase Activity During Pregnancy: Evidence for Potential Pregnancy Complications and Consequences on Fetal Development and Metabolism"],"prefix":"10.3390","volume":"26","author":[{"given":"Polina","family":"Pavli","sequence":"first","affiliation":[{"name":"2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, \u201cAretaieion\u201d University Hospital, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1929-3275","authenticated-orcid":false,"given":"George","family":"Mastorakos","sequence":"additional","affiliation":[{"name":"Unit of Endocrinology, Diabetes Mellitus and Metabolism, Aretaieion Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4967-2505","authenticated-orcid":false,"given":"Makarios","family":"Eleftheriades","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, \u201cAretaieion\u201d University Hospital, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgios","family":"Valsamakis","sequence":"additional","affiliation":[{"name":"2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, \u201cAretaieion\u201d University Hospital, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"284","DOI":"10.3109\/14767058.2016.1171308","article-title":"Dysregulation of 11beta-hydroxysteroid dehydrogenases: Implications during pregnancy and beyond","volume":"30","author":"Konstantakou","year":"2017","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1038\/ncpendmet0515","article-title":"Mechanisms of disease: Glucocorticoids, their placental metabolism and fetal \u2018programming\u2019 of adult pathophysiology","volume":"3","author":"Seckl","year":"2007","journal-title":"Nat. Clin. Pract. Endocrinol. Metab."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1126\/science.1095292","article-title":"Living with the past: Evolution, development, and patterns of disease","volume":"305","author":"Gluckman","year":"2004","journal-title":"Science"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.biopsych.2005.03.032","article-title":"Prenatal anxiety predicts individual differences in cortisol in pre-adolescent children","volume":"58","author":"Heron","year":"2005","journal-title":"Biol. Psychiatry"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1093\/ije\/31.2.413","article-title":"Fetal environment and subsequent obesity: A study of maternal smoking","volume":"31","author":"Power","year":"2002","journal-title":"Int. J. Epidemiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1111\/tog.12797","article-title":"Impact of the intrauterine environment on future reproductive and metabolic health","volume":"24","author":"Dunkerton","year":"2002","journal-title":"Obstet. Gynaecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"R1","DOI":"10.1530\/REP-19-0197","article-title":"Mechanisms of intergenerational transmission of polycystic ovary syndrome","volume":"159","author":"Dumesic","year":"2020","journal-title":"Reproduction"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/j.jadohealth.2012.04.008","article-title":"Maternal stress in pregnancy: Considerations for fetal development","volume":"51","author":"DiPietro","year":"2012","journal-title":"J. Adolesc. Health"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Dahlerup, B.R., Egsmose, E.L., Siersma, V., Mortensen, E.L., Hedegaard, M., Knudsen, L.E., and Mathiesen, L. (2018). Maternal stress and placental function, a study using questionnaires and biomarkers at birth. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0207184"},{"key":"ref_10","first-page":"1","article-title":"Glucocorticoid excess and the developmental origins of disease: Two decades of testing the hypothesis","volume":"38","author":"Reynolds","year":"2013","journal-title":"PNEC"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"498e1","DOI":"10.1016\/j.ajog.2008.03.006","article-title":"Prenatal psychosocial stress exposure is associated with insulin resistance in young adults","volume":"199","author":"Entringer","year":"2008","journal-title":"AJOG"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Li, J., Olsen, J., Vestergaard, M., Obel, C., Kristensen, J.K., and Virk, J. (2012). Prenatal exposure to bereavement and type-2 diabetes: A Danish longitudinal population based study. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0043508"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/j.earlhumdev.2011.06.007","article-title":"Disaster-related prenatal maternal stress influences birth outcomes: Project Ice Storm","volume":"87","author":"Dancause","year":"2011","journal-title":"Early Hum. Dev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1097\/PSY.0000000000000410","article-title":"Prenatal Major Depressive Disorder, Placenta Glucocorticoid and Serotonergic Signaling, and Infant Cortisol Response","volume":"78","author":"Stroud","year":"2016","journal-title":"Psychosom. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1647","DOI":"10.1289\/ehp.1003253","article-title":"Stress during pregnancy and offspring pediatric disease: A National Cohort Study","volume":"119","author":"Tegethoff","year":"2011","journal-title":"EHP"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1016\/j.dsx.2020.06.048","article-title":"Effect of maternal perceived stress during pregnancy on gestational diabetes mellitus risk: A prospective case-control study","volume":"14","author":"Mishra","year":"2020","journal-title":"Diabetes Metab. Syndr. Obes."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1530\/JOE-12-0540","article-title":"Sex-specific effects of prenatal stress on glucose homoeostasis and peripheral metabolism in rats","volume":"217","author":"Brunton","year":"2013","journal-title":"J. Endocrinol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1053\/beem.2000.0119","article-title":"Cortisol metabolism and the role of 11beta-hydroxysteroid dehydrogenase","volume":"15","author":"Tomlinson","year":"2001","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"219e232","DOI":"10.1042\/CS20070107","article-title":"Mechanisms underlying the role of glucocorticoids in the early life programming of adult disease","volume":"113","author":"Drake","year":"2007","journal-title":"Clin. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.placenta.2016.08.079","article-title":"Compartmentalized localization of 11\u03b2-HSD 1 and 2 at the feto-maternal interface in the first trimester of human pregnancy","volume":"46","author":"Yang","year":"2016","journal-title":"Placenta"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1002\/dev.21142","article-title":"The association between the acute psychobiological stress response in second trimester pregnant women, amniotic fluid glucocorticoids, and neonatal birth outcome","volume":"56","author":"Ghaemmaghami","year":"2014","journal-title":"Dev. Psychobiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1866","DOI":"10.1096\/fj.12-203489","article-title":"Reconciling the nutritional and glucocorticoid hypotheses of fetal programming","volume":"26","author":"Cottrell","year":"2012","journal-title":"FASEB J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.yhbeh.2010.06.007","article-title":"Glucocorticoids, prenatal stress and the programming of disease","volume":"59","author":"Harris","year":"2011","journal-title":"Horm. Behav."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1152\/physrev.00041.2006","article-title":"Physiology and neurobiology of stress and adaptation: Central role of the brain","volume":"87","author":"McEwen","year":"2007","journal-title":"Physiol. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.yfrne.2018.03.001","article-title":"More than a feeling: A unified view of stress measurement for population science","volume":"49","author":"Epel","year":"2018","journal-title":"Front. Neuroendocrinol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1080\/10615806.2018.1439263","article-title":"Deconstructing trait anxiety: A network perspective","volume":"31","author":"Heeren","year":"2018","journal-title":"Anxiety Stress Coping"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Schernthaner-Reiter, M.H., Wolf, P., Vila, G., and Luger, A. (2021). The Interaction of Insulin and Pituitary Hormone Syndromes. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.626427"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.biopsych.2018.06.023","article-title":"Maternal Cortisol Concentrations During Pregnancy and Sex-Specific Associations with Neonatal Amygdala Connectivity and Emerging Internalizing Behaviors","volume":"85","author":"Graham","year":"2019","journal-title":"Biol. Psychiatry"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1677\/JOE-07-0289","article-title":"Glucocorticoid-induced apoptosis in human decidua: A novel role for 11beta-hydroxysteroid dehydrogenase in late gestation","volume":"195","author":"Chan","year":"2007","journal-title":"J. Endocrinol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1095\/biolreprod60.2.234","article-title":"Dual function of 11beta-hydroxysteroid dehydrogenase in placenta: Modulating placental glucocorticoid passage and local steroid action","volume":"60","author":"Burton","year":"1999","journal-title":"Biol. Reprod."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1196\/annals.1365.012","article-title":"Causes of intrauterine growth restriction and the postnatal development of the metabolic syndrome","volume":"1092","author":"Valsamakis","year":"2006","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1385\/ENDO:28:3:319","article-title":"Role of stress and sympathetic innervation in the development of polycystic ovarian syndrome","volume":"28","author":"Greiner","year":"2005","journal-title":"Endocrine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1097\/00001648-199607000-00002","article-title":"Psychosocial work stress and pregnancy-induced hypertension","volume":"7","author":"Landsbergis","year":"1996","journal-title":"Epidemiology"},{"key":"ref_34","first-page":"487","article-title":"Depression and anxiety in early pregnancy and risk for preeclampsia","volume":"95","author":"Kurki","year":"2000","journal-title":"Obstet. Gynecol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"438.e1","DOI":"10.1016\/j.ajog.2013.07.003","article-title":"The combined association of psychosocial stress and chronic hypertension with preeclampsia","volume":"209","author":"Yu","year":"2013","journal-title":"AJOG"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1080\/0167482X.2020.1778666","article-title":"Life stressors, hypertensive disorders of pregnancy, and preterm birth","volume":"43","author":"Morgan","year":"2022","journal-title":"J. Psychosom. Obstet. Gynecol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"S257","DOI":"10.1016\/S0002-9378(99)70712-X","article-title":"Maternal plasma corticotropin-releasing hormone associated with stress at 20 weeks\u2019 gestation in pregnancies ending in preterm delivery","volume":"180","author":"Hobel","year":"1999","journal-title":"AJOG"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Lilliecreutz, C., Lar\u00e9n, J., Sydsj\u00f6, G., and Josefsson, A. (2016). Effect of maternal stress during pregnancy on the risk for preterm birth. BMC Pregnancy Childbirth, 16.","DOI":"10.1186\/s12884-015-0775-x"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1093\/oxfordjournals.aje.a008789","article-title":"Association of stressful life events with chromosomally normal spontaneous abortion","volume":"143","author":"Neugebauer","year":"1996","journal-title":"Am. J. Epidemiol."},{"key":"ref_40","first-page":"1155","article-title":"Prenatal depression and stress\u2014Risk factors for placental pathology and spontaneous abortion","volume":"55","author":"Marinescu","year":"2014","journal-title":"Rom. J. Morphol. Embryol."},{"key":"ref_41","first-page":"989","article-title":"The characteristics of the dominant frequency of the a- wave and its influence on the psychological behavior in anxious adolescents","volume":"21","author":"Xiaoming","year":"2013","journal-title":"China J. Health Psychol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.psyneuen.2017.06.008","article-title":"In pregnancy increased maternal STAI trait stress score shows decreased insulin sensitivity and increased stress hormones","volume":"84","author":"Valsamakis","year":"2017","journal-title":"Psychoneuroendocrinology"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1111\/1552-6909.12554","article-title":"The relationship between gestational diabetes and antenatal depression","volume":"44","author":"Byrn","year":"2015","journal-title":"J. Obstet. Gynecol. Neonatal Nurs."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1111\/bjhp.12197","article-title":"Stress exposure and psychological stress responses are related to glucose concentrations during pregnancy","volume":"21","author":"Horsch","year":"2016","journal-title":"Br. J. Health Psychol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1111\/ppe.12057","article-title":"The association between a medical history of depression and gestational diabetes in a large multi-ethnic cohort in the United States","volume":"27","author":"Bowers","year":"2013","journal-title":"Paediatr. Perinat. Epidemiol."},{"key":"ref_46","first-page":"1935","article-title":"Investigation and analysis of anxiety and depression in pregnant women with gestational diabetes mellitus","volume":"15","author":"Zhi","year":"2009","journal-title":"Chin. J. Mod. Nurs."},{"key":"ref_47","first-page":"242","article-title":"Clinical investigation and analysis of mental health status of pregnant women with gestational diabetes mellitus","volume":"9","author":"Baorong","year":"2015","journal-title":"Chin. J. Mod. Drug Appl."},{"key":"ref_48","first-page":"178","article-title":"Effects of anxiety and depression on pregnancy outcome in pregnant women with gestational diabetes mellitus","volume":"43","author":"Chengxian","year":"2016","journal-title":"J. Int. Psychiatry"},{"key":"ref_49","first-page":"144","article-title":"Investigation of depression in patients with gestational diabetes mellitus and its relationship with delivery style and adverse pregnancy outcome","volume":"45","author":"Lijuan","year":"2018","journal-title":"J. Int. Psychiatry"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"R175","DOI":"10.1530\/REP-13-0258","article-title":"Effects of maternal exposure to social stress during pregnancy: Consequences for mother and offspring","volume":"146","author":"Brunton","year":"2013","journal-title":"Reproduction"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1677\/joe.0.1810291","article-title":"Prenatal stress induces intrauterine growth restriction and programmes glucose intolerance and feeding behaviour disturbances in the aged rat","volume":"181","author":"Lesage","year":"2004","journal-title":"J. Endocrinol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1111\/j.1469-8749.1994.tb08192.x","article-title":"Prenatal stressors of human life affect fetal brain development","volume":"36","author":"Lou","year":"1994","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.psyneuen.2015.01.006","article-title":"Maternal prenatal stress is associated with the infant intestinal microbiota","volume":"53","author":"Ziljmans","year":"2015","journal-title":"Psychoneuroendocrinology"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1111\/j.1471-0528.1999.tb08406.x","article-title":"Psychosocial predictors of low birth weight: A prospective study","volume":"6","author":"Paarlberg","year":"1999","journal-title":"Br. J. Obstet. Gynaecol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.bbi.2004.09.006","article-title":"The potential influence of maternal stress hormones on development and mental health of the offspring","volume":"19","author":"Weinstock","year":"2005","journal-title":"Brain Behav. Immun."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1097\/01.AOG.0000250535.97920.b5","article-title":"Chronic stress and low birth weight neonates in a low-income population of women","volume":"109","author":"Borders","year":"2007","journal-title":"Obstet. Gynecol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"34.e1","DOI":"10.1016\/j.ajog.2010.02.023","article-title":"Prenatal life events stress: Implications for preterm birth and infant birthweight","volume":"203","author":"Zhu","year":"2010","journal-title":"AJOG"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.psyneuen.2018.04.022","article-title":"Maternal hypothalamus-pituitary-adrenal (HPA) system activity and stress during pregnancy: Effects on gestational age and infant\u2019s anthropometric measures at birth","volume":"94","author":"Gilles","year":"2018","journal-title":"Psychoneuroendocrinology"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.7863\/ultra.16.08085","article-title":"Maternal Depressive Symptoms, Perceived Stress, and Fetal Growth","volume":"36","author":"Grobman","year":"2017","journal-title":"J. Ultrasound Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1017\/S2040174416000076","article-title":"Prenatal maternal mental health and fetal growth restriction: A systematic review","volume":"17","author":"Lewis","year":"2016","journal-title":"J. Dev. Orig. Health Dis."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/j.ajog.2011.05.003","article-title":"The use of psychosocial stress scales in preterm birth research","volume":"205","author":"Chen","year":"2011","journal-title":"AJOG"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.neubiorev.2009.11.008","article-title":"Prenatal stress and the programming of the HPA axis","volume":"35","author":"Glover","year":"2010","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijdevneu.2017.04.001","article-title":"Prenatal stress and depression associated neuronal development in neonates","volume":"60","author":"Fatima","year":"2017","journal-title":"Int. J. Dev. Neurosci."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/BF00707788","article-title":"Prenatal stress and childhood psychopathology","volume":"22","author":"Ward","year":"1991","journal-title":"Child Psychiatry Hum. Dev."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1001\/jamapsychiatry.2013.4291","article-title":"Epigenetic mechanisms of depression","volume":"71","author":"Nestler","year":"2014","journal-title":"JAMA Psychiatry"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Li, J., Olsen, J., Vestergaard, M., Obel, C., Baker, J.L., and S\u00f8rensen, T.I. (2010). Prenatal stress exposure related to maternal bereavement and risk of childhood overweight. PLoS ONE, 5.","DOI":"10.1371\/journal.pone.0011896"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1016\/j.psyneuen.2011.09.014","article-title":"Maternal prenatal anxiety and downregulation of placental 11\u03b2-HSD2","volume":"37","author":"Freeman","year":"2012","journal-title":"Psychoneuroendocrinology"},{"key":"ref_68","first-page":"1174","article-title":"Elevated levels of umbilical cord plasma corticotropin-releasing hormone in growthretarded fetuses","volume":"77","author":"Goland","year":"1993","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"104591","DOI":"10.1016\/j.psyneuen.2020.104591","article-title":"Maternal chronic stress correlates with serum levels of cortisol, glucose and C-peptide in the fetus, and maternal non chronic stress with fetal growth","volume":"114","author":"Valsamakis","year":"2020","journal-title":"Psychoneuroendocrinology"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"4115","DOI":"10.1210\/jc.2005-0550","article-title":"Transgenerational effects of posttraumatic stress disorder in babies of mothers exposed to the World Trade Center attacks during pregnancy","volume":"90","author":"Yehuda","year":"2005","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"153316","DOI":"10.1016\/j.tox.2022.153316","article-title":"11\u03b2-hydroxysteroid dehydrogenases and biomarkers in fetal development","volume":"479","author":"Cao","year":"2022","journal-title":"Toxicology"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1017\/S2040174415000100","article-title":"Maternal restraint stress during pregnancy in mice induces 11\u03b2-HSD1-associated metabolic changes in the livers of the offspring","volume":"6","author":"Maeyama","year":"2015","journal-title":"J. Dev. Orig. Health Dis."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Jensen Pe\u00f1a, C., Monk, C., and Champagne, F.A. (2012). Epigenetic effects of prenatal stress on 11\u03b2-hydroxysteroid dehydrogenase-2 in the placenta and fetal brain. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0039791"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.placenta.2020.12.008","article-title":"Maternal stress, placental 11\u03b2-hydroxysteroid dehydrogenase type 2, and infant HPA axis development in humans: Psychosocial and physiological pathways","volume":"104","author":"Jahnke","year":"2021","journal-title":"Placenta"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"107060","DOI":"10.1016\/j.psyneuen.2024.107060","article-title":"Prenatal psychological distress and 11\u03b2-HSD2 gene expression in human placentas: Systematic review and meta-analysis","volume":"166","author":"Tartour","year":"2024","journal-title":"Psychoneuroendocrinology"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"27482","DOI":"10.3390\/ijms161126034","article-title":"Maternal Prenatal Mental Health and Placental 11\u03b2-HSD2 Gene Expression: Initial Findings from the Mercy Pregnancy and Emotional Wellbeing Study","volume":"16","author":"Seth","year":"2015","journal-title":"Int. J. Mol. Sci."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"R7","DOI":"10.1677\/joe.1.06374","article-title":"Chronic maternal stress inhibits the capacity to up-regulate placental 11beta-hydroxysteroid dehydrogenase type 2 activity","volume":"186","author":"Welberg","year":"2005","journal-title":"J. Endocrinol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"154396","DOI":"10.1016\/j.scitotenv.2022.154396","article-title":"Differential expression of placental 11\u03b2-HSD2 induced by high maternal glucocorticoid exposure mediates sex differences in placental and fetal development","volume":"827","author":"Yu","year":"2022","journal-title":"Sci. Total Environ."},{"key":"ref_79","first-page":"11961","article-title":"The effect of cold exposure on the levels of glucocorticoids, 11-hydroxysteroid dehydrogenase 2, and placental vascularization in a rat model","volume":"27","author":"Zhang","year":"2023","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_80","first-page":"734","article-title":"Glucocorticoid synthesis-related genes:HSD11B1 and HSD11B2 in hypertensive disorders in pregnancy","volume":"36","author":"Shimodaira","year":"2013","journal-title":"Gynecol. Endocrinol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.mce.2016.08.023","article-title":"Expression and regulation of 11\u03b2-hydroxysteroid dehydrogenase type 1 in first trimester human decidua cells: Implication in preeclampsia","volume":"437","author":"Funghi","year":"2016","journal-title":"Mol. Cell. Endocrinol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1210\/er.2017-00188","article-title":"11\u03b2-HSD1 in Human Fetal Membranes as a Potential Therapeutic Target for Preterm Birth","volume":"39","author":"Wang","year":"2018","journal-title":"Endocr. Rev."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.mam.2007.04.003","article-title":"11beta-Hydroxysteroid dehydrogenase type 2 in pregnancy and preeclampsia","volume":"28","author":"Causevic","year":"2007","journal-title":"Mol. Asp. Med."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1203\/PDR.0b013e31818d6c24","article-title":"Prematurity is related to high placental cortisol in preeclampsia","volume":"65","author":"Aufdenblatten","year":"2009","journal-title":"Pediatr. Res."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/S0039-128X(98)00056-7","article-title":"Placental 11beta-hydroxysteroid dehydrogenase activity in normotensive and preeclamptic pregnancies","volume":"63","author":"McCalla","year":"1998","journal-title":"Steroids"},{"key":"ref_86","first-page":"1313","article-title":"Decreased gene expression of 11beta-hydroxysteroid dehydrogenase type 2 and 15-hydroxyprostaglandin dehydrogenase in human placenta of patients with preelampsia","volume":"86","author":"Schoof","year":"2001","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"15379","DOI":"10.1096\/fj.202001003RR","article-title":"Contribution of placental 11\u03b2-HSD2 to the pathogenesis of preeclampsia","volume":"34","author":"Wang","year":"2020","journal-title":"FASEB J."},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Siemi\u0105tkowska, A., Kosicka, K., Szpera-Go\u017adziewicz, A., Krzy\u015bcin, M., Br\u0119borowicz, G.H., and G\u0142\u00f3wka, F.K. (2019). Cortisol metabolism in pregnancies with small for gestational age neonates. Sci. Rep., 9.","DOI":"10.1038\/s41598-019-54362-0"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1016\/j.steroids.2012.03.007","article-title":"Differential expression of placental 11\u03b2-hydroxysteroid dehydrogenases in pregnant women with diet-treated gestational diabetes mellitus","volume":"77","author":"Ma","year":"2012","journal-title":"Steroids"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1530\/EJE-09-0308","article-title":"Differences in expression and activity of 11beta-hydroxysteroid dehydrogenase type 1 and 2 in human placentas of term pregnancies according to birth weight and gender","volume":"161","author":"Mericq","year":"2009","journal-title":"Eur. J. Endocrinol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"5232","DOI":"10.1016\/S0002-9378(99)70707-6","article-title":"A central theory of preterm and term labor: Putative role for corticotrophin-releasing hormone","volume":"180","author":"Majzoub","year":"1999","journal-title":"AJOG"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1203\/PDR.0b013e31819e7337","article-title":"Placental 11beta-HSD2 gene expression at birth is inversely correlated with growth velocity in the first year of life after intrauterine growth restriction","volume":"65","author":"Tzschoppe","year":"2009","journal-title":"Pediatr. Res."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1159\/000235879","article-title":"Differential expression and activity of 11beta-hydroxysteroid dehydrogenase in human placenta and fetal membranes from pregnancies with intrauterine growth restriction","volume":"25","author":"Wachter","year":"2009","journal-title":"Fetal Diagn. Ther."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1210\/jc.2002-021378","article-title":"Placental 11beta-hydroxysteroid dehydrogenase type 2 and fetal cortisol\/cortisone shuttle in small preterm infants","volume":"88","author":"Kajantie","year":"2003","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_95","first-page":"2244","article-title":"Examination of genotype and phenotype relationships in 14 patients with apparent mineralocorticoid excess","volume":"83","author":"Wilson","year":"1998","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/j.lfs.2007.07.002","article-title":"Diabetic pregnancy in rats leads to impaired glucose metabolism in offspring involving tissue-specific dysregulation of 11beta-hydroxysteroid dehydrogenase type 1 expression","volume":"81","author":"Fujisawa","year":"2007","journal-title":"Life Sci."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/22\/11071\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T10:29:43Z","timestamp":1763375383000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/22\/11071"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,16]]},"references-count":96,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["ijms262211071"],"URL":"https:\/\/doi.org\/10.3390\/ijms262211071","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,16]]}}}