Jayasuriya NA, et al. - In this investigation, researchers identified the correlation between the ratio of maternal serum cortisol to cortisone at various stages of pregnancy and the risk of preeclampsia or fetal growth restriction (FGR). For this analysis, they studied women from the Pregnancy Outcome Prediction (POP) study experiencing preeclampsia (n=194) or FGR (n=185) plus a random sample of healthy controls (n=279). The data presented in this work showed a lower ratio of maternal serum cortisol to cortisone precedes many weeks of clinical manifestation of preeclampsia and preterm FGR, despite previous reports of lower placental 11-beta-hydroxysteroid dehydrogenase-type 2 (11βHSD2) levels under these conditions. The adjustment for maternal characteristics did not affect associations materially. The observations involve enhanced maternal activity of 11βHSD2 or reduced activity of 11βHSD1 in preeclampsia pathophysiology.