Peripartum Androgen-Related Hormones and Anogenital Distance in Preeclampsia: A Cross-Sectional Case-Control Study

Background/Objectives: Preeclampsia is associated with placental, vascular, and endocrine alterations. We compared peripartum maternal androgen-related hormone measures and anogenital distance (AGD) between women with preeclampsia and normotensive controls and assessed whether observed differences persisted after clinical and sampling-related adjustment. Methods: In this prospectively recruited cross-sectional case-control study, 129 women were assessed for eligibility during delivery admission, and 87 women with singleton pregnancies were included: 41 with preeclampsia and 46 normotensive controls. Serum total testosterone, estradiol, androstenedione, dehydroepiandrosterone sulfate, and sex hormone-binding globulin were measured, and the free androgen index (FAI) was calculated. AGD was assessed as anus-to-clitoris distance (AGDac) and anus-to-fourchette distance (AGDaf). Adjusted linear models used heteroscedasticity-consistent robust standard errors; hormone outcomes were log-transformed. Sensitivity analyses excluded at-delivery samples. Results: Women with preeclampsia had higher total testosterone (3.22 vs. 2.31 nmol/L; p = 0.032), higher FAI (0.95% vs. 0.64%; p = 0.007), lower mean AGDac (10.41 vs. 11.35 cm; p = 0.032), and lower mean AGDaf (3.20 vs. 3.72 cm; p = 0.008). In adjusted models, preeclampsia remained associated with higher total testosterone (+78.3%), higher FAI (+99.9%), shorter AGDac (−1.56 cm), and shorter AGDaf (−0.60 cm). After excluding at-delivery samples (n = 69), only the AGDac association remained statistically significant (−1.39 cm; 95% confidence interval, −2.62 to −0.16; p = 0.026). Conclusions: Peripartum endocrine and AGD differences were observed in preeclampsia. After exclusion of at-delivery samples, AGDac remained statistically significant, whereas the endocrine associations and AGDaf did not. These cross-sectional findings do not establish causality or predictive utility and warrant longitudinal confirmation.