Thus, it is apparent that the fetal membranes have the full potential to synthesize estrogens and progesterone from DHEAS and P 5 S, a not surprising conclusion in view of the common trophoblastic origin of the placenta and chorion laeve. Amniotic fluid contains an abundant supply of steroidal sulfates that can serve as substrates for these biosynthetic enzymes, including DHEAS, 16-OH-DHEAS, pregnenolone, and 16 α -OH-P 5 S ( Schindler and Siiteri, 1968 ). Furthermore, the pattern of steroids found in amniotic fluid derived from fetal urine appears to closely reflect fetal adrenal secretory activity ( Sippell et al ., 1981 ). Most individuals worldwide with CAH have 21-hydroxylase deficiency (80-90%). The incidence of classic 21-hydroxylase deficiency varies by population and ranges from 1 case per 5000-15,000 live births to as high as 1 case per 300-700 births in Alaskan Yupik Eskimos. The next most common type of CAH, 11-beta-hydroxylase deficiency, has an incidence of about 1 in 100,000 persons.
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