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Ushida T, Nakatochi M, Kobayashi Y, Nakamura N, Fuma K, Iitani Y, Imai K, Sato Y, Hayakawa M, Kajiyama H, Kotani T. Antenatal corticosteroids and outcomes of small for gestational age infants born at 24-31 gestational weeks: a population-based propensity score matching analysis. Arch Gynecol Obstet 2023; 308:1463-1471. [PMID: 36352162 DOI: 10.1007/s00404-022-06834-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the effect of antenatal corticosteroid (ACS) treatment on neonatal outcomes in small for gestational age (SGA) infants born at 24-31 gestational weeks compared with non-SGA infants. METHODS A population-based retrospective study was conducted that analyzed clinical data from the Neonatal Research Network of Japan database, which enrolls neonates born at < 32 gestational weeks and weighing 1500 g or less (n = 22,414). Propensity score matching (with the ratio of ACS to no-ACS groups of 1:1) was performed in SGA (n = 7028) and non-SGA (n = 15,386) infants, respectively. Univariate logistic and interaction analyses were performed to compare the short-term neonatal outcomes of infants with and without ACS treatment in utero. RESULTS In the SGA and non-SGA infants, ACS treatment significantly reduced in-hospital mortality (odds ratio 0.67 95% confidence interval [0.50-0.88] and 0.62 [0.50-0.78], respectively), respiratory distress syndrome (0.77 [0.69-0.87] and 0.63 [0.58-0.68], respectively), and composite adverse outcomes (0.73 [0.58-0.91] and 0.57 [0.50-0.65], respectively). ACS treatment also significantly reduced intraventricular hemorrhage (grade III/IV), periventricular leukomalacia, and sepsis in the non-SGA infants, but not in the SGA infants. However, interaction analyses revealed no significant differences between the SGA and non-SGA infants in the efficacy of ACS treatment on short-term outcomes except for respiratory distress syndrome. CONCLUSIONS ACS treatment was associated with beneficial effects on mortality, respiratory distress syndrome, and adverse composite outcomes in extremely and very preterm SGA infants, with similar efficacy on all neonatal outcomes except for respiratory distress syndrome observed in the non-SGA infants.
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Affiliation(s)
- Takafumi Ushida
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
- Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
| | - Masahiro Nakatochi
- Public Health Informatics Unit, Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yumiko Kobayashi
- Data Science Division, Data Coordinating Center, Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Noriyuki Nakamura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Kazuya Fuma
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Yukako Iitani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Kenji Imai
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Yoshiaki Sato
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Masahiro Hayakawa
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
- Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
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Saito K, Nishimura E, Ota E, Namba F, Swa T, Ramson J, Lavin T, Cao J, Vogel JP. Antenatal corticosteroids in specific groups at risk of preterm birth: a systematic review. BMJ Open 2023; 13:e065070. [PMID: 37739474 PMCID: PMC10533784 DOI: 10.1136/bmjopen-2022-065070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/01/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE This study aimed to synthesise available evidence on the efficacy of antenatal corticosteroid (ACS) therapy among women at risk of imminent preterm birth with pregestational/gestational diabetes, chorioamnionitis or fetal growth restriction (FGR), or planned caesarean section (CS) in the late preterm period. METHODS A systematic search of MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Science and Global Index Medicus was conducted for all comparative randomised or non-randomised interventional studies in the four subpopulations on 6 June 2021. Risk of Bias Assessment tool for Non-randomised Studies and the Cochrane Risk of Bias tool were used to assess the risk of bias. Grading of Recommendations Assessment, Development and Evaluations tool assessed the certainty of evidence. RESULTS Thirty-two studies involving 5018 pregnant women and 10 819 neonates were included. Data on women with diabetes were limited, and evidence on women undergoing planned CS was inconclusive. ACS use was associated with possibly reduced odds of neonatal death (pooled OR: 0.51; 95% CI: 0.31 to 0.85, low certainty), intraventricular haemorrhage (pooled OR: 0.41; 95% CI: 0.23 to 0.72, low certainty) and respiratory distress syndrome (pooled OR: 0.59; 95% CI: 0.45 to 0.77, low certainty) in women with chorioamnionitis. Among women with FGR, the rates of surfactant use (pooled OR: 0.38; 95% CI: 0.23 to 0.62, moderate certainty), mechanical ventilation (pooled OR: 0.42; 95% CI: 0.26 to 0.66, moderate certainty) and oxygen therapy (pooled OR: 0.48; 95% CI: 0.30 to 0.77, moderate certainty) were probably reduced; however, the rate of hypoglycaemia probably increased (pooled OR: 2.06; 95% CI: 1.27 to 3.32, moderate certainty). CONCLUSIONS There is a paucity of evidence on ACS for women who have diabetes. ACS therapy may have benefits in women with chorioamnionitis and is probably beneficial in FGR. There is limited direct trial evidence on ACS efficacy in women undergoing planned CS in the late preterm period, though the totality of evidence suggests it is probably beneficial. PROSPERO REGISTRATION NUMBER CRD42021267816.
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Affiliation(s)
- Kana Saito
- Pediatrics, Saitama Medical Center, Kawagoe, Saitama, Japan
| | - Etsuko Nishimura
- Graduate School of Nursing Science, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Erika Ota
- Graduate School of Nursing Science, St Luke's International University, Chuo-ku, Tokyo, Japan
- The Tokyo Foundation for Policy Research, Minato-ku, Tokyo, Japan
| | - Fumihiko Namba
- Pediatrics, Saitama Medical Center, Kawagoe, Saitama, Japan
| | - Toshiyuki Swa
- Division of Health Science, Osaka University School of Medicine Graduate School of Medicine, Suita, Osaka, Japan
| | - Jenny Ramson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Tina Lavin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Jenny Cao
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Joshua Peter Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
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Cahill LS, Shinar S, Whitehead CL, Hobson SR, Stortz G, Ayyathurai V, Ravi Chandran A, Rahman A, Kingdom JC, Baschat A, Murphy KE, Serghides L, Macgowan CK, Sled JG. Sex differences in modulation of fetoplacental vascular resistance in growth-restricted mouse fetuses following betamethasone administration: comparisons with human fetuses. Am J Obstet Gynecol MFM 2020; 3:100251. [PMID: 33451599 DOI: 10.1016/j.ajogmf.2020.100251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/26/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Maternally administered corticosteroids are routinely used to accelerate fetal lung maturation in pregnancies at risk of early preterm delivery. Although, among the subgroup with growth restriction, a majority show a temporary improvement in umbilical artery Doppler waveforms that may be sustained up to 7 days, a minority will acutely decompensate in response to corticosteroids in association with deteriorating umbilical and fetal Doppler waveforms. The basis for such acute Doppler changes is presently unknown. Our group has developed a noninvasive ultrasound methodology to measure wave reflections in the umbilical artery and have established that wave reflection metrics are sensitive to structural changes in the placental vasculature and to acute changes in vascular tone. Using this approach, we demonstrated in healthy pregnant mice that fetoplacental vascular resistance decreased in betamethasone-treated mice compared with saline-treated controls. OBJECTIVE This study aimed to investigate the effects of betamethasone administration on the wave reflection metrics in a mouse model of fetal growth restriction and to compare these findings with equivalent measurements in human fetuses. STUDY DESIGN Pregnant CD-1 mice were housed from embryonic day 14.5 to embryonic day 17.5 in either a normoxic (21% O2, n=24) or hypoxic environment (11% O2, n=22), the latter being an established mouse model of fetal growth restriction. To investigate the effect of maternally administered betamethasone on the fetoplacental vasculature, ultrasound imaging was performed at baseline and 4 hours after treatment (either betamethasone or sterile saline). Umbilical artery wave reflection metrics were compared between the groups and for the effect of fetal sex. In addition, a cohort of 10 pregnant women with elevated umbilical artery pulsatility index and evidence of fetal growth restriction and 6 controls were imaged before and after corticosteroid administration. RESULTS In the mouse model, after betamethasone administration, the female fetuses from the hypoxia group showed a 15% increase in umbilical artery diameter, a 98% increase in umbilical artery blood flow, and a 27% decrease in umbilical artery reflection coefficient, whereas the males from the hypoxia group showed no substantial changes. In agreement with our mouse findings, umbilical artery reflections were found to be larger in human growth-restricted fetuses than controls in women at risk of preterm birth. CONCLUSION Our studies provide insight into the mechanism whereby the human growth-restricted fetus may exhibit a temporary favorable fetoplacental vascular response to maternally administered corticosteroids. Further investigations are needed to understand why the male growth-restricted fetus seems unable to mount this favorable vascular response.
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Affiliation(s)
- Lindsay S Cahill
- Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Chemistry, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada.
| | - Shiri Shinar
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Clare L Whitehead
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada; Pregnancy Research Centre, Department of Maternal-Fetal Medicine, The Royal Women's Hospital, Parkville, Victoria Australia
| | - Sebastian R Hobson
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Greg Stortz
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Viji Ayyathurai
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anjana Ravi Chandran
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anum Rahman
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - John C Kingdom
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Ahmet Baschat
- The Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, MD
| | - Kellie E Murphy
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Lena Serghides
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christopher K Macgowan
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - John G Sled
- Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
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Blankenship SA, Brown KE, Simon LE, Stout MJ, Tuuli MG. Antenatal corticosteroids in preterm small-for-gestational age infants: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2020; 2:100215. [PMID: 33345924 DOI: 10.1016/j.ajogmf.2020.100215] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to estimate the effect of antenatal corticosteroid administration on neonatal mortality and morbidity in preterm small-for-gestational age infants through a systematic review and meta-analysis. DATA SOURCES A predefined, systematic search was conducted through Ovid MEDLINE, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trial Registry Platform, and ClinicalTrials.gov yielding 5324 articles from 1970 to 2019. STUDY ELIGIBILITY CRITERIA Eligible studies compared neonatal morbidity and mortality among small-for-gestational age infants delivered preterm who received antenatal corticosteroids with those who did not. METHODS The primary outcome was neonatal mortality. Secondary outcomes were respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage and periventricular leukomalacia, bronchopulmonary dysplasia or chronic lung disease of prematurity, or neonatal sepsis. We assessed heterogeneity by means of Higgins I2 statistic and Cochran's Q test and calculated pooled odds ratios with 95% confidence intervals using random effects models. RESULTS A total of 16 observational cohort and case-control studies published from 1995 to 2018 met the selection criteria for the systematic review and included 8989 preterm small-for-gestational age infants. Antenatal corticosteroid administration was explicitly reported among 8376 small-for-gestational age infants; 4631 (55.3%) received antenatal corticosteroids and 3741 (44.7%) did not. Of note, 13 studies including 6387 preterm small-for-gestational age infants were then included in the meta-analysis. Neonatal mortality was significantly lower among infants who received antenatal corticosteroids than those who did not (12 studies: 12.8% vs 15.1%; pooled odds ratio, 0.63; 95% confidence interval, 0.46-0.86), with significant heterogeneity between studies (I2=55.1%; P=.011). There was no significant difference in respiratory distress syndrome (12 studies: odds ratio, 0.89; 95% confidence interval, 0.69-1.15), necrotizing enterocolitis (7 studies: odds ratio, 0.93; 95% confidence interval, 0.70-1.22), intraventricular hemorrhage and periventricular leukomalacia (10 studies: odds ratio, 0.82; 95% confidence interval, 0.56-1.20), bronchopulmonary dysplasia or chronic lung disease of prematurity (8 studies: odds ratio, 1.11; 95% confidence interval, 0.88-1.41), or neonatal sepsis (6 studies: odds ratio, 1.13; 95% confidence interval, 0.86-1.49). CONCLUSION These data indicate that antenatal corticosteroid administration reduces neonatal mortality in small-for-gestational age infants delivered preterm, with no apparent effect on neonatal morbidity. This supports the use of antenatal corticosteroids to reduce neonatal mortality in pregnancies with small-for-gestational age infants at risk of preterm birth.
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Affiliation(s)
- Stephanie A Blankenship
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO.
| | - Kristine E Brown
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Laura E Simon
- Bernard Becker Medical Library, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Molly J Stout
- Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Methodius G Tuuli
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN
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Kim YJ, Choi SH, Oh S, Sohn JA, Jung YH, Shin SH, Choi CW, Kim EK, Kim HS, Kim BI, Lee JA. Antenatal Corticosteroids and Clinical Outcomes of Preterm Singleton Neonates with Intrauterine Growth Restriction. NEONATAL MEDICINE 2018. [DOI: 10.5385/nm.2018.25.4.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Elwany E, Omar S, Ahmed A, Heba G, Atef D. Antenatal dexamethasone effect on Doppler blood flow velocity in women at risk for preterm birth: prospective case series. Afr Health Sci 2018; 18:596-600. [PMID: 30602992 PMCID: PMC6307019 DOI: 10.4314/ahs.v18i3.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Maternal administration of corticosteroids is essential to improve fetal lung surfactant production and hasten the fetal lung maturity in women at risk for preterm birth. Objectives The current study aims to evaluate the effects of dexamethasone on fetal and uteroplacental circulation in pregnancies at risk for preterm birth after 24 hours of its administration. Methods A prospective cross-sectional study was carried out in a tertiary University Hospital and included 52 pregnant women with singleton pregnancies. Doppler studies were performed on maternal uterine arteries, umbilical artery, fetal middle cerebral artery (MCA) and fetal descending aorta and just before dexamethasone administration and repeated 24 hours after completion of the course. Results There was a statistically significant difference between all Doppler indices in the umbilical artery (PI= 1.09±0.4 and 1.05±0.39, RI= 0.66±0.14 and 0.63±0.14; p=0.001), fetal MCA (RI= 0.86±0.12 and 0.83±0.13, PI= 2.19±0.72 and 2.15±0.72; p=0.001) and aorta (RI= 0.9±0.55 and 0.87±0.55; p=0.001, PI= 1.91±0.44 and 1.89±0.44; p=0.040) in comparison before and 24 hours after maternal dexamethasone administration respectively. Also uterine artery PI was significantly different (0.9±0.27 and 0.87±0.26; p=0.001). Conclusion Antenatal dexamethasone for women at risk of preterm birth improves the fetal and uteroplacental blood flow at 24 hours after its administration.
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Affiliation(s)
- Elsnosy Elwany
- Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Shaaban Omar
- Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abbas Ahmed
- Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Gaber Heba
- Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Darwish Atef
- Department of Obstetrics and Gynecology, Woman's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt
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Antenatal glucocorticoids, magnesium sulfate, and mode of birth in preterm fetal small for gestational age. Am J Obstet Gynecol 2018; 218:S818-S828. [PMID: 29422213 DOI: 10.1016/j.ajog.2017.12.227] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/09/2017] [Accepted: 12/21/2017] [Indexed: 11/20/2022]
Abstract
A diagnosis of fetal growth restriction and subsequent preterm birth is associated with increased risks of adverse perinatal and neurodevelopmental outcomes and potentially long-lasting effects to adulthood. Most such cases are associated with placental insufficiency and the fetal response to chronic intrauterine hypoxemia and nutrient deprivation leads to substantial physiological and metabolic adaptations. The management of such pregnancies, especially with respect to perinatal interventions and birth mode, remains an unresolved dilemma. The benefits from standard interventions for threatened preterm birth may not be necessarily translated to pregnancies with small-for-gestational-age fetuses. Clinical trials or retrospective studies on outcomes following administration of antenatal glucocorticoids and magnesium sulfate for neuroprotection when preterm birth is imminent either have yielded conflicting results for small-for-gestational-age fetuses, or did not include this subgroup of patients. Experimental models highlight potential harmful effects of administration of antenatal glucocorticoids and magnesium sulfate in the pregnancies with fetal small for gestational age although clinical data do not substantiate these concerns. In addition, heterogeneity in definitions of fetal small for gestational age, variations in the inclusion criteria, and the glucocorticoid regime contribute to inconsistent results. In this review, we discuss the physiologic adaptions of the small-for-gestational-age fetus to its abnormal in utero environment in relation to antenatal glucocorticoids; the impact of antenatal glucocorticoids and intrapartum magnesium sulfate in pregnancies with fetal small for gestational age; the current literature on birth mode for pregnancies with fetal small for gestational age; and the knowledge gaps in the existing literature.
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Magann EF, Haram K, Ounpraseuth S, Mortensen JH, Spencer HJ, Morrison JC. Use of antenatal corticosteroids in special circumstances: a comprehensive review. Acta Obstet Gynecol Scand 2017; 96:395-409. [DOI: 10.1111/aogs.13104] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 01/20/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Everett F. Magann
- Department of Obstetrics and Gynecology; Department of Biostatistics; University of Arkansas for the Medical Sciences; Little Rock AR USA
| | - Kjell Haram
- Haukeland University Hospital; Department of Public and Primary Care; University of Bergen; Bergen Norway
| | - Songthip Ounpraseuth
- Department of Obstetrics and Gynecology; Department of Biostatistics; University of Arkansas for the Medical Sciences; Little Rock AR USA
| | - Jan H. Mortensen
- Haukeland University Hospital; Department of Public and Primary Care; University of Bergen; Bergen Norway
| | - Horace J. Spencer
- Haukeland University Hospital; Department of Public and Primary Care; University of Bergen; Bergen Norway
| | - John C. Morrison
- Department of Obstetrics and Gynecology; University of Mississippi Medical Center; Jackson MS USA
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Elsnosy E, Shaaban OM, Abbas AM, Gaber HH, Darwish A. Effects of antenatal dexamethasone administration on fetal and uteroplacental Doppler waveforms in women at risk for spontaneous preterm birth. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2017. [DOI: 10.1016/j.mefs.2016.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Riskin-Mashiah S, Reichman B, Bader D, Kugelman A, Boyko V, Lerner-Geva L, Riskin A. Population-based study on antenatal corticosteroid treatment in preterm small for gestational age and non-small for gestational age twin infants. J Matern Fetal Neonatal Med 2017; 31:553-559. [DOI: 10.1080/14767058.2017.1292242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Shlomit Riskin-Mashiah
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Brian Reichman
- Gertner Institute, Women and Children's Health Research Unit, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Bader
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel
| | - Amir Kugelman
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel
| | - Valentina Boyko
- Gertner Institute, Women and Children's Health Research Unit, Tel Hashomer, Israel
| | - Liat Lerner-Geva
- Gertner Institute, Women and Children's Health Research Unit, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arieh Riskin
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel
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Effect of perinatal glucocorticoids on vascular health and disease. Pediatr Res 2017; 81:4-10. [PMID: 27656772 DOI: 10.1038/pr.2016.188] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/26/2016] [Indexed: 11/09/2022]
Abstract
The benefits of antenatal glucocorticoids are now firmly established in the perinatal management of threatened preterm birth. Postnatal glucocorticoid therapy, however, remains controversial in neonatal medicine, with the need to balance short-term physiological benefits against the potential for long-term adverse consequences. This review focuses on the vascular effects of prenatal and postnatal glucocorticoids, synthesizing data from both experimental animal models and human infants with the goal of better appreciation of the short and long-term effects of these commonly used drugs. Due to their widespread and varied use, improved understanding of the cellular and molecular impact of glucocorticoids is important in guiding current practice and future research.
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Melamed N, Shah J, Yoon EW, Pelausa E, Lee SK, Shah PS, Murphy KE, Shah PS, Harrison A, Synnes A, Ting J, Cieslak Z, Sherlock R, Yee W, Aziz K, Toye J, Fajardo C, Kalapesi Z, Sankaran K, Daspal S, Seshia M, Alvaro R, Shivananda S, Da Silva O, Nwaesei C, Lee KS, Dunn M, Lemyre B, Dow K, Pelausa E, Barrington K, Drolet C, Piedboeuf B, Claveau M, Faucher D, Bertelle V, Masse E, Canning R, Makary H, Ojah C, Monterrosa L, Deshpandey A, Afifi J, Kajetanowicz A, Lee SK. The role of antenatal corticosteroids in twin pregnancies complicated by preterm birth. Am J Obstet Gynecol 2016; 215:482.e1-9. [PMID: 27260974 DOI: 10.1016/j.ajog.2016.05.037] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/18/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Data regarding the effects of antenatal corticosteroids in twin pregnancies are limited because of the insufficient number of women with twins enrolled in randomized controlled trials on antenatal corticosteroids. Furthermore, the interpretation of available data is limited by the fact that the interval from the administration of antenatal corticosteroids to delivery is greater than 7 days in a large proportion of twins, a factor that has been shown to affect the efficacy of antenatal corticosteroids and has not been controlled for in previous studies. OBJECTIVE The objective of the study was to compare neonatal mortality and morbidity in preterm twins receiving a complete course of antenatal corticosteroids 1-7 days before birth to those who did not receive antenatal corticosteroids and to compare these outcome effects with those observed in singletons. STUDY DESIGN We performed a retrospective cohort study using data collected on singleton and twin neonates born between 24(0/7) and 33(6/7) weeks' gestational age and were admitted to tertiary neonatal units in Canada between 2010 and 2014. A comparison of neonatal outcomes between twin neonates who received a complete course of antenatal corticosteroids 1-7 days before birth (n = 1758) and those who did not receive antenatal corticosteroids (n = 758) and between singleton neonates who received a complete course of antenatal corticosteroids 1-7 days before birth (n = 4638) and those did not receive antenatal corticosteroids (n = 2312) was conducted after adjusting for gestational age, sex, hypertension, outborn status, small for gestational age, parity, and cesarean birth. Adjusted odds ratios and 95% confidence intervals for various neonatal outcomes were calculated. RESULTS Administration of a complete course of antenatal corticosteroids within 1-7 days before birth in both twins and singletons was associated with similar reduced odds of neonatal death (for twins adjusted odds ratio 0.42 [95% confidence interval, 0.24-0.76] and for singletons adjusted odds ratios, 0.38 [95% confidence interval, 0.28-0.50]; P = .7 for comparison of twins vs singletons), mechanical ventilation (for twins adjusted odds ratio, 0.47 [95% confidence interval, 0.35-0.63] and for singletons adjusted odds ratio, 0.47 [95% confidence interval, 0.41-0.55]; P = .9), respiratory distress syndrome (for twins adjusted odds ratio, 0.53 [95% confidence interval, 0.40-0.69], and for singletons adjusted odds ratio, 0.54 [95% confidence interval, 0.47-0.62]; P = .9) and severe neurological injury (for twins adjusted odds ratio, 0.50 [95% confidence interval, 0.30-0.83] and for singletons adjusted odds ratio, 0.45 [95% confidence interval, 0.34-0.59]; P = .7). Administration of a complete course of antenatal corticosteroids was not associated with a reduced odds of bronchopulmonary dysplasia, severe retinopathy of prematurity, or necrotizing enterocolitis in both twins and singletons. CONCLUSION Administration of a complete course of antenatal corticosteroids 1-7 days before birth in twin pregnancies is associated with a clinically significant decrease in neonatal mortality, short-term respiratory morbidity, and severe neurological injury that is similar in magnitude to that observed among singletons.
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McGillick EV, Orgeig S, Williams MT, Morrison JL. Risk of Respiratory Distress Syndrome and Efficacy of Glucocorticoids. Reprod Sci 2016; 23:1459-1472. [DOI: 10.1177/1933719116660842] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Erin V. McGillick
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
- Molecular and Evolutionary Physiology of the Lung Laboratory, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Sandra Orgeig
- Molecular and Evolutionary Physiology of the Lung Laboratory, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Marie T. Williams
- Health and Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Janna L. Morrison
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
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Pedersen LH, Mogra R, Hyett J. Effect of corticosteroids on cardiac function in growth-restricted fetuses. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:204-209. [PMID: 26358625 DOI: 10.1002/uog.15743] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 09/01/2015] [Accepted: 09/04/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To determine the acute effects of corticosteroids on the cardiovascular system in growth-restricted fetuses. METHODS This was a prospective cohort study conducted at a tertiary hospital between January 2011 and October 2013. Fetal cardiovascular function in fetuses with intrauterine growth restriction (IUGR) was assessed immediately before and 24 h after the first dose of betamethasone, administered in routine management of IUGR. Fetal arterial and venous Dopplers were assessed. Fetal cardiac function was evaluated by tissue Doppler echocardiography, with the assessment of both left and right ventricular function by calculating myocardial performance index (MPI') and E':A' ratios. Values were compared before and after exposure. RESULTS Seventeen patients were included at a mean gestational age of 34 + 1 (range, 29 + 1 to 37 + 4) weeks. Fifteen fetuses were below the 5(th) percentile and two were below the 10(th) percentile for estimated fetal weight and abdominal circumference and all had no interval growth during a 2-week period. There was a decrease in right MPI' (from 0.56 to 0.47; P = 0.007) after corticosteroid exposure but no change in left MPI' (from 0.49 to 0.48). Right MPI' was higher than left MPI' before exposure (0.56 vs 0.49, respectively; P = 0.001), but not after exposure (P = 0.55). There was no change in left or right ventricular E':A' ratios and no difference was detected in umbilical artery, middle cerebral artery or ductus venosus pulsatility index following administration of corticosteroids. CONCLUSIONS Corticosteroids altered right-sided, but not left-sided, tissue Doppler MPI' in IUGR fetuses, with no detectable change in arterial or venous Doppler pulsatility indices. Before exposure, the mean right MPI' was higher than the left. However, after exposure, there was no difference, suggesting that corticosteroids may reverse the negative effect of IUGR on fetal heart function. Large prospective studies with a larger sample size are needed to confirm this finding. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- L H Pedersen
- Department of High Risk Obstetrics, RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, Australia
- Department of Clinical Medicine, Obstetrics and Gynecology, Aarhus University, Aarhus, Denmark
| | - R Mogra
- Department of High Risk Obstetrics, RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, Australia
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - J Hyett
- Department of High Risk Obstetrics, RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, Australia
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, Australia
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Amiya RM, Mlunde LB, Ota E, Swa T, Oladapo OT, Mori R. Antenatal Corticosteroids for Reducing Adverse Maternal and Child Outcomes in Special Populations of Women at Risk of Imminent Preterm Birth: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0147604. [PMID: 26841022 PMCID: PMC4740425 DOI: 10.1371/journal.pone.0147604] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 01/06/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND This study synthesizes available evidence on antenatal corticosteroids (ACS) use among special subgroups of women at risk of imminent preterm birth, including those (1) with pregestational and gestational diabetes mellitus, (2) undergoing elective caesarean section (CS) in late preterm (34 to<37 weeks), (3) with chorioamnionitis, and (4) with growth-restricted fetuses. METHODS A systematic search of MEDLINE, EMBASE, CINAHL, Cochrane Library, POPLINE, and World Health Organization Regional Databases was conducted for all comparative studies. Two reviewers independently determined study eligibility, extracted data, and assessed study quality. Pooled mean differences and odds ratios with 95% confidence intervals were estimated from available data, based on fixed- and random-effects models, as appropriate. RESULTS No eligible studies were identified for ACS use in diabetic pregnant women or those undergoing elective CS at late preterm. Nine studies each on ACS use in women with chorioamnionitis and in women with fetal growth restriction met inclusion criteria; eight studies were separately included in the meta-analyses for the two subpopulations. For ACS administration in women with chorioamnionitis, pooled analyses showed reductions in neonatal mortality (OR: 0.49, 95% CI: 0.34-0.73), respiratory distress syndrome (OR: 0.58, 95% CI: 0.44-0.76), intraventricular haemorrhage (OR: 0.41, 95% CI: 0.24-0.69), and severe intraventricular haemorrhage (OR: 0.40, 95% CI: 0.24-0.69). Maternal and long-term newborn outcomes were not reported. Effects of ACS use were inconclusive for cases with fetal growth restriction. CONCLUSION Direct evidence on the effectiveness and safety of ACS is lacking for diabetic pregnant women at risk of preterm birth and those undergoing elective late-preterm CS, though this does not necessarily recommend against their use in diabetic women. While evidence remains inconclusive for women with growth-restricted preterm neonates, ACS appears to benefit preterm neonates delivered by women with chorioamnionitis. High-quality studies on maternal and long-term child outcomes in more diverse settings are needed to establish the balance of potential harms versus benefits in using ACS for these understudied subgroups.
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Affiliation(s)
- Rachel M. Amiya
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
- Department of Family Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Linda B. Mlunde
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Erika Ota
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
- * E-mail:
| | - Toshiyuki Swa
- Graduate School of Human Sciences, Osaka University, Suita, Japan
| | - Olufemi T. Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
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Riskin-Mashiah S, Riskin A, Bader D, Kugelman A, Boyko V, Lerner-Geva L, Reichman B. Antenatal corticosteroid treatment in singleton, small-for-gestational-age infants born at 24-31 weeks’ gestation: a population-based study. BJOG 2015; 123:1779-86. [DOI: 10.1111/1471-0528.13723] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2015] [Indexed: 12/27/2022]
Affiliation(s)
- S Riskin-Mashiah
- Department of Obstetrics and Gynaecology; Lady Davis Carmel Medical Center; Haifa Israel
- Ruth and Bruce Rappaport Faculty of Medicine; Technion-Israel Institute of Technology; Haifa Israel
| | - A Riskin
- Ruth and Bruce Rappaport Faculty of Medicine; Technion-Israel Institute of Technology; Haifa Israel
- Department of Neonatology; Bnai Zion Medical Centre; Haifa Israel
| | - D Bader
- Ruth and Bruce Rappaport Faculty of Medicine; Technion-Israel Institute of Technology; Haifa Israel
- Department of Neonatology; Bnai Zion Medical Centre; Haifa Israel
| | - A Kugelman
- Ruth and Bruce Rappaport Faculty of Medicine; Technion-Israel Institute of Technology; Haifa Israel
- Department of Neonatology; Bnai Zion Medical Centre; Haifa Israel
| | - V Boyko
- Women and Children's Health Research Unit; Gertner Institute; Tel Hashomer Israel
| | - L Lerner-Geva
- Women and Children's Health Research Unit; Gertner Institute; Tel Hashomer Israel
- Sackler Faculty of Medicine Tel Aviv University; Tel Aviv Israel
| | - B Reichman
- Women and Children's Health Research Unit; Gertner Institute; Tel Hashomer Israel
- Sackler Faculty of Medicine Tel Aviv University; Tel Aviv Israel
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Niroomanesh S, Shojaei K, Moghadam SF, Mohammadi N, Rahimi Z, RezaeiKeyhanaei K. Effect of prenatal betamethasone on fetal, uteroplacental, and maternal blood flow velocity in pregnancies complicated by fetal growth restriction. Int J Gynaecol Obstet 2015; 130:270-3. [PMID: 26184101 DOI: 10.1016/j.ijgo.2015.04.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 04/06/2015] [Accepted: 06/19/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess Doppler flow velocity in fetal, uteroplacental, and maternal arteries before and after betamethasone therapy among singleton pregnancies complicated by fetal growth restriction (FGR). METHODS A prospective, longitudinal, multicenter study was conducted at three university-affiliated hospitals in Tehran, Iran, between January 1 and November 30, 2013. The inclusion criteria were FGR, a gestational age of 24-34 weeks, no fetal anomalies, and no previous betamethasone therapy. Doppler blood flow was measured in uterine, umbilical, and middle cerebral arteries before treatment, and 24 hours and 5 days after completion of betamethasone therapy (two 12-mg doses at a 24-hour interval). RESULTS Overall, 40 women were enrolled. Doppler blood flow through the uterine and umbilical arteries showed significant but transient changes across the three timepoints (P<0.001), whereas the middle cerebral artery showed no changes. CONCLUSION Prenatal betamethasone led to transient improvements in blood flow in the uterine and umbilical arteries among pregnancies affected by FGR.
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Affiliation(s)
- Shirin Niroomanesh
- Department of Obstetrics and Gynecology, Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kobra Shojaei
- Department of Obstetrics and Gynecology, Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sahar F Moghadam
- Department of Obstetrics and Gynecology, Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Noshin Mohammadi
- Department of Obstetrics and Gynecology, Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Rahimi
- Department of Obstetrics and Gynecology, Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Khadija RezaeiKeyhanaei
- Department of Obstetrics and Gynecology, Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Neonatal Morbidity in Growth-Discordant Monochorionic Twins: Comparison Between the Larger and the Smaller Twin. Twin Res Hum Genet 2012; 15:541-6. [DOI: 10.1017/thg.2012.26] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Fetal growth restriction in singletons has been shown to enhance fetal lung maturation and reduce the risk of respiratory distress syndrome due to increased endogenous steroid production. However, data on lung maturation in growth-discordant monochorionic (thus, identical) twins are lacking. Our objective was to compare the risk of severe neonatal morbidity between the larger and the smaller twin in monochorionic twins with birth weight discordance (BWD). We included in the study all consecutive monochorionic diamniotic pregnancies with severe BWD (≥25%) and two live-born twins delivered at our center (n = 47 twin pairs). We compared the incidence of neonatal morbidity, particularly respiratory distress syndrome (RDS), and cerebral lesions between the larger and the smaller co-twin. The incidence of severe neonatal morbidity in the larger and smaller twin was 38% (18/47) and 19% (9/47), respectively (odds ratio (OR) 2.66, 95% confidence interval (CI) 0.94–7.44) and was due primarily to the higher incidence of RDS, 32% (15/47) and 6% (3/47), respectively (OR 6.88, 95% CI 1.66–32.83). In conclusion, this study shows that the larger twin in monochorionic twin pairs with BWD is at increased risk of severe neonatal morbidity, particularly RDS, compared to the smaller twin.
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Vidaeff AC, Blackwell SC. Potential risks and benefits of antenatal corticosteroid therapy prior to preterm birth in pregnancies complicated by severe fetal growth restriction. Obstet Gynecol Clin North Am 2011; 38:205-14, ix. [PMID: 21575796 DOI: 10.1016/j.ogc.2011.02.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The antepartum administration of fluorinated corticosteroids for fetal maturation represents the most important clinical contribution in the battle against prematurity. This treatment reduces the risk of neonatal death and handicap. It is also known that on corticosteroid exposure, fetuses are subjected to transiently increased physiologic and metabolic demands. Healthy fetuses are able to cope, although emerging evidence suggests this may not be the case with severely growth-restricted fetuses. This review presents evidence of efficacy and safety pertaining to corticosteroid administration in fetal growth restriction–affected pregnancies, offers guidance to clinicians, and points out questions that still need answers.
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Affiliation(s)
- Alex C Vidaeff
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Medical School at Houston, Houston, TX 77030, USA.
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Ganzevoort W, Sibai BM. Temporising versus interventionist management (preterm and at term). Best Pract Res Clin Obstet Gynaecol 2011; 25:463-76. [DOI: 10.1016/j.bpobgyn.2011.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 01/13/2011] [Indexed: 10/18/2022]
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Thuring A, Malcus P, Maršál K. Effect of maternal betamethasone on fetal and uteroplacental blood flow velocity waveforms. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:668-672. [PMID: 21618314 DOI: 10.1002/uog.8879] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To investigate the effects of antenatal betamethasone on fetal and uteroplacental hemodynamics. METHODS The study comprised 33 women with singleton high-risk pregnancies (23-33 weeks; 27 pregnancies < 30 weeks) not in labor, but at risk for preterm delivery based on fetal or maternal indications. They were treated with two doses of 12 mg betamethasone intramuscularly 24 h apart to enhance fetal lung maturity. Flow velocity waveforms were recorded with Doppler ultrasound from the umbilical artery, the fetal middle cerebral artery, the ductus venosus and both maternal uterine arteries, once before and twice after betamethasone administration. RESULTS Twenty-one (64%) women delivered within 4 days, nine (27%) women within 5-7 days and three (9%) within 8-15 days after the first dose of betamethasone. Two days after betamethasone, a decrease in pulsatility index was found in the umbilical artery (P = 0.0002) and ductus venosus (P = 0.003). Changes in the umbilical artery waveform from reversed to absent, and from absent to positive diastolic flow, were noted in 12 of 15 cases (P < 0.01). After 4 days, umbilical artery and ductus venosus velocity waveforms in the undelivered fetuses either returned to the type of waveform observed before treatment or showed further deterioration. No significant effects of betamethasone were observed in the fetal middle cerebral artery and uteroplacental circulation. CONCLUSIONS Maternal antenatal betamethasone resulted in a significant transient change in the velocity waveform and a decrease in the pulsatility index in the umbilical artery and ductus venosus, but did not influence uteroplacental circulation. These findings indicate a direct effect of betamethasone on fetal circulation.
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Affiliation(s)
- A Thuring
- Department of Obstetrics and Gynecology, Clinical Sciences Lund, Lund University, Lund, Sweden.
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van den Broek AJM, Kok JH, Houtzager BA, Scherjon SA. Behavioural problems at the age of eleven years in preterm-born children with or without fetal brain sparing: a prospective cohort study. Early Hum Dev 2010; 86:379-84. [PMID: 20554130 DOI: 10.1016/j.earlhumdev.2010.04.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 04/29/2010] [Accepted: 04/29/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND In severe intrauterine growth restriction (IUGR) due to placental insufficiency a haemodynamic adaptation occurs, resulting in preferential blood flow to the fetal brain (brain sparing). With Doppler ultrasound an increased ratio between the umbilical and the cerebral artery pulsatility index (U/C ratio) can be demonstrated. IUGR is associated with impaired neurodevelopmental outcome. OBJECTIVE Evaluation of the effect of fetal brain sparing on behavioural problems at eleven years in premature born children. METHODS Prospective cohort study in premature children born in 1989, with a gestational age of 26 0/7 to 33 0/7 weeks. An U/C ratio>0.72 was defined as brain sparing. Behavioural problems were assessed with the parent-reported Child Behaviour Check List (CBCL) and the Teacher's Report Form (TRF). T scores >60 for total problem score and subscales of internalizing and externalizing behaviour, were considered abnormal. RESULTS Ninety-eight of the 116 survivors were assessed, of which 31 with antenatally established fetal brain sparing. According to the CBCL-total problem score 23.3% of the premature born babies in the brain sparing group had behavioural problems compared with 22.8% of those without brain sparing. According to the TRF-total problem score the percentages were 21.4% and 20.0%, respectively. Logistic regression analysis failed to show a significant association of U/C ratio with behavioural problems. In this model oxygen dependency at 28 days, IQ<85 at five years, cranial ultrasound abnormalities, fetal growth ratio<0.80, Apgar scores<7 after 5 min and birth weight<p10 contributed significantly. CONCLUSION In this cohort brain sparing itself has no significant association with behavioural problems at eleven years.
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Verhaeghe J, van Bree R, Van Herck E. Oxidative stress after antenatal betamethasone: acute downregulation of glutathione peroxidase-3. Early Hum Dev 2009; 85:767-71. [PMID: 19926412 DOI: 10.1016/j.earlhumdev.2009.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 10/13/2009] [Accepted: 10/30/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Human and experimental data show that antenatal exposure to glucocorticoids (GC) temporarily reduces fetal well-being and impairs the fetal response to hypoxemia. AIMS We tested the hypothesis that antenatal betamethasone provokes transient oxidative stress, which may be triggered directly by the GC or indirectly by metabolic signals such as increased glucose and free fatty acid (FFA) concentrations. STUDY DESIGN Prospective (single center, 18 months) cohort study in newborns <34 weeks gestational age at birth. METHODS We studied 105 newborns and measured oxidative damage to lipids [malondialdehyde (MDA)] and proteins (protein carbonyls), as well as glutathione peroxidase-3 (GPx3), an important antioxidant enzyme, in umbilical vein (UV) plasma. In addition, we measured umbilical artery and UV blood gases, and metabolic indices (plasma glucose, FFA and insulin) in UV. RESULTS MDA but not protein carbonyl concentrations was inversely related to time elapsed since the first or last betamethasone administration (p=0.006); MDA remained elevated by 69-96% for at least 72 h after the last betamethasone. By contrast, GPx3 concentrations were repressed in newborns who received betamethasone < or =24h before birth. GPx3 and MDA concentrations were correlated (r=-0.38, p<0.001). Labor, GA, sex, size at birth, blood gases or metabolic indices did not explain the effects of betamethasone on MDA and GPx3. CONCLUSIONS Antenatal GC elicit a rapid suppression of the GPx3 antioxidant defense system which may contribute to a longer-lasting but also transient rise in lipid oxidative damage.
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Affiliation(s)
- Johan Verhaeghe
- Department of Obstetrics and Gynecology, Health Campus Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
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