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Sgayer I, Hassan S, Sarhan T, Ashkar N, Lowenstein L, Wolf MF. Antenatal corticosteroids for late small-for-gestational-age fetuses. J Perinat Med 2025; 53:88-93. [PMID: 39405107 DOI: 10.1515/jpm-2024-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 09/21/2024] [Indexed: 02/09/2025]
Abstract
OBJECTIVES To compare neonatal morbidity in late preterm pregnancies with small-for-gestational-age fetuses, between those exposed and not exposed to antenatal corticosteroids (ACS). METHODS A retrospective study which included growth-restricted fetuses delivered at gestational week 34+0 to 36+6 weeks at a tertiary university-affiliated hospital, from March 2016 to March 2022. The primary composite outcome included the need for oxygen therapy or ventilation, respiratory distress syndrome, transient tachypnea of the newborn, bronchopulmonary dysplasia, necrotizing enterocolitis, intraventricular hemorrhage grade III/IV and neonatal mortality. RESULTS The primary composite outcome was comparable between those who did and did not receive ACS (26.1 vs. 20.8 %, p=0.512). Neonatal morbidity rates did not differ significantly between the groups, except for hypoglycemia, which was more common among neonates from ACS-exposed mothers (37.0 vs. 19.5 %, p=0.037). Multivariate analysis, adjusted for gestational diabetes and the mode of delivery showed no significant difference in the composite outcome between the groups (OR=2.03, 95 % CI 0.79-5.20, p=0.142). Cesarean delivery was associated with a higher risk of the primary outcome (OR=2.13, 95 % CI 1.17-3.85, p=0.013). After excluding those who did not receive the initial betamethasone dose within 2-7 days before delivery, the primary composite outcome remained similar between the groups. The primary composite outcome was similar among severely growth-restricted fetuses (<5th percentile) exposed and not exposed to ACS (29.2 vs. 22.0 %, p=0.560). CONCLUSIONS Among preterm pregnancies complicated by small-for-gestational-age fetuses, ACS did not lower the rate of neonatal morbidity.
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Affiliation(s)
- Inshirah Sgayer
- Department of Obstetrics and Gynecology, 61255 Galilee Medical Center , Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Sondos Hassan
- Department of Obstetrics and Gynecology, 61255 Galilee Medical Center , Nahariya, Israel
| | - Talal Sarhan
- Department of Obstetrics and Gynecology, 61255 Galilee Medical Center , Nahariya, Israel
| | - Nadine Ashkar
- Department of Obstetrics and Gynecology, 61255 Galilee Medical Center , Nahariya, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, 61255 Galilee Medical Center , Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Maya Frank Wolf
- Department of Obstetrics and Gynecology, 61255 Galilee Medical Center , Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Vidaeff AC, Asztalos E. Late Preterm Corticosteroids Exposure and Neurodevelopmental Outcomes. JAMA 2024; 331:1626-1627. [PMID: 38656755 DOI: 10.1001/jama.2024.2228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Alex C Vidaeff
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
- Texas Children's Hospital, Houston
| | - Elizabeth Asztalos
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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Cojocaru L, Chakravarthy S, Tadbiri H, Reddy R, Ducey J, Fruhman G. Use, misuse, and overuse of antenatal corticosteroids. A retrospective cohort study. J Perinat Med 2023; 51:1046-1051. [PMID: 37216498 DOI: 10.1515/jpm-2023-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To evaluate the timing of antenatal corticosteroids (ACS) administration in relation to the delivery timing based on indications and risk factors for preterm delivery. METHODS We conducted a retrospective cohort study to understand what factors predict the optimal timing of ACS administration (ACS administration within seven days). We reviewed consecutive charts of adult pregnant women receiving ACS from January 1, 2011, to December 31, 2019. We excluded pregnancies under 23 weeks, incomplete and duplicate records, and patients delivered outside our health system. The timing of ACS administration was categorized as optimal or suboptimal. These groups were analyzed regarding demographics, indications for ACS administration, risk factors for preterm delivery, and signs and symptoms of preterm labor. RESULTS We identified 25,776 deliveries. ACS were administered to 531 pregnancies, of which 478 met the inclusion criteria. Of the 478 pregnancies included in the study, 266 (55.6 %) were delivered in the optimal timeframe. There was a higher proportion of patients receiving ACS for the indication of threatened preterm labor in the suboptimal group as compared to the optimal group (85.4 % vs. 63.5 %, p<0.001). In addition, patients who delivered in the suboptimal timeframe had a higher proportion of short cervix (33 % vs. 6.4 %, p<0.001) and positive fetal fibronectin (19.8 % vs. 1.1 %, p<0.001) compared to those who delivered in the optimal timeframe. CONCLUSIONS More emphasis should be placed on the judicious use of ACS. Emphasis should be placed on clinical assessment rather than relying solely on imaging and laboratory tests. Re-appraisal of institutional practices and thoughtful ACS administration based on the risk-benefit ratio is warranted.
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Affiliation(s)
- Liviu Cojocaru
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - Shruti Chakravarthy
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - Hooman Tadbiri
- Department of Obstetrics, Gynecology, and Reproductive Science, Division of Maternal-Fetal Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rishika Reddy
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - James Ducey
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
| | - Gary Fruhman
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, New York, NY, USA
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Familiari A, Napolitano R, Visser GHA, Lees C, Wolf H, Prefumo F, the TRUFFLE‐2 feasibility study investigators ArabinB.BergerA.BergmanE.BhideA.BilardoC. M.BreezeA. C.BrodszkiJ.CaldaP.CesariE.CetinI.DerksJ. B.EbbingC.FerrazziE.FruscaT.GanzevoortW.GordijnS. J.GyselaersW.HecherK.KlaritschP.KroftaL.LindgrenP.LobmaierS. M.MarlowN.MaruottiG. M.MecacciF.MyklestadK.Mylrea‐FoleyB.RaioL.RichterJ.SandeR. K.StampalijaT.ThorntonJ.ValensiseH.WeeL.. Antenatal corticosteroids and perinatal outcome in late fetal growth restriction: analysis of prospective cohort. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:191-197. [PMID: 36412975 PMCID: PMC10108243 DOI: 10.1002/uog.26127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the role of antenatal administration of corticosteroids for fetal lung maturation on the short-term perinatal outcome of pregnancy complicated by late fetal growth restriction (FGR). METHODS This cohort study was a secondary analysis of a multicenter prospective observational study, the TRUFFLE-2 feasibility study, conducted between 2017 and 2018 in 33 European perinatal centers. The study included women with a singleton pregnancy from 32 + 0 to 36 + 6 weeks of gestation with a fetus considered at risk for FGR, defined as estimated fetal weight (EFW) and/or fetal abdominal circumference < 10th percentile, or umbilicocerebral ratio (UCR) ≥ 95th percentile or a drop of more than 40 percentile points in abdominal circumference measurement from the 20-week scan. For the purposes of the current study, we identified women who received a single course of steroids to improve fetal lung maturation before delivery. Each exposed pregnancy was matched with one that did not receive antenatal corticosteroids (ACS) (control), based on gestational age at delivery and birth weight. The primary adverse outcome was a composite of abnormal condition at birth, major neonatal morbidity or perinatal death. RESULTS A total of 86 pregnancies that received ACS were matched to 86 controls. The two groups were similar with respect to gestational age (33.1 vs 33.3 weeks), EFW (1673 vs 1634 g) and UCR (0.68 vs 0.62) at inclusion, and gestational age at delivery (35.5 vs 35.9 weeks) and birth weight (1925 vs 1948 g). No significant differences were observed between the exposed and non-exposed groups in the incidence of composite adverse outcome (28% vs 24%; P = 0.73) or any of its elements. CONCLUSION The present data do not show a beneficial effect of steroids on short-term outcome of fetuses with late FGR. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A. Familiari
- Department of Woman and Child Health and Public HealthFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - R. Napolitano
- Elizabeth Garrett Anderson Institute for Women's HealthUniversity College LondonLondonUK
- Fetal Medicine UnitUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - G. H. A. Visser
- Department of ObstetricsUniversity Medical CenterUtrechtThe Netherlands
| | - C. Lees
- Centre for Fetal Care, Department of Obstetrics and GynaecologyQueen Charlotte's and Chelsea Hospital, Imperial College LondonLondonUK
| | - H. Wolf
- Department of Obstetrics and GynecologyAmsterdam University Medical Center (Location AMC), University of AmsterdamAmsterdamThe Netherlands
| | - F. Prefumo
- Obstetrics and Gynecology UnitIRCCS Istituto Giannina GasliniGenoaItaly
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Lin YH, Lin CH, Lin MC, Hsu YC, Hsu CT. Antenatal Corticosteroid Exposure is Associated with Childhood Mental Disorders in Late Preterm and Term Infants. J Pediatr 2023; 253:245-251.e2. [PMID: 36202238 DOI: 10.1016/j.jpeds.2022.09.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/24/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To study the association between antenatal corticosteroids treatment and childhood mental disorders in infants born at different gestational ages, and to investigate the effect of different administration timing. STUDY DESIGN This population-based cohort study used data from the Taiwan National Health Insurance Research Database. All singleton live births born between 2004 and 2010 were enrolled and followed up for at least 6 years. The primary outcome was any childhood mental disorder. Secondary outcomes included 7 specific subgroups of mental disorders. RESULTS A total of 1 163 443 singleton infants were included in the analysis, and 16 847 (1.45%) infants were exposed to antenatal corticosteroid treatment. Children exposed to antenatal corticosteroids were found to have a higher risk of developing childhood mental disorders in the entire cohort (hazard ratio [HR], 1.13; 95% CI, 1.08-1.18), the term group (HR, 1.11; 95% CI, 1.05-1.16), and the late-preterm group (HR, 1.15; 95% CI, 1.06-1.25). The administration of corticosteroids in the early stage of pregnancy (<28 weeks of gestation) significantly increased the risk of childhood mental disorders (HR, 1.22; 95% CI, 1.14-1.31). CONCLUSIONS Exposure to antenatal corticosteroid treatment increases the cumulative risk of childhood mental disorders and attention deficit hyperactivity disorders, both in term and late preterm infants. The administration of corticosteroids in the early stage of pregnancy tends to increase the risk of mental disorders.
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Affiliation(s)
- Yi-Hsuan Lin
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Chih Lin
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Food and Nutrition, Providence University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
| | - Ya-Chi Hsu
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Ting Hsu
- Children's Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
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De Nardo MC, Petrella C, Di Chiara M, Di Mario C, Deli G, Travaglia E, Baldini L, Russo A, Parisi P, Fiore M, Terrin G. Early nutritional intake influences the serum levels of nerve growth factor (NGF) and brain-derived neurotrophic factor in preterm newborns. Front Neurol 2022; 13:988101. [PMID: 36324384 PMCID: PMC9620475 DOI: 10.3389/fneur.2022.988101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/16/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Parenteral nutrition (PN) may have detrimental effects on neurodevelopment in preterm newborns. Moreover, enteral nutrition (EN) seems to be protective. To understand the mechanisms of how neurological development can be influenced by the route of administration of nutritional intake, we investigated the relationship between the serum levels of the nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) and nutritional intake received in early life by preterm newborns. Materials and methods Specimens of blood were obtained at 28 days of life (DOL) for NGF/BDNF determination in neonates <32 weeks of gestation and/or with birth weight <1,500 g, consecutively observed in the neonatal intensive care unit. We analyzed the relation between amino acid content and energy intake and NGF/BDNF measurements at 28 DOL. PN protein intake was referred to as the total amounts of amino acid intake received daily. Results We enrolled 20 newborns (gestational age 30.45 ± 1.76 weeks, birth weight 1,340 ± 352.63 g). Serum NGF value at 28 DOL was positively correlated with enteral protein and energy intake (r = 0.767; r = 0.746, p < 0.001), whereas, negatively correlated with parenteral amino acid and energy intake (r = −0.652, p < 0.001; r = −0.466, p < 0.05). Similar significant correlations were described between BDNF level at 28 DOL and enteral energy intake (r = 0.493, p < 0.05). Multivariate regression analysis showed that NGF level at 28 DOL depends on enteral protein and energy intake administrated in the 1st week of life. Conclusion Neurotrophin values varied according to the route of nutrition administration in preterm newborns. NGF/BDNF serum levels are influenced positively and negatively by EN and PN, respectively.
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Affiliation(s)
- Maria Chiara De Nardo
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Carla Petrella
- Institute of Biochemistry and Cell Biology (IBB) of the National Research Council (CNR), Rome, Italy
| | - Maria Di Chiara
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Chiara Di Mario
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Giorgia Deli
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Elisa Travaglia
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Laura Baldini
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Alessia Russo
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Pasquale Parisi
- Department of Pediatrics, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, c/o Sant'Andrea Hospital, Sapienza University, Rome, Italy
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine and Psychology, c/o Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Marco Fiore
- Institute of Biochemistry and Cell Biology (IBB) of the National Research Council (CNR), Rome, Italy
| | - Gianluca Terrin
- Department of Maternal and Child Health Policlinico Umberto I, Sapienza University, Rome, Italy
- *Correspondence: Gianluca Terrin
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Ozgur Gursoy O, Gurer HG, Yildiz Eren C, Erdogan Ozgur P, Gursoy H. The association of various obstetric and perinatal factors with retinopathy of prematurity. Int Ophthalmol 2022; 42:2719-2728. [DOI: 10.1007/s10792-022-02260-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 03/12/2022] [Indexed: 10/18/2022]
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8
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Krey FC, Stocchero BA, Creutzberg KC, Heberle BA, Tractenberg SG, Xiang L, Wei W, Kluwe-Schiavon B, Viola TW. Neurotrophic Factor Levels in Preterm Infants: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:643576. [PMID: 33868149 PMCID: PMC8047113 DOI: 10.3389/fneur.2021.643576] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/05/2021] [Indexed: 01/11/2023] Open
Abstract
Objectives: Through a systematic review and meta-analysis of the literature we aimed to compare the levels of BDNF, NGF, NT-3, NT-4, and GDNF between human term and preterm infants, and investigate factors implicated in the variability of effect size estimates. Methods: The analysis was performed in three online databases, MEDLINE Complete, PsycINFO, and CINAHL. A random effects model was used to calculate the standardized mean difference (SMD) of neurotrophic factor levels in preterm infants vs. term within a 95% confidence interval (CI). To explore sources of heterogeneity meta-regression models were implemented. Results: Sixteen studies were included in this meta-analysis. A combined sample of 1,379 preterm and 1,286 term newborns were evaluated. We identified significant lower BDNF (SMD = -0.32; 95% CI: -0.59, -0.06; p = 0.014) and NT-3 (SMD = -0.31; 95% CI: -0.52, -0.09; p = 0.004) levels in preterm compared to term infants. No significant difference was observed in NGF and NT-4 levels between groups. Given that only two effect sizes were generated for GDNF levels, no meta-analytical model was performed. Meta-regression models revealed sample type (placental tissue, cerebrospinal fluid, peripheral blood, and umbilical cord blood) as a significant moderator of heterogeneity for BDNF meta-analysis. No significant associations were found for gestational week, birth weight, and clinical comorbidity of newborns with effect sizes. Conclusions: Our findings indicated that lower BDNF and NT-3 levels may be associated with preterm birth. Future studies with larger samples sizes should investigate neurodevelopmental manifestations resulting from neurotrophic factor dysregulation among preterm infants.
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Affiliation(s)
- Francieli Cristina Krey
- Developmental Cognitive Neuroscience Lab (DCNL), Graduate Program in Pediatrics and Child Health-School of Medicine, Pontifical University Catholic of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Bruna Alvim Stocchero
- Developmental Cognitive Neuroscience Lab (DCNL), Graduate Program in Pediatrics and Child Health-School of Medicine, Pontifical University Catholic of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | | | - Bernardo Aguzzoli Heberle
- Developmental Cognitive Neuroscience Lab (DCNL), Graduate Program in Pediatrics and Child Health-School of Medicine, Pontifical University Catholic of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | | | - Li Xiang
- Neuroepigenetic Research Lab, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Wei
- Neuroepigenetic Research Lab, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bruno Kluwe-Schiavon
- DCNL, PUCRS, Graduate Program in Psychology-School of Health Sciences, Porto Alegre, Brazil.,School of Psychology, Psychology Research Centre, University of Minho, Braga, Portugal
| | - Thiago Wendt Viola
- Developmental Cognitive Neuroscience Lab (DCNL), Graduate Program in Pediatrics and Child Health-School of Medicine, Pontifical University Catholic of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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9
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Dingsdale H, Nan X, Garay SM, Mueller A, Sumption LA, Chacón-Fernández P, Martinez-Garay I, Ghevaert C, Barde YA, John RM. The placenta protects the fetal circulation from anxiety-driven elevations in maternal serum levels of brain-derived neurotrophic factor. Transl Psychiatry 2021; 11:62. [PMID: 33462179 PMCID: PMC7813890 DOI: 10.1038/s41398-020-01176-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/16/2020] [Accepted: 11/30/2020] [Indexed: 01/30/2023] Open
Abstract
Brain-derived neurotrophic factor (BDNF) plays crucial roles in brain function. Numerous studies report alterations in BDNF levels in human serum in various neurological conditions, including mood disorders such as depression. However, little is known about BDNF levels in the blood during pregnancy. We asked whether maternal depression and/or anxiety during pregnancy were associated with altered serum BDNF levels in mothers (n = 251) and their new-born infants (n = 212). As prenatal exposure to maternal mood disorders significantly increases the risk of neurological conditions in later life, we also examined the possibility of placental BDNF transfer by developing a new mouse model. We found no association between maternal symptoms of depression and either maternal or infant cord blood serum BDNF. However, maternal symptoms of anxiety correlated with significantly raised maternal serum BDNF exclusively in mothers of boys (r = 0.281; P = 0.005; n = 99). Serum BDNF was significantly lower in male infants than female infants but neither correlated with maternal anxiety symptoms. Consistent with this observation, we found no evidence for BDNF transfer across the placenta. We conclude that the placenta protects the developing fetus from maternal changes in serum BDNF that could otherwise have adverse consequences for fetal development.
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Affiliation(s)
- Hayley Dingsdale
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK
| | - Xinsheng Nan
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK
| | - Samantha M Garay
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK
| | - Annett Mueller
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, UK
| | - Lorna A Sumption
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK
| | - Pedro Chacón-Fernández
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK
- Hospital Universitario Virgen Macarena-FISEVI, University of Seville, E41009, Seville, Spain
| | | | - Cedric Ghevaert
- Department of Haematology, University of Cambridge, Cambridge, CB2 0PT, UK
| | - Yves-Alain Barde
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK
| | - Rosalind M John
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK.
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10
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Wolford E, Lahti-Pulkkinen M, Girchenko P, Lipsanen J, Tuovinen S, Lahti J, Heinonen K, Hämäläinen E, Kajantie E, Pesonen AK, Villa PM, Laivuori H, Reynolds RM, Räikkönen K. Associations of antenatal glucocorticoid exposure with mental health in children. Psychol Med 2020; 50:247-257. [PMID: 30688183 DOI: 10.1017/s0033291718004129] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Synthetic glucocorticoids, to enhance fetal maturation, are a standard treatment when preterm birth before 34 gestational weeks is imminent. While morbidity- and mortality-related benefits may outweigh potential neurodevelopmental harms in children born preterm (<37 gestational weeks), this may not hold true when pregnancy continues to term (⩾37 gestational weeks). We studied the association of antenatal betamethasone exposure on child mental health in preterm and term children. METHODS We included 4708 women and their children, born 2006-2010, from the Prediction and Prevention of Pre-eclampsia and Intrauterine Growth Restriction Study with information on both antenatal betamethasone treatment and child mental and behavioral disorders from the Finnish Hospital Discharge Register from the child's birth to 31 December 2016. Additional follow-up data on mother-reported psychiatric problems and developmental milestones were available for 2640 children at 3.5 (s.d. = 0.07) years-of-age. RESULTS Of the children, 187 were born preterm (61 betamethasone-exposed) and 4521 at term (56 betamethasone-exposed). The prevalence of any mental and behavioral, psychological development, emotional and behavioral, and comorbid disorders was higher in the betamethasone-exposed, compared to non-exposed children [odds ratio 2.76 (95% confidence interval 1.76-4.32), 3.61 (2.19-5.95), 3.29 (1.86-5.82), and 6.04 (3.25-11.27), respectively]. Levels of psychiatric problems and prevalence of failure to meet the age-appropriate development in personal-social skills were also higher in mother-reports of betamethasone-exposed children. These associations did not vary significantly between preterm and term children. CONCLUSIONS Antenatal betamethasone exposure may be associated with mental health problems in children born preterm and in those who end up being born at term.
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Affiliation(s)
- Elina Wolford
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Marius Lahti-Pulkkinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Polina Girchenko
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari Lipsanen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Soile Tuovinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari Lahti
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Helsinki Collegium for Advanced Studies, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
| | - Kati Heinonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Esa Hämäläinen
- Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland
| | - Eero Kajantie
- National Institute for Health and Welfare, Helsinki, Finland
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Anu-Katriina Pesonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Pia M Villa
- Obstetrics and Gynaecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hannele Laivuori
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Institute for Molecular Medicine Finland, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Rebecca M Reynolds
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Katri Räikkönen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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11
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Affiliation(s)
- Joshua I Rosenbloom
- Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Adam K Lewkowitz
- Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Methodius G Tuuli
- Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, St Louis, Missouri
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