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Carelli MCB, Peixoto-Filho FM, Velarde LGC, de Sá RAM, Monteiro V, Araujo Júnior E. Effects of antenatal corticosteroids on fetal hemodynamics: a longitudinal study. Radiol Bras 2024; 57:e20230129. [PMID: 38993967 PMCID: PMC11235072 DOI: 10.1590/0100-3984.2023.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/10/2024] [Accepted: 02/04/2024] [Indexed: 07/13/2024] Open
Abstract
Objective To study the effect of antenatal corticosteroid administration on fetal hemodynamics using longitudinal analysis of Doppler waveforms in the umbilical artery (UA) and middle cerebral artery (MCA). Materials and Methods This was a retrospective study that included 30 fetuses at risk for preterm birth. Twenty-eight pregnant women were treated with betamethasone for fetal lung maturation. Doppler examinations of the UA and MCA were performed once before and three or eight times after corticosteroid administration. We used a Bayesian hierarchical linear model. Reference ranges were constructed, and associations between variables (gestational age and pre-eclampsia) were tested. Results The mean maternal age, gestational age at betamethasone administration, and gestational age at delivery were 32.6 ± 5.89 years, 30.2 ± 2.59 weeks, and 32.9 ± 3.42 weeks, respectively. On UA Doppler, there was a significant decrease in the pulsatility index (PI) after corticosteroid administration, with a mean of 0.1147 (credibility interval: 0.03687-0.191) in three observations and a median of 0.1437 (credibility interval: 0.02509-0.2627) in eight observations. However, there was no significant change in the Doppler MCA PI, regardless of gestational age and the presence or absence of pre-eclampsia. Conclusion Although antenatal corticosteroid administration induced a significant decrease in the Doppler UA PI, we observed no change in the cerebral vasculature.
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Affiliation(s)
| | - Fernando Maia Peixoto-Filho
- Department of Obstetrics, Gynecology, and Fetal Medicine, Perinatal
Maternity, Rio de Janeiro, RJ, Brazil
- Department of Obstetrics and Fetal Medicine, Instituto Fernandes
Figueira (IFF/Fiocruz), Rio de Janeiro, RJ, Brazil
| | | | - Renato Augusto Moreira de Sá
- Department of Obstetrics, Gynecology, and Fetal Medicine, Perinatal
Maternity, Rio de Janeiro, RJ, Brazil
- Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Viviane Monteiro
- Department of Obstetrics and Fetal Medicine, Instituto Fernandes
Figueira (IFF/Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Escola Paulista de Medicina da
Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
- Discipline of Human Health, Universidade Municipal de São
Caetano do Sul (USCS), Campus Bela Vista, São Paulo, SP, Brazil
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2
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Kumagai Y, Kemp MW, Usuda H, Takahashi T, Takahashi Y, Hamada H, Schmidt AF, Hanita T, Watanabe S, Sato S, Ikeda H, Fee EL, Furfaro L, Newnham JP, Jobe AH, Yaegashi N, Saito M. A Reduction in Antenatal Steroid Dose Was Associated with Reduced Cardiac Dysfunction in a Sheep Model of Pregnancy. Reprod Sci 2023; 30:3222-3234. [PMID: 37264260 PMCID: PMC10643432 DOI: 10.1007/s43032-023-01264-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/07/2023] [Indexed: 06/03/2023]
Abstract
Despite widespread use, dosing regimens for antenatal corticosteroid (ACS) therapy are poorly unoptimized. ACS therapy exerts a programming effect on fetal development, which may be associated with an increased risk of cardiovascular disease. Having demonstrated that low-dose steroid therapy is an efficacious means of maturing the preterm lung, we hypothesized that a low-dose steroid exposure would exert fewer adverse functional and transcriptional changes on the fetal heart. We tested this hypothesis using low-dose steroid therapy (10 mg delivered to the ewe over 36 h via constant infusion) and compared cardiac effects with those of a higher dose treatment (30 mg delivered to the ewe over 24 h by intramuscular injection; simulating currently employed clinical ACS regimens). Fetal cardiac function was assessed by ultrasound on the day of ACS treatment initiation. Transcriptomic analyses were performed on fetal myocardial tissue. Relative to saline control, fetuses in the higher-dose clinical treatment group had significantly lower ratios between early diastolic ventricular filling and ventricular filling during atrial systole, and showed the differential expression of myocardial hypertrophy-associated transcripts including βMHC, GADD45γ, and PPARγ. The long-term implications of these changes remain unstudied. Irrespective, optimizing ACS dosing regimens to maximize respiratory benefit while minimizing adverse effects on key organ systems, such as the heart, offers a means of improving the acute and long-term outcomes associated with this important obstetric therapy.
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Affiliation(s)
- Yusaku Kumagai
- Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan.
| | - Matthew W Kemp
- Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
- Division of Obstetrics and Gynecology, The University of Western Australia, Perth, WA, Australia
- College of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Haruo Usuda
- Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
- Division of Obstetrics and Gynecology, The University of Western Australia, Perth, WA, Australia
| | - Tsukasa Takahashi
- Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
- Division of Obstetrics and Gynecology, The University of Western Australia, Perth, WA, Australia
| | - Yuki Takahashi
- Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
- Division of Obstetrics and Gynecology, The University of Western Australia, Perth, WA, Australia
| | - Hirotaka Hamada
- Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | | | - Takushi Hanita
- Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Shimpei Watanabe
- Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Shinichi Sato
- Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Hideyuki Ikeda
- Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Erin L Fee
- Division of Obstetrics and Gynecology, The University of Western Australia, Perth, WA, Australia
| | - Lucy Furfaro
- Division of Obstetrics and Gynecology, The University of Western Australia, Perth, WA, Australia
| | - John P Newnham
- Division of Obstetrics and Gynecology, The University of Western Australia, Perth, WA, Australia
| | - Alan H Jobe
- Division of Obstetrics and Gynecology, The University of Western Australia, Perth, WA, Australia
- Cincinnati Children's Hospital Medical Centre, Cincinnati, OH, USA
| | - Nobuo Yaegashi
- Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Masatoshi Saito
- Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
- Division of Obstetrics and Gynecology, The University of Western Australia, Perth, WA, Australia
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3
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Garrud TAC, Teulings NEWD, Niu Y, Skeffington KL, Beck C, Itani N, Conlon FG, Botting KJ, Nicholas LM, Tong W, Derks JB, Ozanne SE, Giussani DA. Molecular mechanisms underlying adverse effects of dexamethasone and betamethasone in the developing cardiovascular system. FASEB J 2023; 37:e22887. [PMID: 37132324 PMCID: PMC10946807 DOI: 10.1096/fj.202200676rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 05/04/2023]
Abstract
Antenatal glucocorticoids accelerate fetal lung maturation and reduce mortality in preterm babies but can trigger adverse effects on the cardiovascular system. The mechanisms underlying off-target effects of the synthetic glucocorticoids mostly used, Dexamethasone (Dex) and Betamethasone (Beta), are unknown. We investigated effects of Dex and Beta on cardiovascular structure and function, and underlying molecular mechanism using the chicken embryo, an established model system to isolate effects of therapy on the developing heart and vasculature, independent of effects on the mother or placenta. Fertilized eggs were treated with Dex (0.1 mg kg-1 ), Beta (0.1 mg kg-1 ), or water vehicle (Control) on embryonic day 14 (E14, term = 21 days). At E19, biometry, cardiovascular function, stereological, and molecular analyses were determined. Both glucocorticoids promoted growth restriction, with Beta being more severe. Beta compared with Dex induced greater cardiac diastolic dysfunction and also impaired systolic function. While Dex triggered cardiomyocyte hypertrophy, Beta promoted a decrease in cardiomyocyte number. Molecular changes of Dex on the developing heart included oxidative stress, activation of p38, and cleaved caspase 3. In contrast, impaired GR downregulation, activation of p53, p16, and MKK3 coupled with CDK2 transcriptional repression linked the effects of Beta on cardiomyocyte senescence. Beta but not Dex impaired NO-dependent relaxation of peripheral resistance arteries. Beta diminished contractile responses to potassium and phenylephrine, but Dex enhanced peripheral constrictor reactivity to endothelin-1. We conclude that Dex and Beta have direct differential detrimental effects on the developing cardiovascular system.
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Affiliation(s)
- Tessa A. C. Garrud
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
| | - Noor E. W. D. Teulings
- Institute of Metabolic Science‐Metabolic Research Laboratories, MRC Metabolic Diseases UnitUniversity of Cambridge, Addenbrooke's HospitalCambridgeUK
| | - Youguo Niu
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
| | - Katie L. Skeffington
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
| | - Christian Beck
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
| | - Nozomi Itani
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
| | - Fiona G. Conlon
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
| | - Kimberley J. Botting
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
| | - Lisa M. Nicholas
- Institute of Metabolic Science‐Metabolic Research Laboratories, MRC Metabolic Diseases UnitUniversity of Cambridge, Addenbrooke's HospitalCambridgeUK
| | - Wen Tong
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
| | - Jan B. Derks
- Department of Perinatal MedicineUniversity Medical CentreUtrechtNetherlands
| | - Susan E. Ozanne
- Institute of Metabolic Science‐Metabolic Research Laboratories, MRC Metabolic Diseases UnitUniversity of Cambridge, Addenbrooke's HospitalCambridgeUK
- BHF Cardiovascular Centre for Research ExcellenceUniversity of CambridgeCambridgeUK
- Strategic Research Initiative in ReproductionUniversity of CambridgeCambridgeUK
- Centre for Trophoblast ResearchUniversity of CambridgeCambridgeUK
| | - Dino A. Giussani
- Department of Physiology, Development and NeuroscienceUniversity of CambridgeCambridgeUK
- BHF Cardiovascular Centre for Research ExcellenceUniversity of CambridgeCambridgeUK
- Strategic Research Initiative in ReproductionUniversity of CambridgeCambridgeUK
- Centre for Trophoblast ResearchUniversity of CambridgeCambridgeUK
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4
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Kane AD, Herrera EA, Niu Y, Camm EJ, Allison BJ, Tijsseling D, Lusby C, Derks JB, Brain KL, Bronckers IM, Cross CM, Berends L, Giussani DA. Combined Statin and Glucocorticoid Therapy for the Safer Treatment of Preterm Birth. Hypertension 2023; 80:837-851. [PMID: 36724801 PMCID: PMC10017302 DOI: 10.1161/hypertensionaha.122.19647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/03/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Prematurity is strongly associated with poor respiratory function in the neonate. Rescue therapies include treatment with glucocorticoids due to their anti-inflammatory and maturational effects on the developing lung. However, glucocorticoid treatment in the infant can increase the risk of long-term cardiovascular complications including hypertension, cardiac, and endothelial dysfunction. Accumulating evidence implicates a molecular link between glucocorticoid excess and depletion of nitric oxide (NO) bioavailability as a mechanism underlying the detrimental effects of postnatal steroids on the heart and circulation. Therefore, combined glucocorticoid and statin therapy, by increasing NO bioavailability, may protect the developing cardiovascular system while maintaining beneficial effects on the lung. METHODS We investigated combined glucocorticoid and statin therapy using an established rodent model of prematurity and combined experiments of cardiovascular function in vivo, with those in isolated organs as well as measurements at the cellular and molecular levels. RESULTS We show that neonatal glucocorticoid treatment increases the risk of later cardiovascular dysfunction in the offspring. Underlying mechanisms include decreased circulating NO bioavailability, sympathetic hyper-reactivity, and NO-dependent endothelial dysfunction. Combined neonatal glucocorticoid and statin therapy protects the developing cardiovascular system by normalizing NO and sympathetic signaling, without affecting pulmonary maturational or anti-inflammatory effects of glucocorticoids. CONCLUSIONS Therefore, combined glucocorticoid and statin therapy may be safer than glucocorticoids alone for the treatment of preterm birth.
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Affiliation(s)
- Andrew D. Kane
- Department of Physiology, Development and Neuroscience, University of Cambridge, United Kingdom (A.D.K., E.A.H., Y.N., E.J.C., B.J.A., C.L., K.L.B., C.M.C., D.A.G.)
| | - Emilio A. Herrera
- Department of Physiology, Development and Neuroscience, University of Cambridge, United Kingdom (A.D.K., E.A.H., Y.N., E.J.C., B.J.A., C.L., K.L.B., C.M.C., D.A.G.)
- Laboratory of Vascular Function & Reactivity, Pathophysiology Program, ICBM, Faculty of Medicine, Universidad de Chile, Santiago, Chile (E.A.H.)
| | - Youguo Niu
- Department of Physiology, Development and Neuroscience, University of Cambridge, United Kingdom (A.D.K., E.A.H., Y.N., E.J.C., B.J.A., C.L., K.L.B., C.M.C., D.A.G.)
- The Cambridge BHF Centre for Research Excellence, Cambridge, United Kingdom (Y.N., D.A.G.)
- The Cambridge Strategic Research Initiative in Reproduction, Cambridge, United Kingdom (Y.N., D.A.G.)
| | - Emily J. Camm
- Department of Physiology, Development and Neuroscience, University of Cambridge, United Kingdom (A.D.K., E.A.H., Y.N., E.J.C., B.J.A., C.L., K.L.B., C.M.C., D.A.G.)
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia (E.J.C., B.J.A.)
| | - Beth J. Allison
- Department of Physiology, Development and Neuroscience, University of Cambridge, United Kingdom (A.D.K., E.A.H., Y.N., E.J.C., B.J.A., C.L., K.L.B., C.M.C., D.A.G.)
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia (E.J.C., B.J.A.)
| | - Deodata Tijsseling
- Perinatal Center, University Medical Center, Utrecht, the Netherlands (D.T., J.B.D.)
| | - Ciara Lusby
- Department of Physiology, Development and Neuroscience, University of Cambridge, United Kingdom (A.D.K., E.A.H., Y.N., E.J.C., B.J.A., C.L., K.L.B., C.M.C., D.A.G.)
| | - Jan B. Derks
- Perinatal Center, University Medical Center, Utrecht, the Netherlands (D.T., J.B.D.)
| | - Kirsty L. Brain
- Department of Physiology, Development and Neuroscience, University of Cambridge, United Kingdom (A.D.K., E.A.H., Y.N., E.J.C., B.J.A., C.L., K.L.B., C.M.C., D.A.G.)
| | - Inge M. Bronckers
- Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, the Netherlands (I.M.B.)
| | - Christine M. Cross
- Department of Physiology, Development and Neuroscience, University of Cambridge, United Kingdom (A.D.K., E.A.H., Y.N., E.J.C., B.J.A., C.L., K.L.B., C.M.C., D.A.G.)
| | - Lindsey Berends
- Institute of Metabolic Science, University of Cambridge Metabolic Research Laboratories, Addenbrooke’s Hospital, Cambridge, United Kingdom (L.B.)
| | - Dino A. Giussani
- Department of Physiology, Development and Neuroscience, University of Cambridge, United Kingdom (A.D.K., E.A.H., Y.N., E.J.C., B.J.A., C.L., K.L.B., C.M.C., D.A.G.)
- The Cambridge BHF Centre for Research Excellence, Cambridge, United Kingdom (Y.N., D.A.G.)
- The Cambridge Strategic Research Initiative in Reproduction, Cambridge, United Kingdom (Y.N., D.A.G.)
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5
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Prenatal or postnatal corticosteroids favor clinical, respiratory, metabolic outcomes and oxidative balance of preterm lambs corticotherapy for premature neonatal lambs. Theriogenology 2022; 182:129-137. [DOI: 10.1016/j.theriogenology.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/24/2022] [Accepted: 02/07/2022] [Indexed: 11/17/2022]
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Tournier A, Beacom M, Westgate JA, Bennet L, Garabedian C, Ugwumadu A, Gunn AJ, Lear CA. Physiological control of fetal heart rate variability during labour: Implications and controversies. J Physiol 2021; 600:431-450. [PMID: 34951476 DOI: 10.1113/jp282276] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/25/2021] [Indexed: 11/08/2022] Open
Abstract
The interpretation of fetal heart rate (FHR) patterns is the only available method to continuously monitor fetal wellbeing during labour. One of the most important yet contentious aspects of the FHR pattern is changes in FHR variability (FHRV). Some clinical studies suggest that loss of FHRV during labour is a sign of fetal compromise so this is reflected in practice guidelines. Surprisingly, there is little systematic evidence to support this observation. In this review we methodically dissect the potential pathways controlling FHRV during labour-like hypoxaemia. Before labour, FHRV is controlled by the combined activity of the parasympathetic and sympathetic nervous systems, in part regulated by a complex interplay between fetal sleep state and behaviour. By contrast, preclinical studies using multiple autonomic blockades have now shown that sympathetic neural control of FHRV was potently suppressed between periods of labour-like hypoxaemia, and thus, that the parasympathetic system is the sole neural regulator of FHRV once FHR decelerations are present during labour. We further discuss the pattern of changes in FHRV during progressive fetal compromise and highlight potential biochemical, behavioural and clinical factors that may regulate parasympathetic-mediated FHRV during labour. Further studies are needed to investigate the regulators of parasympathetic activity to better understand the dynamic changes in FHRV and their true utility during labour. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Alexane Tournier
- Department of Obstetrics, Universite de Lille, CHU Lille, ULR 2694 - METRICS, Lille, F 59000, France
| | - Michael Beacom
- The Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Jenny A Westgate
- The Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Laura Bennet
- The Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Charles Garabedian
- Department of Obstetrics, Universite de Lille, CHU Lille, ULR 2694 - METRICS, Lille, F 59000, France
| | - Austin Ugwumadu
- Department of Obstetrics and Gynaecology, St George's Hospital, St George's University of London, London, SW17 0RE, UK
| | - Alistair J Gunn
- The Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Christopher A Lear
- The Fetal Physiology and Neuroscience Group, Department of Physiology, The University of Auckland, Auckland, New Zealand
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7
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Effect of Preterm Birth on Cardiac and Cardiomyocyte Growth and the Consequences of Antenatal and Postnatal Glucocorticoid Treatment. J Clin Med 2021; 10:jcm10173896. [PMID: 34501343 PMCID: PMC8432182 DOI: 10.3390/jcm10173896] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 12/18/2022] Open
Abstract
Preterm birth coincides with a key developmental window of cardiac growth and maturation, and thus has the potential to influence long-term cardiac function. Individuals born preterm have structural cardiac remodelling and altered cardiac growth and function by early adulthood. The evidence linking preterm birth and cardiovascular disease in later life is mounting. Advances in the perinatal care of preterm infants, such as glucocorticoid therapy, have improved survival rates, but at what cost? This review highlights the short-term and long-term impact of preterm birth on the structure and function of the heart and focuses on the impact of antenatal and postnatal glucocorticoid treatment on the immature preterm heart.
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8
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Vafaei H, Kaveh Baghbahadorani F, Asadi N, Kasraeian M, Faraji A, Roozmeh S, Zare M, Bazrafshan K. The impact of betamethasone on fetal pulmonary, umbilical and middle cerebral artery Doppler velocimetry and its relationship with neonatal respiratory distress syndrome. BMC Pregnancy Childbirth 2021; 21:188. [PMID: 33676432 PMCID: PMC7937237 DOI: 10.1186/s12884-021-03655-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/22/2021] [Indexed: 11/24/2022] Open
Abstract
Background Prenatal corticosteroid administration is known to be an effective strategy in improving fetal pulmonary maturity. This study aimed to evaluate the impact of maternal betamethasone administration on fetal pulmonary and other arteries Doppler velocity and the correlation between RDS development and Doppler indices results. Methods Fifty one singleton pregnancies between 26 and 34 gestational weeks with a diagnosis of preterm labor were included in the exposed group and received betamethasone. Fifty one uncomplicated pregnancies were included in the non-exposed group. Fetal pulmonary, umbilical and middle cerebral arteries Doppler parameters were evaluated before and 24 to 48 h after steroid administration in the exposed group and two times at same intervals in the non-exposed group. Maternal records were matched to neonatal charts if delivery happened, and demographic and outcome data were abstracted. Results When compared with the nonexposed group, fetuses treated with corticosteroids demonstrated significantly decreased umbilical artery Pulsatility index (PI) and significantly increased the middle cerebral artery PI, pulmonary artery Acceleration time (AT) and pulmonary artery AT/ET (Ejection time), while all other indices remained similar. We found significantly decreased pulmonary artery AT in the fetuses with respiratory distress syndrome (RDS) compared to those that did not. Conclusions The results of our study showed that maternal antenatal betamethasone administration caused significant changes in the fetus blood velocity waveforms and also affected the blood flow in the pulmonary artery which led to an increase in the pulmonary artery AT and AT/ET. Among those fetuses with RDS, we found a significant decrease in the pulmonary artery AT, but we did not observe any pulmonary artery AT/ET differences.
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Affiliation(s)
- Homeira Vafaei
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fahimeh Kaveh Baghbahadorani
- Maternal-Fetal Medicine Research Center, Perinatology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Asadi
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Maryam Kasraeian
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azam Faraji
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shohreh Roozmeh
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marjan Zare
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khadije Bazrafshan
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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9
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Smolich JJ, Mynard JP. Antenatal betamethasone redistributes central blood flows and preferentially augments right ventricular output and pump function in preterm fetal lambs. Am J Physiol Regul Integr Comp Physiol 2021; 320:R611-R618. [PMID: 33596742 DOI: 10.1152/ajpregu.00273.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The glucocorticosteroid betamethasone, which is routinely administered prior to anticipated preterm birth to enhance maturation of the lungs and the cardiovascular system, has diverse fetal regional blood flow effects ranging from increased pulmonary flow to decreased cerebral flow. The aim of this study was to test the hypothesis that these diverse effects reflect alterations in major central flow patterns that are associated with complementary shifts in left ventricular (LV) and right ventricular (RV) pumping performance. Studies were performed in anesthetized preterm fetal lambs (gestation = 127 ± 1 days, term = 147 days) with (n = 14) or without (n = 12) preceding betamethasone treatment via maternal intramuscular injection. High-fidelity central arterial blood pressure and flow signals were obtained to calculate LV and RV outputs and total hydraulic power. Betamethasone therapy was accompanied by 1) increased RV, but not LV, output; 2) a greater RV than LV increase in total power; 3) a redistribution of LV output away from the fetal upper body region and toward the lower body and placenta; 4) a greater proportion of RV output passing to the lungs, and a lesser proportion to the lower body and placenta; and 5) a change in the relative contribution of venous streams to ventricular filling, with the LV having increased pulmonary venous and decreased foramen ovale components, and the RV having lesser superior vena caval and greater inferior vena caval portions. Taken together, these findings suggest that antenatal betamethasone produces a widespread redistribution of central arterial and venous flows in the fetus, accompanied by a preferential rise in RV pumping performance.
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Affiliation(s)
- Joseph J Smolich
- Heart Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Jonathan P Mynard
- Heart Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Cardiology, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
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10
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Fratelli N, Prefumo F, Wolf H, Hecher K, Visser GHA, Giussani D, Derks JB, Shaw CJ, Frusca T, Ghi T, Ferrazzi E, Lees CC. Effects of Antenatal Betamethasone on Fetal Doppler Indices and Short Term Fetal Heart Rate Variation in Early Growth Restricted Fetuses. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:56-64. [PMID: 31476786 DOI: 10.1055/a-0972-1098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To investigate the effects of the antenatal administration of betamethasone on fetal Doppler and short term fetal heart rate variation (CTG-STV) in early growth restricted (FGR) fetuses. MATERIALS AND METHODS Post hoc analysis of data derived from the TRUFFLE study, a prospective, multicenter, randomized management trial of severe early onset FGR. Repeat Doppler and CTG-STV measurements between the last recording within 48 hours before the first dose of betamethasone (baseline value) and for 10 days after were evaluated. Multilevel analysis was performed to analyze the longitudinal course of the umbilico-cerebral ratio (UC ratio), the ductus venosus pulsatility index (DVPIV) and CTG-STV. RESULTS We included 115 fetuses. A significant increase from baseline in CTG-STV was found on day + 1 (p = 0.019) but no difference thereafter. The DVPIV was not significantly different from baseline in any of the 10 days following the first dose of betamethasone (p = 0.167). Multilevel analysis revealed that, over 10 days, the time elapsed from antenatal administration of betamethasone was significantly associated with a decrease in CTG-STV (p = 0.045) and an increase in the DVPIV (p = 0.001) and UC ratio (p < 0.001). CONCLUSION Although steroid administration in early FGR has a minimal effect on increasing CTG-STV one day afterwards, the effects on Doppler parameters were extremely slight with regression coefficients of small magnitude suggesting no clinical significance, and were most likely related to the deterioration with time in FGR. Hence, arterial and venous Doppler assessment of fetal health remains informative following antenatal steroid administration to accelerate fetal lung maturation.
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Affiliation(s)
- Nicola Fratelli
- Department of Obstetrics and Gynaecology, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynaecology, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Hans Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, Netherlands
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg-Eppendorf, Germany
| | - Gerard H A Visser
- Department of Perinatal Medicine, University of Utrecht, Netherlands
| | - Dino Giussani
- Department of Physiology Development & Neuroscience, University of Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Jan B Derks
- Department of Perinatal Medicine, University of Utrecht, Netherlands
| | - Caroline J Shaw
- Department of Surgery and Cancer, Imperial College London, United Kingdom of Great Britain and Northern Ireland
| | - Tiziana Frusca
- Department of Surgical Sciences, Obstetrics and Gynecology Unit, University of Parma, Italy
| | - Tullio Ghi
- Department of Surgical Sciences, Obstetrics and Gynecology Unit, University of Parma, Italy
| | - E Ferrazzi
- Children's Hospital Buzzi, University of Milan, Italy
| | - Christoph C Lees
- Department of Surgery and Cancer, Imperial College London, United Kingdom of Great Britain and Northern Ireland
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11
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Cahill LS, Whitehead CL, Hobson SR, Stortz G, Kingdom JC, Baschat A, Murphy KE, Serghides L, Macgowan CK, Sled JG. Effect of maternal betamethasone administration on feto-placental vascular resistance in the mouse†. Biol Reprod 2020; 101:823-831. [PMID: 31318405 DOI: 10.1093/biolre/ioz128] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/10/2019] [Accepted: 05/15/2019] [Indexed: 12/24/2022] Open
Abstract
Antenatal corticosteroids are often administered to women at risk of preterm birth to accelerate fetal lung development; however, there is evidence that this treatment may adversely affect placental function in some fetuses. Our group has recently demonstrated that wave reflections in the umbilical artery (UA), measured using high-frequency ultrasound, are sensitive to placental vascular abnormalities. In the present study, we used this approach to investigate the effect of maternal administration of betamethasone, a clinically relevant corticosteroid, on the feto-placental vasculature of the mouse. Fetuses were assessed at embryonic day (E)15.5 and E17.5 in C57BL6/J mice. At both gestational ages, the UA diameter, UA blood flow, and the wave reflection coefficient were significantly elevated in the betamethasone-treated mice compared to vehicle-treated controls. These observations support the interpretation that placental vascular resistance dropped with betamethasone treatment to an extent that could not be explained by vasodilation of the UA alone. Consistent with clinical studies, the effect of betamethasone on UA end-diastolic velocity was heterogeneous. Our results suggest that UA wave reflections are more sensitive to acute changes in placental vascular resistance compared with the UA pulsatility index, and this technique may have clinical application to identify a favorable placental vascular response to fetal therapies such as antenatal corticosteroids, where the fetal heart rate is likely to vary.
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Affiliation(s)
- Lindsay S Cahill
- Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Sebastian R Hobson
- Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Greg Stortz
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John C Kingdom
- Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Ahmet Baschat
- Centre for Fetal Therapy, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Kellie E Murphy
- Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Lena Serghides
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.,Department of Immunology and Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, 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.,Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
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12
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Teulings NEWD, Garrud TAC, Niu Y, Skeffington KL, Beck C, Itani N, Conlon FG, Botting KJ, Nicholas LM, Ashmore TJ, Blackmore HL, Tong W, Camm EJ, Derks JB, Logan A, Murphy MP, Ozanne SE, Giussani DA. Isolating adverse effects of glucocorticoids on the embryonic cardiovascular system. FASEB J 2020; 34:9664-9677. [PMID: 32502311 PMCID: PMC7611332 DOI: 10.1096/fj.202000697r] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/04/2020] [Accepted: 05/10/2020] [Indexed: 01/07/2023]
Abstract
Antenatal glucocorticoid therapy reduces mortality in the preterm infant, but evidence suggests off-target adverse effects on the developing cardiovascular system. Whether deleterious effects are direct on the offspring or secondary to alterations in uteroplacental physiology is unclear. Here, we isolated direct effects of glucocorticoids using the chicken embryo, a model system in which the effects on the developing heart and circulation of therapy can be investigated, independent of effects on the mother and/or the placenta. Fertilized chicken eggs were incubated and divided randomly into control (C) or dexamethasone (Dex) treatment at day 14 out of the 21-day incubation period. Combining functional experiments at the isolated organ, cellular and molecular levels, embryos were then studied close to term. Chicken embryos exposed to dexamethasone were growth restricted and showed systolic and diastolic dysfunction, with an increase in cardiomyocyte volume but decreased cardiomyocyte nuclear density in the left ventricle. Underlying mechanisms included a premature switch from tissue accretion to differentiation, increased oxidative stress, and activated signaling of cellular senescence. These findings, therefore, demonstrate that dexamethasone treatment can have direct detrimental off-target effects on the cardiovascular system in the developing embryo, which are independent of effects on the mother and/or placenta.
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Affiliation(s)
- Noor E. W. D. Teulings
- Institute of Metabolic Science-Metabolic Research Laboratories, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Tessa A. C. Garrud
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Youguo Niu
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Katie L. Skeffington
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Christian Beck
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Nozomi Itani
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Fiona G. Conlon
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Kimberley J. Botting
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Lisa M. Nicholas
- Institute of Metabolic Science-Metabolic Research Laboratories, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Thomas J. Ashmore
- Institute of Metabolic Science-Metabolic Research Laboratories, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Heather L. Blackmore
- Institute of Metabolic Science-Metabolic Research Laboratories, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Wen Tong
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Emily J. Camm
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Jan B. Derks
- Department of Perinatal Medicine, University Medical Centre, Utrecht, Netherlands
| | - Angela Logan
- Medical Research Council Mitochondrial Biology Unit, University of Cambridge, Cambridge, UK
| | - Michael P. Murphy
- Medical Research Council Mitochondrial Biology Unit, University of Cambridge, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Susan E. Ozanne
- Institute of Metabolic Science-Metabolic Research Laboratories, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Dino A. Giussani
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
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13
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Shaw CJ, Rivens I, Civale J, Botting KJ, Allison BJ, Brain KL, Niu Y, Ter Haar G, Giussani DA, Lees CC. Maternal and fetal cardiometabolic recovery following ultrasound-guided high-intensity focused ultrasound placental vascular occlusion. J R Soc Interface 2020; 16:20190013. [PMID: 31039691 PMCID: PMC6544891 DOI: 10.1098/rsif.2019.0013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
High-intensity focused ultrasound (HIFU) is a non-invasive method of selective placental vascular occlusion, providing a potential therapy for conditions such as twin–twin transfusion syndrome. In order to translate this technique into human studies, evidence of prolonged fetal recovery and maintenance of a healthy fetal physiology following exposure to HIFU is essential. At 116 ± 2 days gestation, 12 pregnant ewes were assigned to control (n = 6) or HIFU vascular occlusion (n = 6) groups and anaesthetized. Placental blood vessels were identified using colour Doppler ultrasound; HIFU-mediated vascular occlusion was performed through intact maternal skin (1.66 MHz, 5 s duration, in situ ISPTA 1.8–3.9 kW cm−2). Unidentifiable colour Doppler signals in targeted vessels following HIFU exposure denoted successful occlusion. Ewes and fetuses were then surgically instrumented with vascular catheters and transonic flow probes and recovered from anaesthesia. A custom-made wireless data acquisition system, which records continuous maternal and fetal cardiovascular data, and daily blood sampling were used to assess wellbeing for 20 days, followed by post-mortem examination. Based on a comparison of pre- and post-treatment colour Doppler imaging, 100% (36/36) of placental vessels were occluded following HIFU, and occlusion persisted for 20 days. All fetuses survived. No differences in maternal or fetal blood pressure, heart rate, heart rate variability, metabolic status or oxygenation were observed between treatment groups. There was evidence of normal fetal maturation and no evidence of chronic fetal stress. There were no maternal injuries and no placental vascular haemorrhage. There was both a uterine and fetal burn, which did not result in any obstetric or fetal complications. This study demonstrates normal long-term recovery of fetal sheep from exposure to HIFU-mediated placental vascular occlusion and underlines the potential of HIFU as a potential non-invasive therapy in human pregnancy.
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Affiliation(s)
- Caroline J Shaw
- 1 Department of Physiology, Development and Neuroscience, University of Cambridge , Cambridge CB2 3EG , UK.,2 Institute of Reproductive and Developmental Biology, Imperial College London , London W12 0HS , UK
| | - Ian Rivens
- 3 Joint Department of Physics, Institute of Cancer Research , Sutton SM2 5NG , UK
| | - John Civale
- 3 Joint Department of Physics, Institute of Cancer Research , Sutton SM2 5NG , UK
| | - Kimberley J Botting
- 1 Department of Physiology, Development and Neuroscience, University of Cambridge , Cambridge CB2 3EG , UK.,4 Cardiovascular Strategic Research Initiative, University of Cambridge , Cambridge , UK
| | - Beth J Allison
- 1 Department of Physiology, Development and Neuroscience, University of Cambridge , Cambridge CB2 3EG , UK
| | - Kirsty L Brain
- 1 Department of Physiology, Development and Neuroscience, University of Cambridge , Cambridge CB2 3EG , UK
| | - Y Niu
- 1 Department of Physiology, Development and Neuroscience, University of Cambridge , Cambridge CB2 3EG , UK.,4 Cardiovascular Strategic Research Initiative, University of Cambridge , Cambridge , UK
| | - Gail Ter Haar
- 3 Joint Department of Physics, Institute of Cancer Research , Sutton SM2 5NG , UK
| | - Dino A Giussani
- 1 Department of Physiology, Development and Neuroscience, University of Cambridge , Cambridge CB2 3EG , UK.,4 Cardiovascular Strategic Research Initiative, University of Cambridge , Cambridge , UK
| | - Christoph C Lees
- 2 Institute of Reproductive and Developmental Biology, Imperial College London , London W12 0HS , UK.,5 Department of Obstetrics and Gynaecology, University Hospitals Leuven , 3000 Leuven , Belgium
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14
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Jellyman JK, Fletcher AJW, Fowden AL, Giussani DA. Glucocorticoid Maturation of Fetal Cardiovascular Function. Trends Mol Med 2020; 26:170-184. [PMID: 31718939 DOI: 10.1016/j.molmed.2019.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/17/2019] [Accepted: 09/30/2019] [Indexed: 12/27/2022]
Abstract
The last decade has seen rapid advances in the understanding of the central role of glucocorticoids in preparing the fetus for life after birth. However, relative to other organ systems, maturation by glucocorticoids of the fetal cardiovascular system has been ignored. Here, we review the effects of glucocorticoids on fetal basal cardiovascular function and on the fetal cardiovascular defense responses to acute stress. This is important because glucocorticoid-driven maturational changes in fetal cardiovascular function under basal and stressful conditions are central to the successful transition from intra- to extrauterine life. The cost-benefit balance for the cardiovascular health of the preterm baby of antenatal glucocorticoid therapy administered to pregnant women threatened with preterm birth is also discussed.
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Affiliation(s)
- Juanita K Jellyman
- Department of Biological Sciences, California State Polytechnic University, Pomona, CA, USA.
| | | | - Abigail L Fowden
- Department of Physiology Development and Neuroscience, University of Cambridge, Cambridge, UK; Cambridge Cardiovascular Strategic Research Initiative, Cambridge, UK; Cambridge Strategic Research Initiative in Reproduction, Cambridge, UK
| | - Dino A Giussani
- Department of Physiology Development and Neuroscience, University of Cambridge, Cambridge, UK; Cambridge Cardiovascular Strategic Research Initiative, Cambridge, UK; Cambridge Strategic Research Initiative in Reproduction, Cambridge, UK.
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15
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Cardiovascular effects of prenatal stress-Are there implications for cerebrovascular, cognitive and mental health outcome? Neurosci Biobehav Rev 2019; 117:78-97. [PMID: 31708264 DOI: 10.1016/j.neubiorev.2018.05.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 05/21/2018] [Accepted: 05/22/2018] [Indexed: 01/17/2023]
Abstract
Prenatal stress programs offspring cognitive and mental health outcome. We reviewed whether prenatal stress also programs cardiovascular dysfunction which potentially modulates cerebrovascular, cognitive and mental health disorders. We focused on maternal stress and prenatal glucocorticoid (GC) exposure which have different programming effects. While maternal stress induced cortisol is mostly inactivated by the placenta, synthetic GCs freely cross the placenta and have different receptor-binding characteristics. Maternal stress, particularly anxiety, but not GC exposure, has adverse effects on maternal-fetal circulation throughout pregnancy, probably by co-activation of the maternal sympathetic nervous system, and by raising fetal catecholamines. Both effects may impair neurodevelopment. Experimental data also suggest that severe maternal stress and GC exposure during early and mid-gestation may increase the risk for cardiovascular disorders. Human data are scarce and especially lacking for older age. Programming mechanisms include aberrations in cardiac and kidney development, and functional changes in the renin-angiotensin-aldosterone-system, stress axis and peripheral and coronary vasculature. Adequate experimental or human studies examining the consequences for cerebrovascular, cognitive and mental disorders are unavailable.
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16
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Agnew EJ, Garcia-Burgos A, Richardson RV, Manos H, Thomson AJW, Sooy K, Just G, Homer NZM, Moran CM, Brunton PJ, Gray GA, Chapman KE. Antenatal dexamethasone treatment transiently alters diastolic function in the mouse fetal heart. J Endocrinol 2019; 241:279-292. [PMID: 31013474 PMCID: PMC6541236 DOI: 10.1530/joe-18-0666] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/23/2019] [Indexed: 12/27/2022]
Abstract
Endogenous glucocorticoid action is important in the structural and functional maturation of the fetal heart. In fetal mice, although glucocorticoid concentrations are extremely low before E14.5, glucocorticoid receptor (GR) is expressed in the heart from E10.5. To investigate whether activation of cardiac GR prior to E14.5 induces precocious fetal heart maturation, we administered dexamethasone in the drinking water of pregnant dams from E12.5 to E15.5. To test the direct effects of glucocorticoids upon the cardiovascular system we used SMGRKO mice, with Sm22-Cre-mediated disruption of GR in cardiomyocytes and vascular smooth muscle. Contrary to expectations, echocardiography showed no advancement of functional maturation of the fetal heart. Moreover, litter size was decreased 2 days following cessation of antenatal glucocorticoid exposure, irrespective of fetal genotype. The myocardial performance index and E/A wave ratio, markers of fetal heart maturation, were not significantly affected by dexamethasone treatment in either genotype. Dexamethasone treatment transiently decreased the myocardial deceleration index (MDI; a marker of diastolic function), in control fetuses at E15.5, with recovery by E17.5, 2 days after cessation of treatment. MDI was lower in SMGRKO than in control fetuses and was unaffected by dexamethasone. The transient decrease in MDI was associated with repression of cardiac GR in control fetuses following dexamethasone treatment. Measurement of glucocorticoid levels in fetal tissue and hypothalamic corticotropin-releasing hormone (Crh) mRNA levels suggest complex and differential effects of dexamethasone treatment upon the hypothalamic-pituitary-adrenal axis between genotypes. These data suggest potentially detrimental and direct effects of antenatal glucocorticoid treatment upon fetal heart function.
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Affiliation(s)
- E J Agnew
- Centre for Cardiovascular Science, The University of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, UK
| | - A Garcia-Burgos
- Centre for Cardiovascular Science, The University of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, UK
| | - R V Richardson
- Centre for Cardiovascular Science, The University of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, UK
| | - H Manos
- Centre for Cardiovascular Science, The University of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, UK
| | - A J W Thomson
- Centre for Cardiovascular Science, The University of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, UK
| | - K Sooy
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Centre for Cardiovascular Science, The University of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, UK
| | - G Just
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Centre for Cardiovascular Science, The University of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, UK
| | - N Z M Homer
- Mass Spectrometry Core, Edinburgh Clinical Research Facility, Centre for Cardiovascular Science, The University of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, UK
| | - C M Moran
- Centre for Cardiovascular Science, The University of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, UK
| | - P J Brunton
- Centre for Discovery Brain Sciences, The University of Edinburgh, Hugh Robson Building, George Square, Edinburgh, UK
| | - G A Gray
- Centre for Cardiovascular Science, The University of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, UK
| | - K E Chapman
- Centre for Cardiovascular Science, The University of Edinburgh, The Queen’s Medical Research Institute, Edinburgh, UK
- Correspondence should be addressed to K E Chapman:
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17
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Chen L, Guilmette J, Luo ZC, Cloutier A, Wang WJ, Yang MN, Fraser WD, Dubois J, Nuyt AM. Placental 11β-HSD2 and Cardiometabolic Health Indicators in Infancy. Diabetes Care 2019; 42:964-971. [PMID: 30833369 DOI: 10.2337/dc18-2041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/05/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Fetal excessive exposure to glucocorticoids may program cardiometabolic risk. Placental 11 β-hydroxysteroid dehydrogenase 2 (11β-HSD2) serves as a barrier to prevent fetal overexposure to maternal glucocorticoids. It has not been explored whether placental 11β-HSD2 levels are associated with cardiometabolic health in postnatal life. RESEARCH DESIGN AND METHODS In a prospective birth cohort study of 246 mother-infant pairs, we measured placental 11β-HSD2 expression and maternal (32-35 weeks of gestation) and cord plasma cortisol concentrations. The primary outcomes were HOMA of insulin resistance (IR) and blood pressure (BP) in infants at age 1 year. Other outcomes included fasting insulin, HOMA β-cell function, carotid intima-media thickness, weight z score, and skinfold thickness (triceps and subscapular) at age 1 year. RESULTS Placental 11β-HSD2 expression was negatively correlated with HOMA-IR (r = -0.17, P = 0.021) and fasting insulin (r = -0.18, P = 0.017) and marginally negatively correlated with systolic BP (r = -0.16, P = 0.057) but was not correlated with HOMA of β-cell function, diastolic BP, carotid intima-media thickness, and skinfold thickness (all P > 0.1) in infants at age 1 year. Cord plasma cortisol was negatively correlated to skinfold thickness (r = -0.20, P = 0007) but was not correlated with other outcomes at age 1 year. Maternal plasma cortisol was positively correlated with maximal carotid intima-media thickness (r = 0.20, P = 0.03) but was not correlated with other outcomes. Adjusting for maternal and infant characteristics, the associations were similar. CONCLUSIONS The study is the first to show that higher placental 11β-HSD2 expression is associated with lower IR in infancy. Independent cohort studies are required to confirm this novel finding.
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Affiliation(s)
- Lu Chen
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Prosserman Center for Population Health Research, Mount Sinai Hospital, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Sainte-Justine University Hospital and Research Center, University of Montreal, Montreal, Quebec, Canada.,Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Julie Guilmette
- Sainte-Justine University Hospital and Research Center, University of Montreal, Montreal, Quebec, Canada.,Department of Pathology, Charles-Lemoyne Hospital, Longueuil, Quebec, Canada
| | - Zhong-Cheng Luo
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Prosserman Center for Population Health Research, Mount Sinai Hospital, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada .,Sainte-Justine University Hospital and Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Anik Cloutier
- Sainte-Justine University Hospital and Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Wen-Juan Wang
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Prosserman Center for Population Health Research, Mount Sinai Hospital, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Meng-Nan Yang
- Department of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Prosserman Center for Population Health Research, Mount Sinai Hospital, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - William D Fraser
- Sainte-Justine University Hospital and Research Center, University of Montreal, Montreal, Quebec, Canada.,Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Josée Dubois
- Sainte-Justine University Hospital and Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Anne Monique Nuyt
- Sainte-Justine University Hospital and Research Center, University of Montreal, Montreal, Quebec, Canada
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18
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Kemp MW, Jobe AH, Usuda H, Nathanielsz PW, Li C, Kuo A, Huber HF, Clarke GD, Saito M, Newnham JP, Stock SJ. Efficacy and safety of antenatal steroids. Am J Physiol Regul Integr Comp Physiol 2018; 315:R825-R839. [PMID: 29641233 DOI: 10.1152/ajpregu.00193.2017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Antenatal steroids (ANS) are among the most important and widely utilized interventions to improve outcomes for preterm infants. A significant body of evidence demonstrates improved outcomes in preterm infants (24-34 wk) delivered between 1 and 7 days after the administration of a single course of ANS. Moreover, ANS have the advantage of being widely available, low cost, and easily administered via maternal intramuscular injection. The use of ANS to mature the fetal lung is, however, not without contention. Their use in pregnancy is not FDA approved, and treatment doses and regimens remain largely unoptimized. Their mode of use varies considerably between countries, and there are lingering concerns regarding the safety of exposing the fetus to high doses of exogenous steroids. A significant proportion of women deliver outside the 1- to 7-day therapeutic window after ANS treatment, and this delay may be associated with an increased risk of adverse outcomes for both mother and baby. Today, animal-based studies are one means by which key questions of dosing and safety relating to ANS may be resolved, allowing for further refinement(s) of this important therapy. Complementary approaches using nonhuman primates, sheep, and rodents have provided invaluable advances to our understanding of how exogenous steroid exposure impacts fetal development. Focusing on these three major model groups, this review highlights the role of three key animal models (sheep, nonhuman primates, rodents) in the development of antenatal steroid therapy, and provides an up-to-date synthesis of current efforts to refine this therapy in an era of personalised medicine.
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Affiliation(s)
- Matthew W Kemp
- Division of Obstetrics and Gynaecology, University of Western Australia , Perth , Australia
- Tohoku University Hospital, Sendai, Miyagi , Japan
| | - Alan H Jobe
- Division of Obstetrics and Gynaecology, University of Western Australia , Perth , Australia
- Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Centre , Cincinnati, Ohio
| | - Haruo Usuda
- Division of Obstetrics and Gynaecology, University of Western Australia , Perth , Australia
- Tohoku University Hospital, Sendai, Miyagi , Japan
| | | | - Cun Li
- Department of Animal Science, University of Wyoming , Laramie, Wyoming
| | - Anderson Kuo
- Department of Radiology, University of Texas Health Science Center San Antonio , San Antonio, Texas
| | - Hillary F Huber
- Department of Animal Science, University of Wyoming , Laramie, Wyoming
| | - Geoffrey D Clarke
- Department of Radiology, University of Texas Health Science Center San Antonio , San Antonio, Texas
| | - Masatoshi Saito
- Division of Obstetrics and Gynaecology, University of Western Australia , Perth , Australia
- Tohoku University Hospital, Sendai, Miyagi , Japan
| | - John P Newnham
- Division of Obstetrics and Gynaecology, University of Western Australia , Perth , Australia
| | - Sarah J Stock
- Division of Obstetrics and Gynaecology, University of Western Australia , Perth , Australia
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
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Increased right ventricular power and ductal characteristic impedance underpin higher pulmonary arterial blood flow after betamethasone therapy in fetal lambs. Pediatr Res 2018; 84:558-563. [PMID: 29983413 DOI: 10.1038/s41390-018-0098-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/24/2018] [Accepted: 05/30/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND The glucocorticosteroid betamethasone is routinely administered prior to anticipated preterm birth to enhance lung maturation. While betamethasone also increases fetal pulmonary blood flow and reduces pulmonary vascular resistance (PVR), we investigated whether alterations in right ventricular (RV) function and ductal characteristic impedance (Zc) additionally contributed to rises in pulmonary flow. METHODS Anesthetized preterm fetal lambs with (n = 10) or without (n = 8) betamethasone pretreatment were instrumented with a pulmonary trunk micromanometer and ductus arteriosus and left pulmonary artery (PA) flow probes to calculate Zc, and obtain RV output and hydraulic power. RESULTS Betamethasone (1) increased systolic and pulse arterial pressures (P ≤ 0.04), heart rate (P = 0.02), and lowered PVR (P = 0.04), (2) increased mean (P = 0.008) and systolic (P = 0.004), but not diastolic PA flow or PA Zc, (3) increased ductal Zc (P < 0.05), but not ductal flow, (4) increased RV output (P = 0.03) and the proportion of PT flow distributed to the lungs (P = 0.02), and (5) increased RV power (P ≤ 0.002). CONCLUSION An increased fetal PA blood flow after betamethasone therapy was confined to the systole and underpinned not only by decreased PVR, but also greater RV power and preferential distribution of an augmented RV systolic outflow to the lungs due to higher ductal Zc.
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Acevedo Gallegos S, Martínez Menjivar N, Gallardo Gaona J, Velázquez Torres B, Camarena Cabrera D, Copado Mendoza D, Ramírez Calvo J. Efectos de los esteroides como inductores de maduración pulmonar en restricción del crecimiento intrauterino. Revisión sistemática. PERINATOLOGÍA Y REPRODUCCIÓN HUMANA 2018. [DOI: 10.1016/j.rprh.2018.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Antolic A, Wood CE, Keller-Wood M. Chronic maternal hypercortisolemia in late gestation alters fetal cardiac function at birth. Am J Physiol Regul Integr Comp Physiol 2017; 314:R342-R352. [PMID: 29092858 DOI: 10.1152/ajpregu.00296.2017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Studies in our laboratory have shown that modest chronic increases in maternal cortisol concentrations over the last 0.20 of gestation impair maternal glucose metabolism and increase the incidence of perinatal stillbirth. Previous studies had found that an increase in maternal cortisol concentrations from 115 to 130 days of gestation in sheep increased both proliferation in fetal cardiomyocytes and apoptosis in the fetal cardiac Purkinje fibers. We hypothesized that the adverse effects of excess cortisol may result in defects in cardiac conduction during labor and delivery. In the present study, we infused cortisol (1 mg·kg-1·day-1) into late gestation pregnant ewes and continuously monitored fetal aortic pressure and ECG through labor and delivery. We found that, although the fetuses of cortisol infused ewes had normal late gestation patterns of arterial pressure and heart rate, there was a significant decrease in fetal aortic pressure and heart rate on the day of birth, specifically in the final hour before delivery. Significant changes in the fetal ECG were also apparent on the day of birth, including prolongation of the P wave and P-R interval. We speculate that chronic exposure to glucocorticoids alters cardiac metabolism or ion homeostasis, contributing to cardiac dysfunction, precipitated by active labor and delivery.
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Affiliation(s)
- Andrew Antolic
- Department of Pharmacodynamics, University of Florida , Gainesville, Florida
| | - Charles E Wood
- Department of Physiology and Functional Genomics, University of Florida , Gainesville, Florida
| | - Maureen Keller-Wood
- Department of Pharmacodynamics, University of Florida , Gainesville, Florida
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Anegroaie P, Frasch MG, Rupprecht S, Antonow-Schlorke I, Müller T, Schubert H, Witte OW, Schwab M. Development of somatosensory-evoked potentials in foetal sheep: effects of betamethasone. Acta Physiol (Oxf) 2017; 220:137-149. [PMID: 27580709 DOI: 10.1111/apha.12795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 06/15/2016] [Accepted: 08/30/2016] [Indexed: 11/30/2022]
Abstract
AIM Antenatal glucocorticoids are used to accelerate foetal lung maturation in babies threatened with premature labour. We examined the influence of glucocorticoids on functional and structural maturation of the central somatosensory pathway in foetal sheep. Somatosensory-evoked potentials (SEP) reflect processing of somatosensory stimuli. SEP latencies are determined by afferent stimuli transmission while SEP amplitudes reveal cerebral processing. METHODS After chronic instrumentation of foetal sheep, mothers received saline (n = 9) or three courses of betamethasone (human equivalent dose of 2 × 110 μg kg-1 betamethasone i.m. 24 h apart, n = 12) at 0.7, 0.75 and 0.8 of gestational age. Trigeminal SEP were evoked prior to, 4 and 24 h after each injection and at 0.8 of gestational age before brains were histologically processed. RESULTS Somatosensory-evoked potentials were already detectable at 0.7 of gestation age. The early and late responses N20 and N200 were the only reproducible peaks over the entire study period. With advancing gestational age, SEP latencies decreased but amplitudes remained unchanged. Acutely, betamethasone did not affect SEP latencies and amplitudes 4 and 24 h following administration. Chronically, betamethasone delayed developmental decrease in the N200 but not N20 latency by 2 weeks without affecting amplitudes. In parallel, betamethasone decreased subcortical white matter myelination but did not affect network formation and synaptic density in the somatosensory cortex. CONCLUSION Somatosensory stimuli are already processed by the foetal cerebral cortex at the beginning of the third trimester. Subsequent developmental decrease in SEP latencies suggests ongoing maturation of afferent sensory transmission. Antenatal glucocorticoids affect structural and functional development of the somatosensory system with specific effects at subcortical level.
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Affiliation(s)
- P. Anegroaie
- Department of Neurology; Jena University Hospital; Jena Germany
- Department of Pediatric Surgery; Jena University Hospital; Jena Germany
| | - M. G. Frasch
- Department of Obstetrics and Gynecology; University of Washington; Seattle WA USA
| | - S. Rupprecht
- Department of Neurology; Jena University Hospital; Jena Germany
| | | | - T. Müller
- Institute of Laboratory Animal Science; Jena University Hospital; Jena Germany
| | - H. Schubert
- Institute of Laboratory Animal Science; Jena University Hospital; Jena Germany
| | - O. W. Witte
- Department of Neurology; Jena University Hospital; Jena Germany
| | - M. Schwab
- Department of Neurology; Jena University Hospital; Jena Germany
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Weyrich J, Setter A, Müller A, Schmidt G, Brambs CE, Ortiz JU, Lobmaier SM. Longitudinal progression of fetal short-term variation and average acceleration and deceleration capacity after antenatal maternal betamethasone application. Eur J Obstet Gynecol Reprod Biol 2017; 212:85-90. [PMID: 28342395 DOI: 10.1016/j.ejogrb.2017.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To analyze the effect of maternal betamethasone given for fetal lung maturation on fetal short-term variation (STV) and average acceleration and deceleration capacity (AAC/ADC). Both of these factors are calculated by phase-rectified signal averaging (PRSA) and represent new parameters to assess the fetal autonomic nervous system. STUDY DESIGN A longitudinal prospective study including 26 pregnant women at risk for preterm delivery was performed. Two injections of 12mg betamethasone were administered intramuscularly at a 24h interval for lung maturation. Cardiotocography recordings were performed at defined time intervals: day 0 (before the first injection) and days 1, 2, 4 after the first corticosteroid administration. AAC/ADC and STV were calculated. RESULTS An increase of all parameters (STV, AAC and ADC) was documented between day 0 and day 1. Between day 1 and day 2, all three indices were significantly reduced (p<0.05). STV declined by 19.8%, AAC by 10.1% and ADC by 14.8%. A normalization of these values was seen after 96h. CONCLUSION Similar to STV, AAC/ADC shows significant changes after maternal betamethasone administration. The corticosteroid-induced transient decrease of the levels needs to be taken into account in the assessment of the fetal status to avoid misinterpretation of these parameters.
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Affiliation(s)
- Joy Weyrich
- Frauenklinik und Poliklinik, Technische Universität München, Munich, Germany.
| | - Anna Setter
- Frauenklinik und Poliklinik, Technische Universität München, Munich, Germany; Department of Neurology, Klinikum Leverkusen, Leverkusen, Germany
| | - Alexander Müller
- I. Medizinische Klinik, Technische Universität München, Munich, Germany
| | - Georg Schmidt
- I. Medizinische Klinik, Technische Universität München, Munich, Germany
| | - Christine E Brambs
- Frauenklinik und Poliklinik, Technische Universität München, Munich, Germany
| | - Javier U Ortiz
- Frauenklinik und Poliklinik, Technische Universität München, Munich, Germany
| | - Silvia M Lobmaier
- Frauenklinik und Poliklinik, Technische Universität München, Munich, Germany
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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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Konstantakou P, Mastorakos G, Vrachnis N, Tomlinson JW, Valsamakis G. Dysregulation of 11beta-hydroxysteroid dehydrogenases: implications during pregnancy and beyond. J Matern Fetal Neonatal Med 2016; 30:284-293. [PMID: 27018008 DOI: 10.3109/14767058.2016.1171308] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Glucococorticoids play a critical role in the developmental programing and fetal growth. Key molecules mediating and regulating tissue-specific glucocorticoid actions are 11beta-hydroxysteroid dehydrogenase (11beta-HSD) type 1 and 2 isozymes, both of which are expressed in the placenta and the fetal membranes. 11beta-HSD1 is implicated in the pathogenesis of metabolic syndrome and its dysregulation has been observed in pregnancy-related complications (pre-eclampsia, intrauterine growth restriction). Interestingly, preliminary clinical data have associated certain 11beta-HSD1 gene polymorphisms with hypertensive disorders in pregnancy, suggesting, if confirmed by further targeted studies, it's potential as a putative prognostic marker. Animal studies and observations in humans have confirmed that 11beta-HSD2 insufficiency is related with pregnancy adversity (pre-eclampsia, intrauterine growth restriction, preterm birth). Importantly, down-regulation or deficiency of placental 11beta-HSD2 is associated with significant restriction in fetal growth and low-birth weight, and unfavorable cardio-metabolic profile in adulthood. The potential association of 11beta-HSD1 tissue-specific dysregulation with gestational diabetes, as well as the plausible utility of 11beta-HSD2, as a biomarker of pregnancy adversity and later life morbidity, are emerging areas of intense scientific interest and future investigation.
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Affiliation(s)
- P Konstantakou
- a Unit of Endocrinology, Diabetes Mellitus and Metabolism, Aretaieio Hospital , Athens , Greece
| | - G Mastorakos
- a Unit of Endocrinology, Diabetes Mellitus and Metabolism, Aretaieio Hospital , Athens , Greece
| | - N Vrachnis
- b Department of Obstetrics and Gynecology , Aretaieio Hospital , Athens , Greece
| | - J W Tomlinson
- c Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Churchill Hospital , Headington , UK
| | - G Valsamakis
- a Unit of Endocrinology, Diabetes Mellitus and Metabolism, Aretaieio Hospital , Athens , Greece
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Rakers F, Bischoff S, Schiffner R, Haase M, Rupprecht S, Kiehntopf M, Kühn-Velten WN, Schubert H, Witte OW, Nijland MJ, Nathanielsz PW, Schwab M. Role of catecholamines in maternal-fetal stress transfer in sheep. Am J Obstet Gynecol 2015. [PMID: 26212181 DOI: 10.1016/j.ajog.2015.07.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We sought to evaluate whether in addition to cortisol, catecholamines also transfer psychosocial stress indirectly to the fetus by decreasing uterine blood flow (UBF) and increasing fetal anaerobic metabolism and stress hormones. STUDY DESIGN Seven pregnant sheep chronically instrumented with uterine ultrasound flow probes and catheters at 0.77 gestation underwent 2 hours of psychosocial stress by isolation. We used adrenergic blockade with labetalol to examine whether decreased UBF is catecholamine mediated and to determine to what extent stress transfer from mother to fetus is catecholamine dependent. RESULTS Stress induced transient increases in maternal cortisol and norepinephrine (NE). Maximum fetal plasma cortisol concentrations were 8.1 ± 2.1% of those in the mother suggesting its maternal origin. In parallel to the maternal NE increase, UBF decreased by maximum 22% for 30 minutes (P < .05). Fetal NE remained elevated for >2 hours accompanied by a prolonged blood pressure increase (P < .05). Fetuses developed a delayed and prolonged shift toward anaerobic metabolism in the presence of an unaltered oxygen supply. Adrenergic blockade prevented the stress-induced UBF decrease and, consequently, the fetal NE and blood pressure increase and the shift toward anaerobic metabolism. CONCLUSION We conclude that catecholamine-induced decrease of UBF is a mechanism of maternal-fetal stress transfer. It may explain the influence of maternal stress on fetal development and on programming of adverse health outcomes in later life especially during early pregnancy when fetal glucocorticoid receptor expression is limited.
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Affiliation(s)
- Florian Rakers
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.
| | - Sabine Bischoff
- Institute of Laboratory Animal Sciences and Welfare, Jena University Hospital, Jena, Germany
| | - Rene Schiffner
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Michelle Haase
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Sven Rupprecht
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Michael Kiehntopf
- Institute of Clinical Chemistry and Laboratory Medicine, Jena University Hospital, Jena, Germany
| | | | - Harald Schubert
- Institute of Laboratory Animal Sciences and Welfare, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Mark J Nijland
- Center for Pregnancy and Newborn Research, Department of Obstetrics and Gynecology, University of Texas, San Antonio, School of Medicine, San Antonio, TX
| | - Peter W Nathanielsz
- Center for Pregnancy and Newborn Research, Department of Obstetrics and Gynecology, University of Texas, San Antonio, School of Medicine, San Antonio, TX
| | - Matthias Schwab
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
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27
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Burns P, Liu HL, Kuthiala S, Fecteau G, Desrochers A, Durosier LD, Cao M, Frasch MG. Instrumentation of Near-term Fetal Sheep for Multivariate Chronic Non-anesthetized Recordings. J Vis Exp 2015:e52581. [PMID: 26555084 DOI: 10.3791/52581] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The chronically instrumented pregnant sheep has been used as a model of human fetal development and responses to pathophysiologic stimuli such as endotoxins, bacteria, umbilical cord occlusions, hypoxia and various pharmacological treatments. The life-saving clinical practices of glucocorticoid treatment in fetuses at risk of premature birth and the therapeutic hypothermia have been developed in this model. This is due to the unique amenability of the non-anesthetized fetal sheep to the surgical placement and maintenance of catheters and electrodes, allowing repetitive blood sampling, substance injection, recording of bioelectrical activity, application of electric stimulation and in vivo organ imaging. Here we describe the surgical instrumentation procedure required to achieve a stable chronically instrumented non-anesthetized fetal sheep model including characterization of the post-operative recovery from blood gas, metabolic and inflammation standpoints.
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Affiliation(s)
- Patrick Burns
- Département de sciences cliniques, CHUV, Université de Montréal, St-Hyacinthe, QC
| | - Hai Lun Liu
- Département d'obstetriques et de gynécologie, CHU Ste-Justine Research Centre, Université de Montréal
| | - Shikha Kuthiala
- Département d'obstetriques et de gynécologie, CHU Ste-Justine Research Centre, Université de Montréal
| | - Gilles Fecteau
- Département de sciences cliniques, CHUV, Université de Montréal, St-Hyacinthe, QC
| | - André Desrochers
- Département de sciences cliniques, CHUV, Université de Montréal, St-Hyacinthe, QC
| | - Lucien Daniel Durosier
- Département d'obstetriques et de gynécologie, CHU Ste-Justine Research Centre, Université de Montréal
| | - Mingju Cao
- Département d'obstetriques et de gynécologie, CHU Ste-Justine Research Centre, Université de Montréal
| | - Martin G Frasch
- Département d'obstetriques et de gynécologie, CHU Ste-Justine Research Centre, Université de Montréal; Département de neurosciences, CHU Ste-Justine Centre de recherche, Université de Montréal; Centre de recherche en reproduction animale (CRRA), Université de Montréal, St-Hyacinthe, QC;
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28
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Woik N, Kroll J. Regulation of lung development and regeneration by the vascular system. Cell Mol Life Sci 2015; 72:2709-18. [PMID: 25894695 PMCID: PMC11113134 DOI: 10.1007/s00018-015-1907-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 02/08/2023]
Abstract
Blood vessels have been described a long time ago as passive circuits providing sufficient blood supply to ensure proper distribution of oxygen and nutrition. Blood vessels are mainly formed during embryonic development and in the early postnatal period. In the adult, blood vessels are quiescent, but can be activated and subsequently induced under pathophysiological conditions, such as ischemia and tumor growth. Surprisingly, recent data have suggested an active function for blood vessels, named angiocrine signaling, releasing trophogens which regulate organ development and organ regeneration including in the pancreas, lung, tumor cells, liver and bone. Lung development is driven by hypoxia as well as an intense endothelial-epithelial interaction, and important mechanisms contributing to these processes have recently been identified. This review aims to summarize recent developments and concepts about embryonic pulmonary vascular development and lung regeneration. We discuss hypoxia-inducible factor HIF-2α and vascular endothelial growth factor VEGF as important mediators in lung development and focus on endothelial-epithelial interactions and angiocrine signaling mechanisms.
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Affiliation(s)
- Nicole Woik
- Department of Vascular Biology and Tumor Angiogenesis, Center for Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim, Heidelberg University, Ludolf-Krehl-Str. 13-17, 68167 Mannheim, Germany
- Division of Vascular Oncology and Metastasis, German Cancer Research Center (DKFZ-ZMBH Alliance), Heidelberg, Germany
| | - Jens Kroll
- Department of Vascular Biology and Tumor Angiogenesis, Center for Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim, Heidelberg University, Ludolf-Krehl-Str. 13-17, 68167 Mannheim, Germany
- Division of Vascular Oncology and Metastasis, German Cancer Research Center (DKFZ-ZMBH Alliance), Heidelberg, Germany
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Yawno T, Mortale M, Sutherland AE, Jenkin G, Wallace EM, Walker DW, Miller SL. The effects of betamethasone on allopregnanolone concentrations and brain development in preterm fetal sheep. Neuropharmacology 2014; 85:342-8. [DOI: 10.1016/j.neuropharm.2014.05.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 05/14/2014] [Accepted: 05/19/2014] [Indexed: 10/25/2022]
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Woik N, Dietz CT, Schäker K, Kroll J. Kelch-like ECT2-interacting protein KLEIP regulates late-stage pulmonary maturation via Hif-2α in mice. Dis Model Mech 2014; 7:683-92. [PMID: 24785085 PMCID: PMC4036475 DOI: 10.1242/dmm.014266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Respiratory distress syndrome (RDS) caused by preterm delivery is a major clinical problem with limited mechanistic insight. Late-stage embryonic lung development is driven by hypoxia and the hypoxia-inducible transcription factors Hif-1α and Hif-2α, which act as important regulators for lung development. Expression of the BTB-and kelch-domain-containing (BTB-kelch) protein KLEIP (Kelch-like ECT2-interacting protein; also named Klhl20) is controlled by two hypoxia response elements, and KLEIP regulates stabilization and transcriptional activation of Hif-2α. Based on the available data, we hypothesized an essential role for KLEIP in murine lung development and function. Therefore, we have performed a functional, histological, mechanistic and interventional study in embryonic and neonatal KLEIP−/− mice. Here, we show that about half of the KLEIP−/− neonates die due to respiratory failure that is caused by insufficient aeration, reduced septal thinning, reduced glycogenolysis, type II pneumocyte immaturity and reduced surfactant production. Expression analyses in embryonic day (E) 18.5 lungs identified KLEIP in lung capillaries, and showed strongly reduced mRNA and protein levels for Hif-2α and VEGF; such reduced levels are associated with embryonic endothelial cell apoptosis and lung bleedings. Betamethasone injection in pregnant females prevented respiratory failure in KLEIP−/− neonates, normalized lung maturation, vascularization, aeration and function, and increased neonatal Hif-2α expression. Thus, the experimental study shows that respiratory failure in KLEIP−/− neonates is determined by insufficient angiocrine Hif-2α–VEGF signaling and that betamethasone activates this newly identified signaling cascade in late-stage embryonic lung development.
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Affiliation(s)
- Nicole Woik
- Department of Vascular Biology and Tumor Angiogenesis, Center for Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim of Heidelberg University, 68167 Mannheim, Germany. Division of Vascular Oncology and Metastasis, German Cancer Research Center (DKFZ-ZMBH Alliance), 69120 Heidelberg, Germany
| | - Christian T Dietz
- Department of Vascular Biology and Tumor Angiogenesis, Center for Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim of Heidelberg University, 68167 Mannheim, Germany
| | - Kathrin Schäker
- Department of Vascular Biology and Tumor Angiogenesis, Center for Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim of Heidelberg University, 68167 Mannheim, Germany. Division of Vascular Oncology and Metastasis, German Cancer Research Center (DKFZ-ZMBH Alliance), 69120 Heidelberg, Germany
| | - Jens Kroll
- Department of Vascular Biology and Tumor Angiogenesis, Center for Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim of Heidelberg University, 68167 Mannheim, Germany. Division of Vascular Oncology and Metastasis, German Cancer Research Center (DKFZ-ZMBH Alliance), 69120 Heidelberg, Germany.
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Galinsky R, Jensen EC, Bennet L, Mitchell CJ, Gunn ER, Wassink G, Fraser M, Westgate JA, Gunn AJ. Sustained sympathetic nervous system support of arterial blood pressure during repeated brief umbilical cord occlusions in near-term fetal sheep. Am J Physiol Regul Integr Comp Physiol 2014; 306:R787-95. [PMID: 24647590 DOI: 10.1152/ajpregu.00001.2014] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sympathetic nervous system (SNS)-mediated peripheral vasoconstriction plays a key role in initial maintenance of blood pressure during rapid-onset asphyxia in the mammalian fetus, but it is attenuated after the first few minutes. It is unclear whether the SNS response is sustained during the brief, but frequently repeated, episodes of asphyxia characteristic of labor. In the present study, 14 fetal sheep at 0.85 of gestation received either chemical sympathectomy with 6-hydroxydopamine (6-OHDA; n = 7) or sham injection (control; n = 7), followed 4-5 days later by repeated 2-min episodes of complete umbilical cord occlusion every 5 min for up to 4 h or until mean arterial blood pressure (MAP) fell to <20 mmHg for two successive occlusions. In controls, umbilical cord occlusions were associated with a rapid initial fall in fetal heart rate (FHR) and femoral blood flow (FBF), with initial hypertension, followed by progressive development of hypotension during ongoing occlusions. Sympathectomy was associated with attenuation of the initial rise in MAP during umbilical cord occlusion, and after the onset of hypotension, a markedly more rapid fall of MAP to the nadir, with a correspondingly slower fall in FBF (P < 0.05). In contrast, MAP and FHR between successive occlusions were higher after sympathectomy (P < 0.05). There was no significant difference in the number of occlusions before terminal hypotension (6-OHDA; 16.1 ± 2.2 vs. control; 18.7 ± 2.3). These data show that SNS activity provides ongoing support for fetal MAP during prolonged exposure to brief repeated asphyxia.
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Affiliation(s)
- Robert Galinsky
- Department of Physiology, University of Auckland, Auckland, New Zealand; and
| | - Ellen C Jensen
- Department of Physiology, University of Auckland, Auckland, New Zealand; and
| | - Laura Bennet
- Department of Physiology, University of Auckland, Auckland, New Zealand; and
| | - Clinton J Mitchell
- Department of Physiology, University of Auckland, Auckland, New Zealand; and
| | - Eleanor R Gunn
- Department of Physiology, University of Auckland, Auckland, New Zealand; and
| | - Guido Wassink
- Department of Physiology, University of Auckland, Auckland, New Zealand; and
| | - Mhoyra Fraser
- Department of Physiology, University of Auckland, Auckland, New Zealand; and The Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jennifer A Westgate
- Department of Physiology, University of Auckland, Auckland, New Zealand; and
| | - Alistair J Gunn
- Department of Physiology, University of Auckland, Auckland, New Zealand; and
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Noorlander CW, Tijsseling D, Hessel EVS, de Vries WB, Derks JB, Visser GHA, de Graan PNE. Antenatal glucocorticoid treatment affects hippocampal development in mice. PLoS One 2014; 9:e85671. [PMID: 24465645 PMCID: PMC3899077 DOI: 10.1371/journal.pone.0085671] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 11/29/2013] [Indexed: 11/18/2022] Open
Abstract
Synthetic glucocorticoids are administered to pregnant women at risk for preterm delivery, to enhance fetal lung maturation. The benefit of this treatment is well established, however caution is necessary because of possible unwanted side effects on development of different organ systems, including the brain. Actions of glucocorticoids are mediated by corticosteroid receptors, which are highly expressed in the hippocampus, a brain structure involved in cognitive functions. Therefore, we analyzed the effects of a single antenatal dexamethasone treatment on the development of the mouse hippocampus. A clinically relevant dose of dexamethasone (0.4 mg/kg) was administered to pregnant mice at embryonic day 15.5 and the hippocampus was analyzed from embryonic day 16 until adulthood. We investigated the effects of dexamethasone treatment on anatomical changes, apoptosis and proliferation in the hippocampus, hippocampal volume and on total body weight. Our results show that dexamethasone treatment reduced body weight and hippocampal volume transiently during development, but these effects were no longer detected at adulthood. Dexamethasone treatment increased the number of apoptotic cells in the hippocampus until birth, but postnatally no effects of dexamethasone treatment on apoptosis were found. During the phase with increased apoptosis, dexamethasone treatment reduced the number of proliferating cells in the subgranular zone of the dentate gyrus. The number of proliferative cells was increased at postnatal day 5 and 10, but was decreased again at the adult stage. This latter long-term and negative effect of antenatal dexamethasone treatment on the number of proliferative cells in the hippocampus may have important implications for hippocampal network function.
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Affiliation(s)
- Cornelle W. Noorlander
- Brain Center Rudolf Magnus, Department of Neuroscience and Pharmacology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Deodata Tijsseling
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
| | - Ellen V. S. Hessel
- Brain Center Rudolf Magnus, Department of Neuroscience and Pharmacology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Willem B. de Vries
- Department of Neonatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan B. Derks
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerard H. A. Visser
- Department of Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pierre N. E. de Graan
- Brain Center Rudolf Magnus, Department of Neuroscience and Pharmacology, University Medical Center Utrecht, Utrecht, The Netherlands
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Longo LD, Goyal R. Cerebral artery signal transduction mechanisms: developmental changes in dynamics and Ca2+ sensitivity. Curr Vasc Pharmacol 2013; 11:655-711. [PMID: 24063382 PMCID: PMC3785013 DOI: 10.2174/1570161111311050008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 06/12/2012] [Accepted: 07/12/2012] [Indexed: 11/22/2022]
Abstract
As compared to the adult, the developing fetus and newborn infant are at much greater risk for dysregulation of cerebral blood flow (CBF), with complications such as intraventricular and germinal matrix hemorrhage with resultant neurologic sequelae. To minimize this dysregulation and its consequences presents a major challenge. Although in many respects the fundamental signal transduction mechanisms that regulate relaxation and contraction pathways, and thus cerebrovascular tone and CBF in the immature organism are similar to those of the adult, the individual elements, pathways, and roles differ greatly. Here, we review aspects of these maturational changes of relaxation/contraction mechanisms in terms of both electro-mechanical and pharmaco-mechanical coupling, their biochemical pathways and signaling networks. In contrast to the adult cerebrovasculature, in addition to attenuated structure with differences in multiple cytoskeletal elements, developing cerebrovasculature of fetus and newborn differs in many respects, such as a strikingly increased sensitivity to [Ca(2+)]i and requirement for extracellular Ca(2+) for contraction. In essence, the immature cerebrovasculature demonstrates both "hyper-relaxation" and "hypo-contraction". A challenge is to unravel the manner in which these mechanisms are integrated, particularly in terms of both Ca(2+)-dependent and Ca(2+)-independent pathways to increase Ca(2+) sensitivity. Gaining an appreciation of these significant age-related differences in signal mechanisms also will be critical to understanding more completely the vulnerability of the developing cerebral vasculature to hypoxia and other stresses. Of vital importance, a more complete understanding of these mechanisms promises hope for improved strategies for therapeutic intervention and clinical management of intensive care of the premature newborn.
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Affiliation(s)
- Lawrence D Longo
- Center for Perinatal Biology, Loma Linda University, School of Medicine, Loma Linda, CA 92350, USA.
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Niu Y, Herrera EA, Evans RD, Giussani DA. Antioxidant treatment improves neonatal survival and prevents impaired cardiac function at adulthood following neonatal glucocorticoid therapy. J Physiol 2013; 591:5083-93. [PMID: 23940378 DOI: 10.1113/jphysiol.2013.258210] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Glucocorticoids are widely used to treat chronic lung disease in premature infants but their longer-term adverse effects on the cardiovascular system raise concerns. We reported that neonatal dexamethasone treatment in rats induced in the short term molecular indices of cardiac oxidative stress and cardiovascular tissue remodelling at weaning, and that neonatal combined antioxidant and dexamethasone treatment was protective at this time. In this study, we investigated whether such effects of neonatal dexamethasone have adverse consequences for NO bioavailability and cardiovascular function at adulthood, and whether neonatal combined antioxidant and dexamethasone treatment is protective in the adult. Newborn rat pups received daily i.p. injections of a human-relevant tapering dose of dexamethasone (D; n = 8; 0.5, 0.3, 0.1 μg g(-1)) or D with vitamins C and E (DCE; n = 8; 200 and 100 mg kg(-1), respectively) on postnatal days 1-3 (P1-3); vitamins were continued from P4 to P6. Controls received equal volumes of vehicle from P1 to P6 (C; n = 8). A fourth group received vitamins alone (CCE; n = 8). At P100, plasma NO metabolites (NOx) was measured and isolated hearts were assessed under both Working and Langendorff preparations. Relative to controls, neonatal dexamethasone therapy increased mortality by 18% (P < 0.05). Surviving D pups at adulthood had lower plasma NOx concentrations (10.6 ± 0.8 vs. 28.0 ± 1.5 μM), an increased relative left ventricular (LV) mass (70 ± 2 vs. 63 ± 1%), enhanced LV end-diastolic pressure (14 ± 2 vs. 8 ± 1 mmHg) and these hearts failed to adapt output with increased preload (cardiac output: 2.9 ± 2.0 vs. 10.6 ± 1.2 ml min(-1)) or afterload (cardiac output: -5.3 ± 2.0 vs.1.4 ± 1.2 ml min(-1)); all P < 0.05. Combined neonatal dexamethasone with antioxidant vitamins improved postnatal survival, restored plasma NOx and protected against cardiac dysfunction at adulthood. In conclusion, neonatal dexamethasone therapy promotes cardiac dysfunction at adulthood. Combined neonatal treatment with antioxidant vitamins is an effective intervention.
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Affiliation(s)
- Youguo Niu
- D. A. Giussani: Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge CB2 3EG, UK.
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Antenatal steroids and the IUGR fetus: are exposure and physiological effects on the lung and cardiovascular system the same as in normally grown fetuses? J Pregnancy 2012; 2012:839656. [PMID: 23227338 PMCID: PMC3512319 DOI: 10.1155/2012/839656] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 09/06/2012] [Indexed: 02/06/2023] Open
Abstract
Glucocorticoids are administered to pregnant women at risk of preterm labour to promote fetal lung surfactant maturation. Intrauterine growth restriction (IUGR) is associated with an increased risk of preterm labour. Hence, IUGR babies may be exposed to antenatal glucocorticoids. The ability of the placenta or blood brain barrier to remove glucocorticoids from the fetal compartment or the brain is compromised in the IUGR fetus, which may have implications for lung, brain, and heart development. There is conflicting evidence on the effect of exogenous glucocorticoids on surfactant protein expression in different animal models of IUGR. Furthermore, the IUGR fetus undergoes significant cardiovascular adaptations, including altered blood pressure regulation, which is in conflict with glucocorticoid-induced alterations in blood pressure and flow. Hence, antenatal glucocorticoid therapy in the IUGR fetus may compromise regulation of cardiovascular development. The role of cortisol in cardiomyocyte development is not clear with conflicting evidence in different species and models of IUGR. Further studies are required to study the effects of antenatal glucocorticoids on lung, brain, and heart development in the IUGR fetus. Of specific interest are the aetiology of IUGR and the resultant degree, duration, and severity of hypoxemia.
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Miller SL, Sutherland AE, Supramaniam VG, Walker DW, Jenkin G, Wallace EM. Antenatal glucocorticoids reduce growth in appropriately grown and growth-restricted ovine fetuses in a sex-specific manner. Reprod Fertil Dev 2012; 24:753-8. [PMID: 22697125 DOI: 10.1071/rd11143] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 07/26/2011] [Indexed: 12/13/2022] Open
Abstract
Antenatal glucocorticoids are administered to mature the fetal lungs before preterm birth. Glucocorticoids also have non-pulmonary effects, including reducing fetal body and brain growth. The present study examined whether glucocorticoid administration has a sex-specific effect on growth in appropriately grown (control) and intrauterine growth-restricted (IUGR) fetal sheep. IUGR was induced at 0.7 gestation in fetal sheep by single umbilical artery ligation. On Days 5 and 6 after surgery, IUGR or control fetuses were exposed to the synthetic glucocorticoid betamethasone (BM; 11.4mg) or saline via intramuscular maternal administration. On Day 7, a postmortem was conducted to determine fetal sex and weight. Compared with control fetuses, the birthweight of male and female IUGR fetuses was significantly reduced (by 18.5±4.4% (P=0.002) and 21.7±6.0% (P=0.001), respectively). Maternal administration of BM significantly reduced bodyweight in both control and IUGR fetuses (by 11.3±2.8% and 20.5±3.6% in control male and female fetuses, respectively; and by 22.9±3.1% and 38.3±3.4% in IUGR male and female fetuses, respectively; P<0.001 for all, versus control+saline) fetuses. In control and IUGR animals the degree of growth restriction was greater in females than males (P<0.05) following administration of BM. These data suggest that antenatal glucocorticoids reduce fetal growth in a sex-specific manner, with females more growth restricted than males.
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Affiliation(s)
- Suzanne L Miller
- The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Vic. 3168, Australia
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Hodges RJ, Wallace EM. Mending a growth-restricted fetal heart: should we use glucocorticoids? J Matern Fetal Neonatal Med 2012; 25:2149-53. [DOI: 10.3109/14767058.2012.697940] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Placenta Share Discordance and Umbilical Artery Doppler Change After Antenatal Betamethasone Administration in Monochorionic Twins With Selective Intrauterine Growth Restriction: Is There a Link? Twin Res Hum Genet 2012; 15:680-4. [DOI: 10.1017/thg.2012.39] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study was designed to evaluate the degree of placenta share discordance in relation to the betamethasone-induced return of positive end-diastolic flow in monochorionic twin pregnancies with selective intrauterine growth restriction (sIUGR) and abnormal umbilical artery Doppler. Monochorionic twins with sIUGR was defined as one twin having an estimated fetal weight below the 10th percentile combined with an estimated fetal weight discordance >25%. The umbilical artery Doppler directly prior to (D0) and 24 hours (D1) and 48 hours (D2) after the first dose of betamethasone administration was recorded. The estimated individual placental weight in monochorionic twins was obtained by cutting the placenta along the vascular equator into two territories; the placenta share discordance was calculated as [(estimated individual placental weight of appropriated for gestational age twin- estimated individual placental weight of growth restricted twin)/estimated individual placental weight of appropriated for gestational age twin] × 100%. Six (23.1%) of the 26 included cases achieved betamethasone-induced return of positive umbilical artery end-diastolic flow. The difference of placenta share discordance and birth weight discordance were not significantly different between twins with and without betamethasone-induced return of positive umbilical artery end-diastolic flow. Thus, according to our study results, it was proposed that although the placenta share discordance correlated with the abnormal umbilical artery Doppler in the IUGR fetus in monochorionic twin, the betamethasone-induced return of positive umbilical artery end-diastolic flow, however, did not reveal the similar relationship with the severity of placenta share discordance.
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Shaltout HA, Rose JC, Chappell MC, Diz DI. Angiotensin-(1-7) deficiency and baroreflex impairment precede the antenatal Betamethasone exposure-induced elevation in blood pressure. Hypertension 2012; 59:453-8. [PMID: 22215705 DOI: 10.1161/hypertensionaha.111.185876] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Betamethasone is administered to accelerate lung development and improve survival of premature infants but may be associated with hypertension later in life. In a sheep model of fetal programming resulting from exposure at day 80 of gestation to Betamethasone (Beta-exposed), adult sheep at 6 to 9 months or 1.8 years of age have elevated mean arterial pressure (MAP) and attenuated spontaneous baroreflex sensitivity (sBRS) for control of heart rate compared to age-matched controls associated with imbalances in angiotensin (Ang) II vs Ang-(1-7) tone. At 6 weeks of age, evoked BRS is already low in the Beta-exposed animals. In this study, we assessed the potential contribution of the renin-angiotensin system to the impaired sBRS. Female lambs (6 weeks old) with Beta exposure in utero had similar MAP to control lambs (78±2 vs 77±2 mm Hg, n=4-5 per group), but lower sBRS (8±1 vs 16±3 ms/mm Hg; P<0.05) and impaired heart rate variability. Peripheral AT1 receptor blockade using candesartan lowered MAP in both groups (≈10 mm Hg) and improved sBRS and heart rate variability in Beta-exposed lambs to a level similar to control. AT7 receptor blockade by infusion of D-ala Ang-(1-7) (700 ng/kg/min for 45 minutes) reduced sBRS 46%±10% in Beta-exposed vs in control lambs (P<0.15) and increased MAP in both groups (≈6±2 mm Hg). Our data reveal that Beta exposure impairs sBRS and heart rate variability at a time point preceding the elevation in MAP via mechanisms involving an imbalance in the Ang II/Ang-(1-7) ratio consistent with a progressive loss in Ang-(1-7) function.
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Affiliation(s)
- Hossam A Shaltout
- Hypertension and Vascular Research Center, Wake Forest University School of Medicine, Hanes Building, 6th floor, Medical Center Boulevard, Winston-Salem, NC 27157-1032, USA.
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Piazze J, Dillon KC, Cerekja A. Betamethasone effects on umbilical arteries and ductus venosus Doppler velocity waveforms in growth-restricted fetuses. J Matern Fetal Neonatal Med 2011; 25:1179-82. [DOI: 10.3109/14767058.2011.624216] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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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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Chang YL, Chang SD, Chao AS, Hsieh PCC, Wang CN, Wang TH. Fetal hemodynamic changes following maternal betamethasone administration in monochorionic twin pregnancies featuring one twin with selective growth restriction and abnormal umbilical artery Doppler. J Obstet Gynaecol Res 2011; 37:1671-6. [DOI: 10.1111/j.1447-0756.2011.01602.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Camm EJ, Tijsseling D, Richter HG, Adler A, Hansell JA, Derks JB, Cross CM, Giussani DA. Oxidative stress in the developing brain: effects of postnatal glucocorticoid therapy and antioxidants in the rat. PLoS One 2011; 6:e21142. [PMID: 21698270 PMCID: PMC3115992 DOI: 10.1371/journal.pone.0021142] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 05/20/2011] [Indexed: 02/07/2023] Open
Abstract
In premature infants, glucocorticoids ameliorate chronic lung disease, but have adverse effects on long-term neurological function. Glucocorticoid excess promotes free radical overproduction. We hypothesised that the adverse effects of postnatal glucocorticoid therapy on the developing brain are secondary to oxidative stress and that antioxidant treatment would diminish unwanted effects. Male rat pups received a clinically-relevant tapering course of dexamethasone (DEX; 0.5, 0.3, and 0.1 mg.kg−1.day−1), with or without antioxidant vitamins C and E (DEXCE; 200 mg.kg−1.day−1 and 100 mg.kg−1.day−1, respectively), on postnatal days 1–6 (P1–6). Controls received saline or saline with vitamins. At weaning, relative to controls, DEX decreased total brain volume (704.4±34.7 mm3 vs. 564.0±20.0 mm3), the soma volume of neurons in the CA1 (1172.6±30.4 µm3 vs. 1002.4±11.8 µm3) and in the dentate gyrus (525.9±27.2 µm3 vs. 421.5±24.6 µm3) of the hippocampus, and induced oxidative stress in the cortex (protein expression: heat shock protein 70 [Hsp70]: +68%; 4-hydroxynonenal [4-HNE]: +118% and nitrotyrosine [NT]: +20%). Dexamethasone in combination with vitamins resulted in improvements in total brain volume (637.5±43.1 mm3), and soma volume of neurons in the CA1 (1157.5±42.4 µm3) and the dentate gyrus (536.1±27.2 µm3). Hsp70 protein expression was unaltered in the cortex (+9%), however, 4-HNE (+95%) and NT (+24%) protein expression remained upregulated. Treatment of neonates with vitamins alone induced oxidative stress in the cortex (Hsp70: +67%; 4-HNE: +73%; NT: +22%) and in the hippocampus (NT: +35%). Combined glucocorticoid and antioxidant therapy in premature infants may be safer for the developing brain than glucocorticoids alone in the treatment of chronic lung disease. However, antioxidant therapy in healthy offspring is not recommended.
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Affiliation(s)
- Emily J. Camm
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Deodata Tijsseling
- Department of Obstetrics, University Medical Center, Utrecht, The Netherlands
| | - Hans G. Richter
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Alexandra Adler
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Jeremy A. Hansell
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Jan B. Derks
- Department of Obstetrics, University Medical Center, Utrecht, The Netherlands
| | - Christine M. Cross
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Dino A. Giussani
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
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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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Schäffer L, Burkhardt T, Tomaske M, Schmidt S, Luzi F, Rauh M, Leone A, Beinder E. Effect of antenatal betamethasone administration on neonatal cardiac autonomic balance. Pediatr Res 2010; 68:286-91. [PMID: 20581746 DOI: 10.1203/pdr.0b013e3181ed0cf2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Beneficial effects of antenatal glucocorticoid treatment in pregnancies at risk for preterm delivery may entail long-term consequences for the establishment of sympathoadrenergic system balance. We analyzed the cardiac autonomic system activity in neonates with a single course of antenatal betamethasone (2 × 12 mg) treatment by calculating heart rate variability (HRV) time-domain parameters from 24 h ECG recordings and short-term frequency-domain parameters during infant active and resting states. In addition, resting and challenged salivary α-amylase levels were measured in 23 betamethasone-exposed neonates and compared with controls. Indicators for overall HRV (SDNN: p = 0.258; triangular index: p = 0.179) and sympathovagal balance [low- to high-frequency power (LF/HF): p = 0.82 (resting state)] were not significantly different in neonates of the betamethasone treatment group. Parameters mostly influenced by sympathetic activity [SD of the average of valid NN intervals (SDANN): p = 0.184 and SDs of all NN intervals (SDNNi): p = 0.784] and vagal tone [RMSSD: p = 1.0; NN50: p = 0.852; HF: p = 0.785 (resting state)] were unaltered. Resting α-amylase levels were not significantly different in the betamethasone treatment group (p = 0.304); however, α-amylase release after a neonatal challenge was slightly reduced (p = 0.045). Thus, cardiac autonomic balance seems to be preserved in neonates exposed to a single course of antenatal betamethasone treatment.
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Affiliation(s)
- Leonhard Schäffer
- Department of Obstetrics and Gynecology, University Hospital of Zürich, Zürich 8091, Switzerland.
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Schneider U, Fiedler A, Schröder B, Jaekel S, Stacke A, Hoyer D, Schleussner E. The effect of antenatal steroid treatment on fetal autonomic heart rate regulation revealed by fetal magnetocardiography (fMCG). Early Hum Dev 2010; 86:319-25. [PMID: 20547444 DOI: 10.1016/j.earlhumdev.2010.05.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 04/10/2010] [Accepted: 05/13/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Steroid administration to accelerate fetal lung maturation reduces neonatal morbidity and mortality in the case of preterm delivery. Behavioral observations suggest effects on fetal cardiovascular regulation. AIM We hypothesize that beat to beat heart rate variability (fHRV) derived from fetal magnetocardiography (fMCG) will reveal a direct, acute steroidal effect on fetal autonomic heart rate regulation. SUBJECTS Eight patients between 29 and 34 weeks of gestation at risk for preterm birth who were treated with betamethasone (2x12 mg within 24 h). STUDY DESIGN Subjects were studied prior to the first and within 6 h after the second administration. Continuous fMCG was recorded with a 31-channel-SQUID biomagnetometer. Each dataset was processed by subtracting maternal cardiac artefacts and determining the time instants of the fetal heart beats. fHRV analysis was applied to periods of fetal quiescence of 4 min length. OUTCOME MEASURES We compared fHRV prior versus post steroid administration. RESULTS Steroid exposure reduced all parameters of overall fHRV significantly. The fHRV parameters representing short term variability remained unaffected. Mean fetal heart rate significantly decreased. The complexity of the heart rate patterns increased. CONCLUSION Our results suggest an acute shift in the sympatho-vagal balance of fetuses exposed to betamethasone in utero toward sympathetic suppression.
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Affiliation(s)
- Uwe Schneider
- Department of Obstetrics, Bachstrasse 18, University Hospital, Jena Germany.
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Rondó PHC, Lemos JO, Pereira JA, Souza JMP. The relationship between cortisol concentrations in pregnancy and systemic vascular resistance in childhood. Early Hum Dev 2010; 86:127-31. [PMID: 20181444 DOI: 10.1016/j.earlhumdev.2010.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 01/27/2010] [Accepted: 02/02/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the relationship between cortisol concentrations in the last trimester of pregnancy and systemic vascular resistance - SVR in childhood. MATERIALS AND METHODS This study is part of a cohort involving 130 Brazilian pregnant women and their children, ages 5 to 7years. Maternal cortisol was determined in saliva by an enzyme immunoassay utilizing the mean concentration of 9 samples of saliva (3 in each different day), collected at the same time, early in the morning. SVR was assessed by the HDI/PulseWave CR-2000 Cardiovascular Profiling System(R). Socioeconomic and demographic characteristics and life style factors were determined by a questionnaire. The nutritional status of the women and children was assessed by the body mass index - BMI. The association between maternal cortisol and SVR in childhood was calculated by multivariate linear regression analysis. RESULTS There were statistically significant associations between maternal cortisol and SVR (p=0.043) and BMI-z score of the children (p=0.027), controlling for maternal BMI, birth weight, age, and gender of the children. CONCLUSION As far as we know this is the first study in the literature assessing the association between cortisol concentrations in pregnancy and SVR in childhood. Overall, the data suggest that exposure to excess glucocorticoid in the prenatal period is associated to vascular complications in childhood, predisposing to cardiovascular diseases in later life.
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Affiliation(s)
- Patricia Helen Carvalho Rondó
- Nutrition Department, School of Public Health, University of São Paulo, Avenida Dr. Arnaldo 715, São Paulo, SP, CEP-01246-904, Brazil
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48
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Miller SL, Supramaniam VG, Jenkin G, Walker DW, Wallace EM. Cardiovascular responses to maternal betamethasone administration in the intrauterine growth-restricted ovine fetus. Am J Obstet Gynecol 2009; 201:613.e1-8. [PMID: 19766978 DOI: 10.1016/j.ajog.2009.07.028] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 05/13/2009] [Accepted: 07/14/2009] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective was to characterize the effect of glucocorticoid treatment on fetal organ blood flow and regional cerebral blood flow in normally grown fetuses and fetuses with intrauterine fetal growth restriction (IUGR). STUDY DESIGN Studies were undertaken in both control and IUGR fetal sheep; growth restriction was induced by ligation of 1 umbilical artery. Fetuses received colored microspheres for organ blood flow calculations before and after 2 maternal betamethasone injections (BM1 and BM2). RESULTS Following BM1, cardiac output was significantly decreased in the control fetuses and blood flow to the heart and placenta was unchanged, whereas total cerebral blood flow was significantly decreased (P<.001), consistent with cerebral vasoconstriction. In the fetuses with IUGR, the cardiac output was significantly increased at +33 hours relative to BM1, and blood flow was increased in all organs; notably, there was a 2-fold increase in cerebral blood flow (P=.03). CONCLUSION The cardiovascular response of the fetus with IUGR to glucocorticoids is profoundly different from the control fetuses, which may induce both short- and long-term injury.
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Affiliation(s)
- Suzanne L Miller
- Department of Obstetrics and Gynecology, Monash Institute of Medical Research, Monash University, Clayton, VIC, Australia.
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de Heus R, Mulder EJH, Derks JB, Visser GHA. The effects of the tocolytics atosiban and nifedipine on fetal movements, heart rate and blood flow. J Matern Fetal Neonatal Med 2009; 22:485-90. [PMID: 19479644 DOI: 10.1080/14767050802702349] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The choice of first-line tocolytic agent is a topic of worldwide debate. The oxytocin receptor antagonist atosiban and the calcium antagonist nifedipine appear to be effective in postponing delivery. However, information is lacking on their possible effects on the fetal biophysical profile. OBJECTIVE To study the direct fetal effects of tocolysis with atosiban or nifedipine combined with a course of betamethasone. METHOD We performed a randomised controlled study including women with preterm labour requiring tocolytic treatment. Primary outcome measures were the effects on fetal heart rate (FHR) and its variation. Secondary endpoints were the effects on fetal movement and blood flow (pulsatility index - PI) of the umbilical (UA) and medial cerebral arteries (MCA). RESULTS One-hour recordings of FHR and fetal movements were made on each of five successive days (days 0-4). Fetal blood flow velocity patterns were studied daily by Doppler ultrasound. Baseline characteristics of 31 women who had not delivered at day 0 and needed no escape tocolysis did not differ between the study groups. Multilevel analysis showed no significant effect of either tocolytic on FHR and movement parameters over the 5-day study period. The use of tocolytics also did not significantly alter the time courses of PI-values for UA (p = 0.37) and MCA (p = 0.62). CONCLUSION This study demonstrates for the first time the direct effects of atosiban on fetal movement, heart rate and blood flow. Tocolysis with either atosiban or nifedipine combined with betamethasone administration appears to have no direct fetal adverse effects.
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Affiliation(s)
- Roel de Heus
- Department of Woman and Baby, University Medical Centre Utrecht, Utrecht, The Netherlands.
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de Heus R, Mulder EJH, Derks JB, Koenen SV, Visser GHA. Differential effects of betamethasone on the fetus between morning and afternoon recordings. J Matern Fetal Neonatal Med 2009; 21:549-54. [DOI: 10.1080/14767050802128214] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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