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Volqvartz T, Andersen HHB, Pedersen LH, Larsen A. Obesity in pregnancy-Long-term effects on offspring hypothalamic-pituitary-adrenal axis and associations with placental cortisol metabolism: A systematic review. Eur J Neurosci 2023; 58:4393-4422. [PMID: 37974556 DOI: 10.1111/ejn.16184] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
Obesity, affecting one in three pregnant women worldwide, is not only a major obstetric risk factor. The resulting low-grade inflammation may have a long-term impact on the offspring's HPA axis through dysregulation of maternal, placental and fetal corticosteroid metabolism, and children born of obese mothers have increased risk of diabetes and cardiovascular disease. The long-term effects of maternal obesity on offspring neurodevelopment are, however, undetermined and could depend on the specific effects on placental and fetal cortisol metabolism. This systematic review evaluates how maternal obesity affects placental cortisol metabolism and the offspring's HPA axis. Pubmed, Embase and Scopus were searched for original studies on maternal BMI, obesity, and cortisol metabolism and transfer. Fifteen studies were included after the screening of 4556 identified records. Studies were small with heterogeneous exposures and outcomes. Two studies found that maternal obesity reduced placental HSD11β2 activity. In one study, umbilical cord blood cortisol levels were affected by maternal BMI. In three studies, an altered cortisol response was consistently seen among offspring in childhood (n = 2) or adulthood (n = 1). Maternal BMI was not associated with placental HSD11β1 or HSD11β2 mRNA expression, or placental HSD11β2 methylation. In conclusion, high maternal BMI is associated with reduced placental HSD11β2 activity and a dampened cortisol level among offspring, but the data is sparse. Further investigations are needed to clarify whether the HPA axis is affected by prenatal factors including maternal obesity and investigate if adverse effects can be ameliorated by optimising the intrauterine environment.
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Affiliation(s)
- Tabia Volqvartz
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Lars Henning Pedersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Biomedicine, Pharmacology, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Agnete Larsen
- Department of Biomedicine, Pharmacology, Aarhus University, Aarhus, Denmark
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Lin D, Fan D, Chen G, Luo C, Guo X, Liu Z. Association of antenatal corticosteroids with morbidity and mortality among preterm multiple gestations: meta-analysis of observational studies. BMJ Open 2021; 11:e047651. [PMID: 34580092 PMCID: PMC8477320 DOI: 10.1136/bmjopen-2020-047651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 09/07/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This meta-analysis aimed to assess the efficacy of antenatal corticosteroids (ACS) on morbidity and mortality among preterm multiple pregnancies. METHODS The PubMed, Embase, Web of Science and Cochrane Library databases were searched for studies investigating the outcomes among preterm multiple gestations following to ACS, from their inception to 1 November 2020. Two authors independently performed the study selection, risk of bias assessment and data extraction. The primary outcomes were respiratory distress syndrome (RDS) and mortality and secondary outcomes included intraventricular haemorrhage (IVH), periventricular leukomalacia (PVL), necrotising enterocolitis, retinopathy of prematurity and bronchopulmonary dysplasia. Pooled ORs were obtained using random effects models. Subgroup analyses were performed to explain heterogeneity by ACS completeness, administration-to-delivery intervals (≤7 days) and single or multicentre. RESULTS A total of 16 observational studies with 36 973 newborns were included in the meta-analysis. ACS treatment was associated with a reduction in RDS (OR 0.66; 95% CI 0.54 to 0.82; I2=91.4%; p<0.001), mortality (OR 0.64; 95% CI 0.50 to 0.81; I2=85.9%; p<0.001), IVH (OR 0.67; 95% CI 0.54 to 0.83; I2=77.4%; p<0.001) and PVL (OR 0.65; 95% CI 0.47 to 0.92; I2=75.5%; p<0.001). Subgroup analyses showed ACS completeness, administration-to-delivery interval and multicentre study affected these associations. DISCUSSION ACS may be beneficial for reducing the risks of RDS, mortality, IVH and PVL among preterm multiple gestations. The efficacy of ACS could be affected by ACS completeness and administration-to-delivery. More robust evidence on the efficacy of ACS treatment among multiple gestations is warranted.
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Affiliation(s)
- Dongxin Lin
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
- Department of Obsterics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
| | - Dazhi Fan
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
- Department of Obsterics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
| | - Gengdong Chen
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
- Department of Obsterics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
| | - Caihong Luo
- Department of Obsterics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
| | - Xiaoling Guo
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
- Department of Obsterics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
| | - Zhengping Liu
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
- Department of Obsterics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China
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Escribano Cobalea M, Peña Salas M, López González E, Gómez Soto P. Morbimortalidad asociada al parto prematuro y su relación con el uso de corticoides y sulfato de magnesio. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kong X, Xu F, Wang Z, Zhang S, Feng Z. Antenatal corticosteroids administration on mortality and morbidity in premature twins born at 25∼34 gestational weeks: A retrospective multicenter study. Eur J Obstet Gynecol Reprod Biol 2020; 253:259-265. [PMID: 32898771 DOI: 10.1016/j.ejogrb.2020.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/15/2020] [Accepted: 08/20/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the effects of antenatal corticosteroids (ACS) administration on mortality and major neonatal complications in early life of preterm twins. STUDY DESIGN This study retrospectively enrolled 1 662 twins delivered at 25∼34+6gestational weeks in China from January 2013 to December 2014. They were divided into ACS group and no-ACS group according to weather their mothers received ACS or not. Moreover, they were subgrouped as 25∼27+6 and 28∼34+6gestational week groups. Multivariable logistic regression was used to analyze the effects of ACS on the incidence of mortality and major morbidities. RESULTS A total of 910 neonates (54.8 %) received one or more doses of ACS, and 752 neonates (45.2 %) did not receive any ACS. No significant difference in infant mortality was observed between the ACS and no-ACS groups (P = 0.321). The ACS group had decreased incidence of respiratory distress syndrome (RDS) and mild RDS compared with the no-ACS group (both P < 0.05). There were no significant differences in the incidence of bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, patent ductus arteriosus, sepsis and severe RDS between the two groups (all P > 0.05). The subgroup analysis showed that the incidence of RDS was lower in the ACS group than in the no-ACS group (P = 0.036) at 28∼34+6weeks. However, the incidence of mild ROP was higher in the ACS group than that in the no-ACS group (P = 0.047) at 25∼27+6 weeks. Multivariable logistic regression analysis demonstrated a decreasing risk of RDS (aOR = 0.661, 95 %CI:0.506-0.863, P = 0.002) after adjusting the gestational week, birth weight, small for gestational age, delivery mode, 5 min Apgar score, and maternal perinatal complications. CONCLUSION In twin preterm infants, ACS administration is associated with a reduced risk of RDS. However, our data suggest that it may not have a beneficial effect on mortality and other short-term morbidities.
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Affiliation(s)
- Xiangyong Kong
- Newborn Care Center, Bayi Children's Hospital, The Seventh Medical Center, General Hospital of the People's Liberation Army, Beijing 100700, China; Clinical Medical College, The Seventh Medical Center, General Hospital of the People's Liberation Army, Southern Medical University, Beijing 100700, China.
| | - Fengdan Xu
- Department of Neonatal Intensive Care Unit, Guangdong Medical University Affiliated Dongguan Children's Hospital, Dongguan, 523325, China; Department of Pediatrics, Guangdong Medical University, Dongguan, 523808, China
| | - Zizhen Wang
- Newborn Care Center, Bayi Children's Hospital, The Seventh Medical Center, General Hospital of the People's Liberation Army, Beijing 100700, China
| | - Shan Zhang
- Newborn Care Center, Bayi Children's Hospital, The Seventh Medical Center, General Hospital of the People's Liberation Army, Beijing 100700, China
| | - Zhichun Feng
- Newborn Care Center, Bayi Children's Hospital, The Seventh Medical Center, General Hospital of the People's Liberation Army, Beijing 100700, China; Clinical Medical College, The Seventh Medical Center, General Hospital of the People's Liberation Army, Southern Medical University, Beijing 100700, China; Beijing Key Laboratory of Pediatric Organ Failure, Beijing 100700, China; National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology, Beijing 100700, China.
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Tuohy JF, Bloomfield FH, Harding JE, Crowther CA. Patterns of antenatal corticosteroid administration in a cohort of women with diabetes in pregnancy. PLoS One 2020; 15:e0229014. [PMID: 32106249 PMCID: PMC7046227 DOI: 10.1371/journal.pone.0229014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/28/2020] [Indexed: 01/13/2023] Open
Abstract
Antenatal corticosteroids administered to the mother prior to birth decrease the risk of mortality and major morbidity in infants born at less than 35 weeks’ gestation. However, the evidence relating to women with diabetes in pregnancy is limited. Clinical guidelines for antenatal corticosteroid administration recommend that women with diabetes in pregnancy are treated in the same way as women without diabetes, but there are no recent descriptions of whether contemporary practice complies with this guidance. This study is a retrospective review of antenatal corticosteroid administration at a New Zealand tertiary hospital in women with diabetes in pregnancy. We found that in this cohort, for both an initial course at less than 35 weeks’ gestation and repeat courses at less than 33 weeks’, the administration of antenatal corticosteroid to women with diabetes in pregnancy is largely consistent with current Australian and New Zealand recommendations. However, almost 25% of women received their last dose of antenatal corticosteroid at or beyond the latest recommended gestation of 35 weeks’ gestation. Pre-existing diabetes and planned caesarean section were independently associated with an increased rate of antenatal corticosteroid administration. We conclude that diabetes in pregnancy does not appear to be a deterrent to antenatal corticosteroid administration. The high rates of administration at gestations beyond recommendations, despite the lack of evidence of benefit in this group of women, highlights the need for further research into the risks and benefits of antenatal corticosteroid administration to women with diabetes in pregnancy, particularly in the late preterm and early term periods.
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Affiliation(s)
- Jeremy F. Tuohy
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | | | - Jane E. Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Basset H, Nusinovici S, Huetz N, Sentilhes L, Berlie I, Flamant C, Roze JC, Gascoin G. Efficacy of Antenatal Corticosteroid Treatment on Neurodevelopmental Outcome according to Head Circumference at Birth. Neonatology 2018; 113:55-62. [PMID: 29073596 DOI: 10.1159/000479675] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/21/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND There are concerns about the efficacy of antenatal corticosteroid treatment (ACT) in the growth-restricted fetus. OBJECTIVE To evaluate the effect of ACT on neurodevelopmental outcome at 2 years of corrected age according to the z score of birth head circumference (ZS HC) in a large prospective cohort of preterm infants. METHODS This study was conducted as a population-based, prospective, multicenter study, including 4,965 infants born between 24 and 33 weeks' gestation and whose status regarding ACT and the measurement of head circumference at birth were available. They were evaluated at 2 years of corrected age to assess neurological outcome. Three approaches were considered to estimate the effect of ACT on neurodevelopment: (i) logistic regression with adjustment on propensity score, (ii) weighted logistic regression using the inverse probability of treatment weighting method, and (iii) 1:1 matching of gestational age, ZS HC, and propensity score between treated and nontreated infants. RESULTS ACT was documented in 60% of infants. Three groups of infants were considered according to their ZS HC: between -3 and -1 standard deviation (SD), -1 and +1 SD, and +1 and +3 SD, respectively. ACT was associated with a significant improvement of neurodevelopmental outcome only for infants with an ZS HC of between +1 and +3 SD (adjusted OR 1.72; 95% CI 1.06-2.79). Moreover, ORs estimated in the -3 to -1 and +1 to +3 categories were significantly different. CONCLUSION We found beneficial effects of ACT on neurodevelopmental outcomes at 2 years of corrected age only in preterm infants with a ZS HC >1 SD.
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Affiliation(s)
- Helene Basset
- Department of Neonatal Medicine, Le Mans Hospital, Le Mans, France
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Vaz A, Malheiro MF, Severo M, Rodrigues T, Guimarães H, Montenegro N. Effect of antenatal corticosteroids on morbidity and mortality of preterm singletons and twins. J Matern Fetal Neonatal Med 2017; 31:754-760. [DOI: 10.1080/14767058.2017.1297408] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Ana Vaz
- Faculty of Medicine of University of Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Maria Filipa Malheiro
- Department of Obstetrics, Gynecology and Pediatrics, São João Hospital Center, Porto, Portugal
| | - Milton Severo
- Epidemiology Research Unit, Institute of Public Health University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Teresa Rodrigues
- Faculty of Medicine of University of Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
- Department of Obstetrics, Gynecology and Pediatrics, São João Hospital Center, Porto, Portugal
- Epidemiology Research Unit, Institute of Public Health University of Porto, Porto, Portugal
| | - Hercília Guimarães
- Faculty of Medicine of University of Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
- Department of Obstetrics, Gynecology and Pediatrics, São João Hospital Center, Porto, Portugal
| | - Nuno Montenegro
- Faculty of Medicine of University of Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
- Department of Obstetrics, Gynecology and Pediatrics, São João Hospital Center, Porto, Portugal
- Epidemiology Research Unit, Institute of Public Health University of Porto, Porto, Portugal
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