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Hantoushzadeh S, Amiri A, Shabani A, Soufi Enayati Y, Mostafaeipour N, Houra Mousavi Vahed S, Nezamnia M, Sheykhian T. Short-term effects of antenatal betamethasone on fetal cardiovascular and circulation status: A quasi-experimental observational (before-after) study. Int J Reprod Biomed 2024; 22:375-382. [PMID: 39091426 PMCID: PMC11290198 DOI: 10.18502/ijrm.v22i5.16436] [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: 08/06/2023] [Revised: 02/04/2024] [Accepted: 03/06/2024] [Indexed: 08/04/2024] Open
Abstract
Background The administration of antenatal corticosteroid is a standard treatment to reduce the rate of perinatal mortality and morbidity; however, there is limited evidence regarding the potential effects of betamethasone on the constriction of the ductus arteriosus (DA). Objective This study aimed to investigate the short-term effects of antenatal betamethasone on fetal cardiovascular and circulation status. Materials and Methods This quasi-experimental observational (before-after) study was conducted on 32 singleton fetuses. The participants were healthy pregnant women with a diagnosis of placenta accreta spectrum who were eligible for 2 doses of betamethasone and referred to prenatal care clinic, Vali-E-Asr hospital, Tehran, Iran from January 2021-May 2022. The results of fetal echocardiography and Doppler sonography were compared before and after the administration of antenatal corticosteroid therapy. Results Following betamethasone injection, significant increases were observed in peak systolic and diastolic velocity of the DA without constriction of the DA (p < 0.001, p = 0.002 respectively). However, no significant changes were observed in right ventricular function, tricuspid valve function, Doppler of ductus venous, and peak systolic velocity of the aortic isthmus (p > 0.05). Doppler examination of the uterine, umbilical, and middle cerebral arteries also showed no significant changes (p > 0.05). Conclusion Considering the benefits of antenatal corticosteroid therapy, its administration seems reasonable in preterm births. The transient changes in ductal blood flow are not prohibitive.
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Affiliation(s)
- Sedigheh Hantoushzadeh
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Amiri
- Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Shabani
- Preventative Gynecology Research Center (PGRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Neda Mostafaeipour
- Department of Obstetrics and Gynecology, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maria Nezamnia
- Department of Gynecology, School of Medicine, Pasteur Hospital, Bam University of Medical Sciences, Bam, Iran
| | - Toktam Sheykhian
- Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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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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Arimi Y, Zamani N, Shariat M, Dalili H. The effects of betamethasone on clinical outcome of the late preterm neonates born between 34 and 36 weeks of gestation. BMC Pregnancy Childbirth 2021; 21:774. [PMID: 34784898 PMCID: PMC8594097 DOI: 10.1186/s12884-021-04246-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Prenatal corticosteroid administration in preterm labor is one of the most important treatments available to improve neonatal outcomes; however, its beneficial effects on late preterm infants (after the 34th week of gestation) remained unknown. We aimed to assess the effects of betamethasone on the clinical condition of the late preterm infants born between 34 and 36 weeks of gestation. Methods This retrospective cohort study was performed on 100 consecutive infants born between 34 and 36 weeks of gestation and received betamethasone before delivery as the cases and 100 neonates with the same delivery conditions but without receiving betamethasone. All neonates were followed up within hospitalization to assess the neonatal outcome. Results The neonates receiving betamethasone suffered more from respiratory distress syndrome (49% versus 31%, p = 0.008, RR = 1.59 95% CI (1.12–2.27)) and requiring more respiratory support (71% versus 50%, p = 0.002, RR = 1.43 95% CI (1.13–1.80)) as compared to the control group. There was no difference between the two groups in other neonatal adverse events or death. Conclusion the use of betamethasone in the late preterm period (after 34 weeks of gestation) has no beneficial effects on lung maturity or preventing neonatal adverse outcomes, even may lead to increase the risk for RDS and requiring respiratory support. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04246-x.
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Affiliation(s)
- Yas Arimi
- Resident of Obstetrics and Gynecology, Maternal Fetal Neonatal Researsh Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Zamani
- Department of Obstetrics and Gynecology, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran. .,Vali-Asr Hospital, Imam Khomeini Hospital Complex (IKHC), Keshavarz Blvd, Tehran, Iran.
| | - Mamak Shariat
- Maternal, Fetal & Neonatal Research Center-Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Dalili
- Breastfeeding Research Center, Vali-e-Asr Hospital, Tehran University Of Medical Sciences, Tehran, Iran
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Henry A, Mahajan A, Crowther CA, Lainchbury A, Roberts L, Shand AW, Welsh AW. Short-Term Effects of Dexamethasone versus Betamethasone on Ultrasonic Measures of Fetal Well-Being: Cohort from a Blinded, Randomized Trial. Fetal Diagn Ther 2021; 48:526-540. [PMID: 34350865 DOI: 10.1159/000517623] [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] [Received: 11/29/2020] [Accepted: 06/03/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Maternal corticosteroid administration for anticipated preterm birth is common; however, the corticosteroid effect on fetal ultrasound and cardiotocograph (CTG) remains contested. This study aimed to evaluate short-term ultrasound and CTG impact of (a) dexamethasone versus betamethasone (b) pooled corticosteroid effect. METHODS Substudy of blinded randomized trial of dexamethasone versus betamethasone (given <34 weeks). Umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV), and uterine artery Doppler, myocardial performance index (MPI), biophysical profile (BPP), and CTG measured pre-corticosteroid then 1, 2, 4, and 7 days post-corticosteroid. RESULTS Of 47 fetuses (39 singleton; 4 dichorionic, diamniotic twins; and 4 monochorionic, diamniotic twins) in the February 2012-2013 period, 24 received dexamethasone and 23 betamethasone at average gestation 29.8 ± 2.9 weeks. Thirteen pregnancies (30%) had pre-corticosteroid fetal concerns (estimated weight <10th centile and/or abnormal UA/MCA Doppler). Few significant differences were seen post-corticosteroid: DV pulsatility index and right MPI initially decreased 15-20%, and average BPP decreased slightly on days 1-2. There were no major differential effects of dexamethasone versus betamethasone. DISCUSSION/CONCLUSION No substantive post-corticosteroid effects were seen for most ultrasound/CTG measures in fetuses with heightened preterm birth risk but predominantly normal pre-corticosteroid measures. Clinically, this suggests avoiding overreliance on individual measures for delivery decisions post-corticosteroid; equally, multiple/marked ultrasound changes suggest true pathology and not corticosteroid effect.
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Affiliation(s)
- Amanda Henry
- School of Women's and Children's Health, UNSW Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Women's and Children's Health, St. George Hospital, Sydney, New South Wales, Australia.,Department of Maternal-Fetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Aditi Mahajan
- School of Women's and Children's Health, UNSW Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Anne Lainchbury
- Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Lynne Roberts
- Department of Women's and Children's Health, St. George Hospital, Sydney, New South Wales, Australia.,St. George and Sutherland Clinical School, UNSW Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Antonia W Shand
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.,Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Alec W Welsh
- School of Women's and Children's Health, UNSW Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Maternal-Fetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia
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Umbilical and Middle Cerebral Artery Doppler Measurements in Fetuses With Congenital Heart Block. J Am Soc Echocardiogr 2020; 34:83-88. [PMID: 33127209 DOI: 10.1016/j.echo.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/29/2020] [Accepted: 09/09/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In fetal congenital complete heart block, the slow fetal heart rate prolongs the diastolic phase of the cardiac cycle, which may affect Doppler measurements that are typically used to quantify placental function. We here describe the umbilical artery (UA) and middle cerebral artery (MCA) Dopplers in a cohort of fetuses with heart block, hypothesizing that values will be increased but nevertheless remain associated with placental function and fetal outcome. METHODS We retrospectively reviewed Doppler measurements of the UA and MCA pulsatility index (PI) and resistance index in fetuses with complete heart block. The cerebroplacental ratio (CPR) was calculated as a marker of central redistribution. Measurements were transformed to Z scores and compared between fetuses born with a normal weight (appropriate for gestational age [AGA]) to those with fetal growth restriction (FGR) and correlated with a composite adverse outcome consisting of FGR, fetal death, or preterm birth prior to 34 weeks' gestation. RESULTS Fifty-four fetuses were included. There were 36 (67%) live births, 8 (22%) stillbirths, and 10 (19%) pregnancy terminations. Of those born alive, 14 (39%) had FGR. The UA PI decreased with gestational age and was higher in FGR compared with AGA fetuses (P < .001). Twenty-three percent of AGA fetuses developed absent end-diastolic flow in the UA. The MCA PI did not change with gestation and did not differ between AGA and FGR fetuses. The CPR was lower in FGR than in AGA fetuses (-2.43 ± 0.85 vs -1.44 ± 1.04, P = .006). The UA PI and resistance index were strongly correlated with the composite adverse outcome (P < .001). CONCLUSIONS The UA and MCA PI are significantly elevated in fetuses with complete heart block. The UA Doppler indices and CPR nevertheless still reflect placental function. Longitudinal measurements may be useful in monitoring well-being in fetuses with heart block.
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Urutherakumar V, Henry A, Welsh A. Effect of maternal corticosteroid provision on middle cerebral artery peak systolic velocity readings in the potentially anaemic fetus prior to planned intrauterine transfusion. Australas J Ultrasound Med 2019; 23:52-58. [PMID: 34760583 DOI: 10.1002/ajum.12182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose Middle Cerebral Artery Peak Systolic Velocity (MCA-PSV) is the main tool for determining need for and timing of intrauterine transfusions (IUT) for severe fetal anaemia. It has been suggested that steroids temporarily decrease MCA-PSV, potentially increasing false-negative MCA-PSV findings in anaemic fetuses. We therefore aimed to assess whether maternal corticosteroid administration prior to IUT is associated with clinically significant temporary decreases in MCA-PSV. Methods Retrospective review 2005-2016 of steroid provision prior to IUT, with correlation of MCA-PSV pre- and post-steroid administration and haemoglobin at IUT. Results In 23 identified cases, there was no significant difference between average MoM pre- and post-steroid (1.71 ± 0.41 vs. 1.66 ± 0.38, -2.9% mean, P = 0.4). There was also no significant difference between pre- and post-steroid MoM taken within 3 days of each other (n = 19, P = 0.21). However, post-steroid MCA-PSV decreased by >15% in 6/23 cases (A-B zone in two cases, B-C zone in one case). Conclusions This study found no sizeable, generalised effect of corticosteroid administration on MCA-PSV readings in the potentially anaemic fetus. A minority showed substantial shifts where reliance on post-steroid MCA-PSV could have unfavourably altered clinical management. Ultimately, further large-scale research is required before we can discount the potential impact of steroids on MCA-PSV values.
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Affiliation(s)
- Varshinee Urutherakumar
- School of Women's and Children's Health University of New South Wales Level 1, Royal Hospital for Women, Barker Street Sydney 2031 Australia
| | - Amanda Henry
- School of Women's and Children's Health University of New South Wales Level 1, Royal Hospital for Women, Barker Street Sydney 2031 Australia.,Department of Maternal-Fetal Medicine Royal Hospital for Women Barker Street, Randwick Sydney 2031 Australia.,Women's and Children's Health St George Hospital Gray St, Kogarah Sydney 2217 Australia
| | - Alec Welsh
- School of Women's and Children's Health University of New South Wales Level 1, Royal Hospital for Women, Barker Street Sydney 2031 Australia.,Department of Maternal-Fetal Medicine Royal Hospital for Women Barker Street, Randwick Sydney 2031 Australia
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Maternal intramuscular dexamethasone versus betamethasone before preterm birth (ASTEROID): a multicentre, double-blind, randomised controlled trial. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:769-780. [PMID: 31523039 DOI: 10.1016/s2352-4642(19)30292-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Antenatal corticosteroids given to women before preterm birth improve infant survival and health. However, whether dexamethasone or betamethasone have better maternal, neonatal, and childhood health outcomes remains unclear. We therefore aimed to assess whether administration of antenatal dexamethasone to women at risk of preterm birth reduced the risk of death or neurosensory disability in their children at age 2 years compared with betamethasone. We also aimed to assess whether dexamethasone reduced neonatal morbidity, had benefits for the mother, or affected childhood body size, blood pressure, behaviour, or general health compared with betamethasone. METHODS In this multicentre, double-blind, randomised controlled trial, we recruited pregnant women from 14 maternity hospitals in Australia and New Zealand that could provide care to preterm babies. Women were eligible for study inclusion if they were at risk of preterm birth before 34 weeks of gestation, had a singleton or twin pregnancy, and had no contraindications to antenatal corticosteroids. We randomly assigned women (1:1) to receive two intramuscular injections of either 12 mg dexamethasone (dexamethasone sodium phosphate) or 11·4 mg betamethasone (Celestone Chronodose), 24 h apart. The randomisation schedule used balanced, variable blocks that were stratified by hospital, gestational age, and number of fetuses (singleton or twins). We masked all participants, staff, and assessors to treatment groups. Analyses were by intention to treat. The primary outcome was death or neurosensory disability at age 2 years (corrected for prematurity). This study is registered with ANZCTR, ACTRN12608000631303. FINDINGS Between Jan 28, 2009, and Feb 1, 2013, we randomly assigned 1346 (78%) women who were pregnant with 1509 fetuses to groups: 679 (50%) women were assigned to receive dexamethasone and 667 (50%) women were assigned to receive betamethasone. 27 (4%) fetuses, infants, or children in the dexamethasone group and 28 (4%) fetuses, infants, or children in the betamethasone group died before age 2 years. The primary outcome of death or neurosensory disability at age 2 years was determined for 603 (79%) of 763 fetuses whose mothers received dexamethasone and 591 (79%) of 746 fetuses whose mothers received betamethasone. We found a similar incidence of death or neurosensory disability in the dexamethasone (198 [33%] of 603 infants) and betamethasone groups (192 [32%] of 591 infants; adjusted relative risk [adjRR] 0·97, 95% CI 0·83 to 1·13; p=0·66). 18 (3%) of 679 women in the dexamethasone group and 28 of 667 (4%) women in the betamethasone group reported side-effects. Discomfort at the injection site, the most frequent side-effect, was less likely in the dexamethasone group than in the betamethasone group (six [1%] women vs 17 [3%] women; p=0·02). INTERPRETATION The incidence of survival without neurosensory disability at age 2 years did not differ between dexamethasone and betamethasone treatment. Our findings indicate that either antenatal corticosteroid can be given to women before preterm birth to improve infant and child health. FUNDING National Health and Medical Research Council (Australia).
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